Help for Horrendous Halitosis

What is Halitosis and how common is it? Halitosis is bad breath.  Nobody wants bad breath.  According the the American Dental Association (ADA.org) up to 50% of adults report having halitosis at some time in their lives.  Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5% of the population (1). The psychological components of halitosis are not often discussed, but the awareness of bad breath inhibits social interactions and impairs quality of life.

What causes bad breath?  Many things contribute to foul breath including (1):

Bacteria: The mouth is a perfect breeding ground for many bacteria, some of which produce the volatile sulphur compounds (VSC’s) that are responsible for the most offensive odors.  The bacteria often inhabit the back of the tongue and throat, areas that are seldom cleaned effectively.  

Dry mouth / Dehydration: As discussed in a previous DHM, a slightly dry mouth allows some particularly offensive bacteria to flourish – and also decay rates to soar.  

Gum Disease: The sticky plaque that is responsible for gum disease (periodontal disease) is also responsible for an increase in foul odor.

Food: Sadly, those salad onions at lunch will follow your breath for many hours.  And your coffee, garlic… the list goes on.  

Smoking: Obvious to anyone within 6 feet of you for hours after you light up.

Medical Conditions: After we have eliminated other sources of malodor, we begin to consider medical conditions such as gastric reflux, sinus infections, diabetes or even liver or kidney disease.  

Dirty removable appliances: Your occlusal guard (see previous DHM article), dentures, partial dentures, snore-guard, Invisalign trays or retainers all can harbor bacteria.  Gentle daily brushing with water and weekly cleaning with a cleansing tablet help keep things fresh. 

What to do?  Good oral hygiene is an essential first step: Brushing gently, thoroughly, and consistently will clean most of your teeth, but only flossing will clean in between your teeth.  Together, this will loosen bacteria off the teeth; tongue scraping and mouthwash will help to clean the back of the throat and remove many of the worst bacteria.  Less odorous food choices, good hydration, stopping smoking addressing dental decay and gum disease will reduce odors too. 

What mouthwash will help?  Some mouthwashes will mask smells… briefly, but as many contain alcohol, they can dry your mouth leading to further foul odors. Many products are effective at reducing bad breath (2).  The most effective ones will not simply mask an odor, but kill the most offensive odor molecules and bacteria where they live – at the back of the tongue and throat (3,4,5). We are fond of TheraBreath (hence the samples we give out), combined with good oral hygiene it’s very effective.

Professional Help

If all the above suggestions do not provide relief, please consider seeking professional help. A consultation with our office and possibly a physician could allow us to find a long-term solution to a tricky problem.

Ask me if you have any bad breath questions, and feel free to share this article!

Sincerely,

Dr. Doodes.

References:

1)  Braz Oral Res. 2011 Sep-Oct;25(5):466-71.Halitosis: an overview of epidemiology, etiology and clinical management.  Rösing CK, Loesche W.

2) Int J Dent Hyg. 2016 May;14(2):117-23. The effect of different mouth rinse products on intra-oral halitosis.  Erovic Ademovski S1, Lingström P2, Renvert S1,3,4.

3) Isr J Dent Sci. 1989 Oct;2(3):142-7. Use of a metastabilized chlorous acid/chlorine dioxide formulation as a mouthrinse for plaque reduction.  Goultschin J1, Green J, Machtei E, Stabholz A, Brayer L, Schwartz Z, Sela MN, Soskolne A.

4) J Oral Biol Craniofac Res. 2016 Jan-Apr;6(1):54-8. Effect of Aloe vera, chlorine dioxide, and chlorhexidine mouth rinses on plaque and gingivitis: A randomized controlled trial. Yeturu SK1, Acharya S2, Urala AS3, Pentapati KC4.

5)  Braz Oral Res. 2016 Aug 22;30(1):e71. Self-reported halitosis and associated demographic and behavioral factors.  Milanesi FC1, Kauer B1, Wagner TP1, Daudt LD1, Haas AN1

6) Diagnosis and Treatment of Halitosis Jon L. Richter, DMD, PhD Compendium of Continuing Education in Dentistry, April 1996.