For The Independent, August Health Issue
Overcoming Bad Breath
By Tareq Khalifeh, DDS, DMD

It’s happened to all of us. You lean closer to a friend or loved one to tell them something confidential, and notice them recoil. Unless you’re telling them something awful, chances are they’re reacting to your breath.

Bad breath, also known by the medical term “halitosis” (coined in 1921 by the makers of Listerine) is an embarrassing condition that is all too common. According to a 2002 study in the Archives of Pediatric & Adolescent Medicine, up to 60 percent of children and adults are plagued with chronic bad breath. The desire to overcome it fuels a $10 billion industry of mouthwash and breath fresheners in every conceivable flavor and form.

August 6th is National Fresh Breath Day, a good reminder to make an appointment with your dentist. Nine out of 10 cases of bad breath are a direct result of poor oral hygiene, and can be overcome with proper dental care.

What Causes Bad Breath?
While we all realize that certain foods can cause temporary bad breath, poor brushing and flossing are by far the most common causes of chronic mouth odor. The tiny particles of food that remain in the mouth decay rapidly, collecting bacteria and decay. When you go to bed at night, your mouth produces less saliva, contributing to this process. So, in many cases, bad breath is simply an indication that your mouth contains rotting materials.

The accumulation of these materials in the mouth also irritates the gum tissues, which can become inflamed and tender. This, in turn, may cause the afflicted person to brush less often or gingerly, leaving the mouth unclean and accelerating the process. Placque and sulfur-producing bacteria build up, producing even worse breath, and leading ultimately to disease of the gums (periodontal disease). This potentially serious inflammation of the tissues surrounding the teeth can create serious pain and destruction, as well as phenomenally bad breath.

Bad breath can also be caused by a condition known as “dry mouth” (xerostomia), which occurs when the natural flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. This condition can arise from taking certain medications, from constant breathing through the mouth, or by malfunctioning salivary glands.

Smoking and alcohol use cause bad breath. And certain medical disorders can also be the culprit. Common medical sources include respiratory tract infections, chronic sinusitis or bronchitis, postnasal drip, diabetes, and liver or kidney disease. Untreated disabetes can produce a fruity odor in the breath, caused by the buildup of by-products of fat metabolism (ketones), which occurs when glucose is not available as a fuel source for the body.) Low carbohydrate diets can also produce foul breath, again associated with the body’s difficulty in excreting fat byproducts. Liver or kidney problems produce a strong odor akin to urine or fish, caused by the failure of these organs to get rid of waste and conserve electrolytes.

Getting Help: Start with Basics
Thankfully, most cases of bad breath are easily treated. A visit with your dentist is the first step. Your dental hygienist will do a thorough cleaning of your teeth and gums, removing placque and decay that you cannot see or reach. Your hygienist and dentist can also advise you how to improve your daily hygiene regimen.

For cases of bad breath caused by simple hygiene deficiencies, your dentist will recommend that you brush your teeth and gums with a fluoride toothpaste twice a day, using a small- to medium-sized toothbrush, with soft nylon bristles. A separate toothbrush is advisable for lightly brushing your tongue. And daily flossing is critical to remove food particles that get trapped between your teeth.

Your dentist may also suggest daily rinsing with an anti-bacterial mouthwash after you brush. Denture wearers should remove their dentures nightly and clean them thoroughly with soap and lukewarm water, a denture cream, or a denture-cleaning tablet and a separate toothbrush from the one you use for your mouth.

Some of your habits may also need to be altered. For example:

• Avoid brushing your teeth for 30 minutes after an acidic drink such as fruit juice, or acidic fruit such as oranges, to prevent tooth erosion.
• Reduce your consumption of foods like coffee, garlic, onions, or very spicy foods. Avoid sweets between meals; chew sugar-free gum instead.
• Reduce or eliminate your alcohol intake.
• Stop smoking. Smoking produces bad breath not only from the lingering odors in the mouth and gastrointestinal passage, but because the smoke is absorbed into the tissues of the lungs.
• If you suffer from dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing your fluid intake.

If your mouth odor is due to more serious problems, your dentist can consult with you about treatment options. For periodontal disease, your dentist can either treat it or refer you to a periodontist. Untreated periodontal 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.

To help your dentist identify other causes of bad breath, make a list of any medications you are taking and any health problems you’ve been having since your last visit. He or she may have to refer you to your physician or a specialist to determine the cause of bad breath and put you on a corrective treatment regimen.

Bad breath can afflict children as well as adults, so all of these measures should become family practice. And one final word of caution. Most people cannot detect their own bad breath. Ask fellow family members or a trusted friend or co-worker to tell you if they detect a foul odor from your mouth. It may be embarrassing, but wouldn’t you rather know and act to correct it?

Dr. Khalifeh owns the Philmont Family Dentistry located on Rte 217 in Philmont, NY. A graduate of the New York City School of Dentistry, he completed his residency at Albany Medical Center and practiced in Albany until 2004. For more information, call 672-4077.