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The Greenville News

Let’s clear the air about bad breath–It can be a serious health issue, not just a social complaint

By Mike Foley
The Greenville News (23 November 2004)

As much as it pains me to tell you readers this, a large number of you have bad breath.

There, I said it.

As your friend, though, I’ll assure you that you’re not alone. National figures show about 25 percent of adults in the United States have chronic bad breath, also known as oral malodor, or halitosis, to be just a little bit clinical.

Don’t worry. There is help available.

You probably think I’m telling you this because of the garlic-laden anchovy, onion and pepper pizza you ate last night. OK, that was a little much, but it’s more serious than that.

There’s a good chance your problem is a result of poor oral health care. Don’t take my word for it. Listen to Dr. Sushma Nachnani, director of University Health Resources Group in Culver City, Calif.

Nachnani is among an increasing number of researchers worldwide who are tackling bad breath as a serious health issue and not just a social complaint.

She’s been researching mouth odor for a decade, and it turns out there are three types of bad breath: physiological, pathological and strangely enough, psychological. Lucky for you, about two-thirds of the cases are classified as physiological and are caused by bacteria that live on your tongue.

The simple resolution to the problem is easy: Get rid of the bacteria.

That’s mainly from their oral hygiene, Nachnani said. They have to take care of it every day.

You say you brush and floss, and we’ll take your word for it. More than likely, you need to do more.

Go to a mirror and stick out your tongue. See the white stuff near the back? That is VSC, volatile sulfur compounds, a normal byproduct of bacteria found in your mouth. If you don’t get rid of it, well, don’t blame me for keeping my distance.

Believe me, it’s not your fault. The accumulation can simply occur from having your mouth closed all night, which gives you the dreaded morning breath. Or this odor can be the result of chronic dry mouth, due to dehydration or as a side effect of some prescription medications. It can also occur among salesmen or teachers, anyone who talks a lot, among other causes. Without adequate saliva flow, VSC collects, and pretty soon your friends put bottles of mouthwash on your desk.

There are other causes, though, and they include health problems such as gum disease, sinus infection, asthma, constipation, tonsillitis or acid reflux. Physiological mouth odor also includes temporary conditions caused from volatile substances released into the lungs from spicy foods, coffee, tea and alcohol.

Remember the Atkins diet? You and everyone else were dropping pounds like crazy, but the low-carb diet with all that excess protein — while eliminating fresh fruits and vegetables — gave bacteria a perfect host on which to grow.

Maybe VSC has built up because you’re not brushing effectively. Bacteria can get trapped in gum crevices, on the back of your tongue or between teeth. Mouthwashes can help, Nachnani said, but not if they’re high in alcohol, which can dry the tongue and start the process all over again.

You’ll probably want to visit your dentist and ask for advice, but practicing good oral hygiene by brushing, flossing, tongue scraping — you’ll find these handy devices at your drugstore — and an effective mouth rinse works for many people, Nachnani said.

“For about 80 percent or 90 percent of the people, this is all they need,” she said.

Since I’m not a doctor, I must advise you there is a chance your problem could be a chronic, or pathological. The real doctor, Nachnani, says pathological odor affects 10 percent to 15 percent of people with mouth odor. In these cases the underlying problem is a serious disease such as kidney disease, diabetes, cystic fibrosis, uremia, hepatitis, emphysema, tumors, pneumonia and even cancer.

Again, you’ll have to start with your dentist. Lucky for you, more and more of them — about 3,500 worldwide — have a device called the Halimeter, a sophisticated gas sensor, to measure the VSC in the mouth, essentially quantifying bad breath in parts per billion.

The medical device tells you and your dentist whether you have odor and at what level. It’s a distinction that in almost all cases individuals can’t determine on their own.

“And your friends won’t tell you,” said Michael Shaw, chief executive officer of Interscan Corp., which makes the Halimeter.

“We tell dentists, 80 percent of your patients are going to be people who have an oral problem,” Shaw said about those diagnosed with mouth odor. “They think they take good care of their teeth and gums, but they really don’t.”

Serving those patients is relatively easy, said Dr. Rogers Reeves, of Simpsonville Dental Associates.

“People with periodontal problems almost always have really bad mouth odor,” Reeves said. “As part of the treatment we’ll measure the odors coming out of their mouths and in the course of treatment we’ll hopefully be able to minimize or eliminate those odors for them.”

By establishing a baseline with a Halimeter, Reeves can measure progress and give people peace of mind that their problems are being resolved.

It’s fairly common to have people complain about their breath, Reeves said, and want to be tested to make sure they’re not offending people.

“People come in and have concerns about their breath, when really there’s really no problem,” he said. “They’re just extremely conscientious and it’s reassuring to them to give them a reading and say, ‘No. You don’t.’ “

When the fears are unreasonable, the mouth odor is psychological. That occurs when a device such as the Halimeter can’t detect it and others can’t smell it either.

“It’s more common than you think,” Shaw said. “We eat certain foods and we think we have bad breath. Or people back off from you and you think you the only reason is bad breath.”

Dr. Louis Touyz, director of the Division of Periodontology at McGill University in Montreal, said if a person believes he has breath odor, it’s important to measure it to objectively show him there is no problem or to confirm the problem.

“If a person insists they smell, and you can’t smell it, it behooves you to send them for a full (medical) diagnosis,” he said, even though they may end up needing psychological help.

People can be delusional, Touyz said, or the smell may exist and be a sign of something dire even though it isn’t readily detectable by the human nose.

“You can measure the strength of the malodor objectively,” he said. “There have been cases where the smell couldn’t be detected, but it was the first sign of a brain tumor.”

Devices such as the Halimeter are objective, but both Nachnani and Touyz say humans can detect some differences in mouth odors in each other, even though it’s highly subjective.

Pathological bad breath usually is more intense and distinct, Nachnani said. Leukemia, respiratory problems, kidney disease or diabetes produce distinct odors different from smells usually associated with bad breath.

“Dentists can act as screens, by determining the quality of the smell,” Touyz said, noting that a mucus discharge associated with a cold has its own distinct smell. “And a very strong, putrid smell may be tuberculosis.”

Let’s hope, dear reader, that isn’t the case for you. Most likely, we’ll all just need to pay a little more attention to our mouths from now on. And remember, I was the first to tell you.


* Food: Garlic and onions, among other foods, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash only mask odor temporarily. Odors continue until the body eliminates the food. Dieters can develop unpleasant breath from infrequent eating.

* Brush and floss: If particles of food remain in the mouth they can collect 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. Brush twice a day with fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an interdental cleaner.

* Dry mouth: Bad breath can also be caused by dry mouth (xerostomia) which occurs when saliva flow decreases. Saliva cleanses the mouth and removes particles that can cause odor. Dry mouth can be caused by medications, salivary gland problems or continuously breathing through your mouth. If you have dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing fluid intake.

* Tobacco: If you use tobacco, ask your dentist for tips on kicking the habit.

* Medical disorders: Problems such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailments can cause bad breath. If your dentist determines your mouth is healthy, you may be referred to your family doctor or a specialist to determine the cause of bad breath.

* Oral health: Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of foods you eat and make a list of medications you take to give to your dentist. Let your dentist know if you’ve had surgery or been ill since your last appointment.

* Mouthwash: Most of these products do not have a long-lasting effect on bad breath. If you must constantly use a breath freshener to hide unpleasant mouth odor, see your dentist. If you need extra help to control plaque, your dentist may recommend using a special antimicrobial mouth rinse. A fluoride mouth rinse, used along with brushing and flossing, can help prevent tooth decay.

Source: American Dental Association