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The Times of Northwest Indiana

Kiss of death—Gum disease is at root of the problem

By Molly Woulfe
The Times of Northwest Indiana (17 July 2006)

Three signs you might have bad breath:

  • You say “hello” and friends arch backward like Olympic gymnasts.
  • You find anonymous gifts of mouthwash, toothbrushes and mints on your desk.
  • When you try to blow out the candles on your birthday cake, the flames burn blue.

Halitosis—Listerine coined the medical term for bad breath in 1921—is more widespread than you think. Surprise, the remedy to minty-freshness may be a toothbrush away.

Bad breath is better than no breath.

That sums up the advantages of halitosis.

When breath is whiffy, life is iffy. A malodorous mouth is a kiss of doom to romance, job interviews and close friendships.

Dental surgeon Rex T. Raper is blunt. The reek of halitosis to similar to road kill. “Everyone knows what a dead animals smells like on the side of the road,” said Raper, head of periodontics at the Cleveland Clinic. “That’s basically what’s happening in your mouth. Bacteria are destroying tissue.”

If this graphic image makes you gulp, prepare to gasp for air.

“Oral malodor” is as common as it is embarrassing. 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 yen to be minty-fresh is the driving force behind the $10 billion mouthwash-breath mint-spray industry.

In honor of National Fresh Breath Day (Aug. 6), vow to make a dentist appointment, pronto. Up to 90 percent of halitosis cases stem from poor oral hygiene.

What you eat does affect the air you exhale, the American Dental Association reports. Garlic, onions and stinky cheese result in breath that can kill water-cooler buzz at 10 yards. Other prime offenders include cigarettes and alcoholic drinks.

But mediocre daily hygiene is the major culprit behind sewer breath. If you don’t brush and floss daily, tiny bits of food remain between your teeth, collect bacteria and decay. As remains of last night’s linguini rots, an objectionable smell results. The remains of the next day’s pierogi and the weekend pizza perpetuate the decay cycle.

When periodontal (gum) disease sets in, a major stink ensues.

Hundreds of species of bacteria live in the warm, wet cave of the mouth. When you go to bed at night and they can multiply and digest food residue in peace, “morning breath” arises. The reduced flow of salvia contributes to this unsavory process, known as putrefaction. A good brushing and flossing in the morning literally washes the problem away.

Yet ongoing neglect causes anaerobic sulfur-producing bacteria to burrow into the crannies of the tongue and pockets under teeth. As the bacteria attack the gums, the smell of decaying flesh makes garlic breath seem like a spritz of Chanel No. 5.

Not that you’ll notice. Most folks are too acclimated to their bodies to detect self-odor. And fail to realize that breath mints, rinses and sprays are temporary quick fixes.

You will note that your gums are red and sensitive to the touch, perhaps spy blood on a toothbrush or toothpick, classic signs of periodontal disease. But you won’t rush to the dentist for help. Au contraire.

Patients typically stop brushing “due to the pain and discomfort,” said Dr. Lou Graham, former dental director of the University of Chicago’s Department of Dentistry. “This, in turn, allows for the (severe) build-up of plaque and bacteria.”

Worse, the tender-gummed bypass crunchy apples and carrots for “soft,” sweet treats that aggravate the problem. “The way our teeth are designed, the normal flow of food is across the molars and incisors,” Raper said. Crunchy foods “stimulate the gum tissues. If you’re eating soft stuff and drinking, it sticks to both the tooth and gum surface.”

Flossing and brushing twice daily with a desensitizing toothpaste such as Sensodyne is a start, Graham said. But regular checkups and follow-ups are the best way to eliminate bad-breath woes.

In many cases, a good cleaning, coupled with routine brushing and flossing, can clear up the problem in a week, Raper said. Severe cases may require antibiotics or even lasers to treat severely damaged gum tissue.

A good dentist will play detective, too, referring a patient with good oral health to a specialist if bad breath persists. In rare cases, the problem may stem from a respiratory infection, a gastrointestinal ailment or a liver or kidney disorder. Another culprit is dry mouth, a side effect of some medications and antidepressants.

Though understudied, bad breath is going high-tech. About 4,000 dentists nationwide have invested in clock radio-sized computers that rate fume toxicity. The Halimeter®, manufactured by Los Angeles-based Interscan Corp., measures an individual’s volume of volatile sulfur compounds per breath. The results are ready in minutes.

“A normal reading is 80 to 120 parts per billion. If it tops 250, there’s going to be a noticeable odor,” vice president of marketing Michael Shaw said. Shaw said. “As the number gets higher, the odor is not only stronger, but foul. One Philadelphia doctor had a patient who went over 1,500… The guy left the room and the odor persisted for several minutes.”

In this case, the pungent party was suffering from advanced gum disease. He recovered after embarking on a strict oral-hygiene routine.

Whether bad breath is mild or severe, clearing the air is a delicate matter. Surveys of executives show that 100 percent wish to be told if they have bad breath. But broaching the subject is awkward.

Etiquette expert Peggy Post advises tact, kindness and subtlety. “Speak up—in private—but only if you know the person well,” she advised. “The bottom line is, people do want to be told, but don’t want to be embarrassed.”

For a low-key approach, be sensitive. “Say, `Because I’m your friend, I’m going to say something that’s awkward, but it’s something I want you to know,'” said Post, of the Emily Post Institute. “Or you can say, ‘I had the same problem, this is how I solved it.’ Be helpful.”

Depending on the relationship, use humor to defuse tension. “I’ve heard spouses say, ‘Hey, your breath stinks!’ and make light of it,” she said.

If you’re in a bind—stuck next to Godzilla Breath at a show one evening—try the old mint ploy. Offer them around so you don’t single out the stinker. “That will get you through the evening,” Post said.