Solving Mysteries of Bad Breath

In my practice we see a lot of folks with bad breath. I’m not talking about the type of bad breath one experiences after smoking a cigar or eating pasta with garlic. We’re talking about bad breath that persists for months or years and never goes away. Breath that is objectionable to the point that it turns people away. If you know someone with this problem, then this is something you must read.

We recently had a patient whose wife finally succeeded in getting into our office for a checkup. It was obvious when I walked into the room that this fellow had a problem. He says that he is not aware of the bad breath, he can’t smell it. He recently had a discussion with his wife about the problem and consulted with his MD about it. Blood chemistries failed to reveal the cause and he was advised that his problem had something to do with excessive stomach acid. All sorts of medications to control stomach acid had no positive effect. Gargling with mouth wash failed to help after an ear, nose and throat doctor told him that he had infected areas on his tonsils.

There are stomach and sinus tonsil problems that can cause bad breath but these kinds of problems are usually transitory and are rarely a problem for more than a few weeks and then go away permanently.

There are too many causes of bad breath to describe here, so some of the more common problems will be addressed. If you have questions, you can call Dr. Ron at 702-310-5970.

The facts are that ninety nine percent of bad breath problems originate in the mouth. Some causes of bad breath can be very serious, so a dental checkup should be the first thing you should do when trying to determine the source of bad breath.

For instance, I recently examined two people with oral cancer, one on the side of the tongue and another in the floor of the mouth, who presented with a chief complaint of bad breath. Although both cases were somewhat advanced, treatment was initiated immediately and they are both doing fine. We then treated them for an oral bacteria imbalance and their breath is now normal. Oral cancer is a very rare cause of bad breath.

The majority of bad breath issues arise from sulfur producing anaerobic bacteria. Usually these bacteria are normal residents in the oral cavity (the mouth). But for reasons not always entirely clear, a species or two of these bacteria become dominant or resistant and overwhelm the normal mix of bacteria in our mouths.

The result is embarrassingly objectionable breath and the patient is usually unaware of the problem.

The oral cavity has a wide range of normal bacteria and is constantly being asaulted by bacteria in the air we breathe, the food we eat and the water we drink. There are oxygen loving bacteria (aerobic) and oxygen hating bacteria (anaerobic) in the mouth in a balanced proportion. Actually the body needs these bacteria for a normal existence. They can be viewed as in a constant sort of warefare for territory in the mouth. When one side wins in a big way, the balance is upset. If the anaerobes win and become over populated, the result will be a very foul smell.

Anareobic (oxygen hating) bacteria require an environment that is dark, warm, and low in oxygen with a good supply of food particles. Areas in the mouth where this circumstance is likely to occur is on the microscopic wrinkles on the surface of the tongue and under the gum line or under a denture made of cheap materials. When these areas become overwhelmed by anaerobic bacteria, the bacteria begin to digest proteins and release foul smelling chemicals referred to as volatile sulphur compounds (VSCs).

It has been shown in extensive research that the levels of VSCs in the mouth are directly related to the foulness of a person’s breath.

If someone you trust has told you that you have bad breath, what can be done about it?

The first line of defense is brushing with special tooth pastes formulated to combat speccific bad breath issues. The anareobic acteria that cause bad breath can grow and completely contaminate a new tooth brush after about two or three weeks. This allows the bacteria in one area to spread to other areas of the mouth every time you brush. So, a good approach is to get a new tooth brush every three to four weeks until the problem is solved. In my office, we give our patients enough special soft tooth brushes to last them several weeks to make sure that the problem is not self inoculation with contaminated tooth brushes.

Complete mouth cleaning is different from brushing your teeth. The average person brushes their teeth for about forty seconds. Studies show that brushing for optimal cleaning and removal of food and bacteria from the teeth alone takes a minimum of three minutes. And even after brushing for three minutes, the average person still has bacterial plaque on 20% of tooth surfaces. Flossing has been shown to be effective in removing the plaque between the teeth, but most folks have never been shown how to properly use dental floss. Dr. Ron’s staff can show you the right kind of tooth paste, the right king of tooth brush and the proper kind and way to floss to minimize odor causing bacteria in the mouth.

Another factor that can lead to bad breath is a lack of adequate saliva, also known as dry mouth syndrome or xerostomia. This can be a result of an inherited condition that manifests in later life or it could be due to medications for control of high blood pressure for instance. As folks take more medications, dry mouth and associated bad breath problems are on the rise. There are specific measures that can be taken to relieve dry mouth and related bad breath.

Chronic use of mouth washes can cause more problerms than they solve. Improper use of mouth washes can upset the delicate balance of the bacteria in the mouth; usually the odor causeing anareobes win and the result is breath that is worse once the fragrances in the mouth wash wear off.

Mouth washes often contain alcohol. The alcohol will mask the bad breath for up to twenty minutes. But it does not solve the bacteria problem and the alcohol supports bacteria that are associated with bad breath and just makes the breath problem worse. In our office we recommend specific types of medicated mouth rinses for control of bad breath. Research with an instrument called a halimeter shows that medicated prescription mouth washes are the most effective agents available to control halitosis once the bacterial infestation is controlled.

Folks that wear dentures have a completely different set of problems. The denture surfaces, in particular the surfaces that fit against the gum tissues are perfect for growing bacteria. Microscopic food particles get under the denture and are partially digested by the saliva and bad breath bacteria. The warm dark moist environment under the denture is perfect for growing bacteria. This can be a source of particularly offensive bad breath.

Another problem can be the type of material the denture is made of. Low cost dentures usually are fabricated with self curing or cheap kinds of gum colored base acrylic. The acrylic bases can be porous and there is an interchange of fluids that soak into the acrylic and allow the entire denture to become contaminated with the oxygen hating bacteria that cause bad breath. There is no way to fix a denture that has bacterial contamination of the pink acrylic material.

The bacteria balance in the mouths of denture patients is usuallyvery much in favor of the odor causing bacteria. Folks who wear dentures have to brush their tongue and the palate and lower jaw areas where the teeth used to be or bad breath bacteria will start growing on the bare gum tissues.

These bacteria are the same critters that cause slight food cuts under dentures to turn into sore spots. If the pink base acrylic of the denture is contaminated with bacteria, if a small food cut occurs the denture itself may be causing the “sore spot” to become infected and much more painful than one would expect. There is no way to sterilize a denture that has contaminated cheap acrylic. The only solution is to remake the denture with high quality materials that are carefully processed to help prevent any problems with bacterial contamination.

The only way to achieve long term success with control of bad breath is to control the bacteria causing the problem. The bacteria that cause bad breath are usually commonly associated with gum and root canal infections, cheap denture materials, etc. So a complete examination to rule out infected teeth and gums is the first plan of attack.

Upper teeth can leak pus into the facial sinus cavities and the tooth will not hurt because the pus has a place to drain. Efforts to control a chronic sinus infection are not successful if the patient has an infected upper tooth that is not causing pain. These problems can be spotted on certain types of x-rays and treated to eliminate a dangerous kind of dental infection.

Certain types of odor causing bacteria can also infect the surface of the tongue. Specific mouth rinses and in some cases antibiotics can eliminate the bacteria. Brushing and scraping the tongue with special instruments help to keep the bacterial infestation under control long term.

If periodontal disease is a problem, certain cleaning procedures along with mouth washes and antibiotics are very successful in controlling halitosis.

If you or a loved one has a problem with chronic bad breath, they need an appointment with Dr. Ron for an evaluation!