HALITOSIS - "Bad Breath"
My Periodontist Helps With Halitosis, Bad Breath

Halitosis is the technical term for bad breath, a condition estimated to affect 50 to 65% of the population. Up to 90% of cases are thought to originate from sources in the mouth, including poor oral hygiene, periodontal disease, coating on the tongue, impacted food, faulty dental restorations, and throat infections. The remaining 10% are due to systemic disorders, such as peptic ulcer (when associated with infection), lung infections (bad breath can be the first sign in some cases), liver or kidney disease, diabetes mellitus, cancer, or even a person's imagination (healthy individuals sometimes complain of bad breath that cannot be smelled by anyone else and is not linked to any clinical disorder).

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash will only mask the odor temporarily. Odors continue until the body eliminates the food. Dieters may develop unpleasant breath from infrequent eating.

If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor. Dentures that are not cleaned properly can also harbor odor-causing bacteria and food particles.

One of the warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Periodontal disease is caused by plaque, the sticky, colorless film of bacteria that constantly forms on teeth. The bacteria create toxins that irritate the gums. In the advanced stage of the disease, the gums, bone and other structures that support the teeth become damaged. With regular dental checkups, your dentist can detect and treat periodontal disease early.

Eliminating periodontal disease and maintaining good oral health is essential to reducing bad breath. Schedule regular periodontal visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odors. Let your periodontist know if you've had any surgery or illness since your last appointment.

What can I do about bad breath?

What is the treatment for bad breath?
If your periodontist determines that your mouth is healthy and that the odor is not of oral origin, you may be referred to your family physician or to a specialist to determine the cause of the odor and for treatment. Of course, if the odor is of oral origin, as it is in the majority of cases, your periodontist can treat the cause of the problem.

If the odor is due to periodontal (gum) disease a periodontist is a specialist in treating gum tissues. Periodontal (gum) disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate. Sometimes more extensive treatment is necessary.

What are the causes for bad breath?
The causes of bad breath are numerous. They include:

Food. The breakdown of food particles in and around your teeth can cause a foul odor. Eating foods containing volatile oils is another source of bad breath. Onions and garlic are the best known examples, but other vegetables and spices also can cause bad breath. After these foods are digested and the pungent oils are absorbed into your bloodstream, they're carried to your lungs and are given off in your breath until the food is eliminated from your body.

Alcohol behaves in the same fashion, allowing the measurement of alcohol levels by breath tests. Alcohol itself has almost no odor, however. The characteristic smell on your breath is mainly the odor of other components of the beverage.

Dental problems. Poor dental hygiene and periodontal disease can be a source of bad breath. If you don't brush and floss daily, food particles remain in your mouth, collecting bacteria and emitting hydrogen sulfur vapors. A colorless, sticky film of bacteria (plaque) forms on your teeth.

If not brushed away, plaque can irritate your gums (gingivitis) and cause tooth decay. Eventually, plaque-filled pockets can form between your teeth and gums (periodontitis), worsening this problem — and your breath. Dentures that aren't cleaned regularly or don't fit properly also can harbor odor-causing bacteria and food particles.

Dry mouth. Saliva helps cleanse and moisten your mouth. A dry mouth enables dead cells to accumulate on your tongue, gums and cheeks. These cells then decompose and cause odor. Dry mouth naturally occurs during sleep. It's what causes "morning breath." Dry mouth is even more of a problem if you sleep with your mouth open. Some medications as well as smoking can lead to a chronic dry mouth, as can a problem with your salivary glands.

Diseases. Chronic lung infections and lung abscesses can produce very foul-smelling breath. Several other illnesses can cause a distinctive breath odor. Kidney failure can cause a urine-like odor, and liver failure may cause an odor described as "fishy." People with uncontrolled diabetes often have a fruity breath odor. Chronic reflux of stomach acids from your stomach (gastroesophageal reflux disease, or GERD) and a slight protrusion of the stomach into the chest cavity (hiatal hernia) also can produce bad breath.

Mouth, nose and throat conditions. Bad breath is also associated with sinus infections because nasal discharge from your sinuses into the back of your throat can cause mouth odor. A child with bad breath may have a foreign object lodged in his or her nose. A bean or small item stuck in the nose can cause persistent nasal discharge and a foul odor. Strep throat, tonsillitis and mononucleosis can cause bad breath until the throat infection clears. Bronchitis and other upper respiratory infections in which you cough up odorous sputum are other sources of bad breath. Canker sores may be related to bad breath, especially if they accompany periodontal disease.

Tobacco products. Smoking dries out your mouth and causes its own unpleasant mouth odor. Tobacco users are also more likely to have periodontal disease, an additional source of bad breath.

Severe dieting. Dieters may develop unpleasant "fruity" breath from ketoacidosis, the breakdown of chemicals during fasting.

When to seek medical advice
Most people can prevent or improve bad breath by practicing proper dental hygiene. If bad breath persists despite self-care, see your periodontist. If the cause isn't dental, see your doctor to determine a possible medical cause. You may need a physical examination and testing to pinpoint the underlying cause.

Self-care
Try the following steps to improve or prevent bad breath:

Brush your teeth after you eat. Keep a toothbrush at work to brush after eating.

Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth.

Brush your tongue. Giving your tongue a good brushing removes dead cells, bacteria and food debris. Use a soft-bristled toothbrush and brush your tongue with at least five to 15 strokes. Pay particular attention to the middle third of the tongue, where most of the bacteria tend to collect.

Clean your dentures well. If you wear a bridge or a partial or complete denture, clean it thoroughly at least once a day or as directed by your dentist.

Drink plenty of water. To keep your mouth moist, be sure to consume plenty of water — not coffee, soft drinks or alcohol. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates saliva, washing away food particles and bacteria. If you have chronic dry mouth, your dentist or doctor may additionally prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.

Use a fairly new toothbrush. Change your toothbrush every three to four months, and choose a soft-bristled toothbrush.

Schedule regular dental checkups. At least twice a year, see your periodontist to have your gums and teeth or dentures examined.

See your periodontist for a checkup or questions you might have. The periodontist specializes in the gums that support the teeth. They are foundation experts of the mouth and give you some great oral advice and help. If the gums, or foundation of your mouth has problems so will your teeth. In addition to daily brushing and flossing, see your dentist or hygienist for regular checkups and cleanings.