Worried about Bad Breath?
Where does bad breath come from?
Bad breath is not contagious and you cannot catch it from someone else. Also, chronic bad breath (Halitosis) does not come from the stomach. The only stomach odor that someone smells occurs when you burp. Certain foods like garlic and spicy foods once absorbed into the body can release odor through the lungs when you breathe. This food odor is transitory and should not be confused with bad breath. Air flow exhaled through the nose of someone with bad breath does not have an offensive odor, only air flow exhaled through the mouth. Because our sense of smell has the ability to adjust to odor most people with halitosis are not aware of their bad breath. Nearly all bad breath originates from the mouth, mostly from the surface of the tongue, below the gum line, between the teeth and other hard to reach areas. The mouth is normally inhabited by bacteria and the balance between the different kinds of bacteria determines the quality of your breath. The odor causing bacteria are anaerobic which means they cannot live in the presence of oxygen. These anaerobic bacteria inhabit the surface of the tongue by residing between the papillae of the tongue which is oxygen deficient i.e. they live “within” the tongue. These bacteria cannot be removed completely with a tongue scraper and will recolonize the mouth following antibody therapy. These naturally occurring bacteria feed on proteins (oral debris) and produce volatile sulfur compounds (vsc) as a by-product of metabolism causing the malodor of bad breath. Everyone has some level of vsc in their mouth, but it is at a low level that cannot be detected by the nose. When these levels of vsc gets high it becomes detectable as bad breath. Halitosis is rarely associated with certain medical conditions e.g. diabetes. If the onset is sudden, grows noticeably worse over a short period of time and is associated with fever, see a doctor.
What are the factors which cause excessive VSC to be produced?
Anything that decreases the flow of saliva or stimulates the growth of anaerobic bacteria.
Saliva irrigates the mouth, stimulates swallowing thereby flushing away debris. Morning breath occurs due to decreased salivary flow during sleep. The decreased amount of saliva during sleep creates a lowered oxygen level and limits washing action which provides a more anaerobic environment for bacteria to produce sulfur compounds. This oral stagnation is more pronounced in mouth breathers and those who snore. Alcohol and even certain mouthwashes containing alcohol can dry the oral tissues causing bacteria to proliferate. Certain medications for high blood pressure, antihistamines and depression can decrease saliva flow. Dehydration and stress also reduce the flow of saliva.
These anaerobic bacteria breakdown proteins as the start to digestion, and produce these sulfur compounds as a by-product. These proteins come from oral cellular debris (poor oral hygiene), dead bacteria, saliva, food debris, mucous, post nasal drip and phlegm. Certain conditions cause these bacteria to produce VSC at an unusually rapid rate. Also, certain types of foods may promote VSC production, such as foods high in protein or dairy products, especially if you are lactose intolerant. Numerous antibiotics or sulfa-drugs upset the balance of bacterial flora causing some to proliferate and others to perish. An important factor in bacterial growth is the pH of the mouth. Bacteria reproduce faster in a more acidic environment. Coffee and acidic foods increase acidity. Hormonal changes have even been implicated with bad breath. During menstruation, estrogen causes sloughing of body lining tissue including that of the mouth. This gives additional nutrition for anaerobic bacteria. Then there is the luck of the draw….your genetics. We all have a different tongue morphology. The more fissured the tongue, the greater the anaerobic environment and the higher the level of VSC.
How do I know if I have bad breath?
- Lick the back of your hand. Let it dry for a few seconds and then smell. If you notice and odor, you have a breath disorder.
- Place dental floss between your back teeth and then smell the floss.
- While looking at the mirror, grab the tip of your tongue with a Kleenex and pull it out as far you can. If you see that the very back of your tongue is whitish in color, it may be a sign that you have bad breath.
- Ask the opinion of someone you can trust. Check your breath several times daily because your breath changes throughout the day.
What is the truth about mouthwashes, breath mints and breath capsules?
Approximately 40 million Americans suffer from halitosis, otherwise known as chronic bad breath. They cover up the odor and do nothing to treat the cause of bad breath. Each year over a billion dollars is spent on over-the-counter products that do not eliminate bad breath but merely mask it for only a few hours. Some even make the problem worse. Alcohol based mouthwash dries out the oral tissue and can worsen the condition.
How do you treat bad breath?
As the anaerobic bacteria which cause bad breath reside within the tongue itself it is impossible to remove these bacteria completely by brushing or using a tongue scraper alone. Scraping the surface of the tongue may remove excessive VSC (a whitish film) that have surfaced to the top of of the tongue. Although bad breath is not necessarily an oral hygiene problem, it is important to brush and floss to maintain oral health. Maintain regular professional cleanings especially if you suffer from Periodontal Disease (gum disease). Broken down diseased tissue is bacterial nutrition. It is important to know that most toothpaste contains sodium laryl sulphate which is used as a foaming agent. This is actually a detergent which dries out the mouth even more. To effectively treat bad breath, the level of anaerobic bacteria and the amount of VSC produced needs to be reduced and or neutralized.
What products reduce anaerobic bacteria and neutralize the VSC of bad breath?
As ph is important, the product used needs to have a neutral or slightly basic ph. As the bacteria thrive in an anaerobic climate, the incorporation of an oxygenating complex would be advantageous. An oxidizing agent is needed to neutralize the volatile sulphur compounds from the active sulfite to an inactive odorless, tasteless sulfate form. The active ingredient is chlorine dioxide. Chlorine dioxide besides neutralizing vsc is also an antimicrobial agent.
Bad Breath in summary:
- Brush and floss using a chlorine dioxide toothpaste (avoid toothpaste containing sodium laryl sulphate)
- Use an oral mouthwash containing chlorine dioxide (gargle as well)
- Use of a tongue scraper to remove any white coating as far back as you can.
- Regular professional cleanings.
- Drink lots of water!!
Products currently available which claim to neutralize vsc include Breath Remedy, BreathRx, CloSys11, Oxyfresh, Profresh and Therabreath
These products do not foam like regular toothpaste and do not contain minty flavoring agents. They are bland tasting and some may even find it unpleasant tasting, but they do appear to work. Profresh is the only product that contains the active form of chlorine dioxide. The others contain a stabilized form of chlorine dioxide which needs an acidic environment to break down to the active form. Some question their efficacy, while others indicate that Profresh is overkill. Oxyfresh is the only one that contains sodium laryl sulphate(a foaming agent-like regular toothpaste) which some say may dry out the mouth. There is inadequate research at this time to indicate any product superiority and it is recommended that you try the different products until you find the one that work best for you.