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January 31, 2014 at 10:33 PMComments: 2 Faves: 0

Bad Breath: Causes and Remedies

By Jeffrey VanWingen M.D. More Blogs by This Author

My daughter climbed on my lap with her favorite book the other day. I love these special bonding moments with my kids and settled in to enjoy the story. As I started in on Mr. Brown Can Moo my daughter hopped off my lap. As she walked away, she turned, looking at me seriously and said, "You mouf stinks!"  I sat there surprised. My two year old had just told me with brutal honesty that I had bad breath. Bad breath is one of those problems that can highlight an underlying medical problem, can be significant and be prevented.

Bad breath, or chronic halitosis, is easy to diagnose by anyone except the person suffering from the affliction. Taste and smell are intimately related but wan relatively quick with constant stimulation. In other words, the body becomes used to a constant smell or taste (good or bad).  This makes it difficult to self-diagnose bad breath. This fact combines with the fact that most of us live in a pretty tight circle of those around us who would let us know that we have bad breath given our human social boundaries. 

What Causes Bad Breath?

Teeth: Most all bad breath occurs with decomposition that occurs in the mouth and throat from food eaten and retained in the mouth/throat or from our own tissues breaking down. Food can get trapped in our teeth and remain their until it either breaks down and softens or is flossed out.  Mostly this happens in the crevices between our teeth. Occasionally a poor fitting crown or dental appliance can be the culprit.

Gums: Gum disease can loosen the pockets between the teeth and gums letting in food debris.  Gum disease can also cause the tissue of the gums or the teeth themselves to decay leading to odor. 

Tonsils: Moving back from the oral cavity are the tonsils. The tonsils are lymph tissue that serve as a presence for the bodies immune system in the mouth and throat. While they are easily seen in children, they tend to decrease in size during adulthood and regress further back in the throat.  This pair of crypt-rich tissue masses takes a beating with both the frequent infections that plague the mouth, throat and respiratory tract and also the constant barrage of food that passes through the back of the mouth. As such, debris from mucous, food and bacteria often get caught in tonsils that are more prominent. 

Tonsil Stones: It can often be seen as white nodules in the crypts of the tissue.  These are known as tonsil stones.  These tonsil stones are a common source of bad breath, teeming with bacteria and essentially rotting food particles. 

Sinuses: Moving further up from the tonsils, into the sinus cavity, infection here can also cause bad breath.  The infection and in these air cavities can circulate foul smelling air into the exhaled breath.  Lastly, moving further back in the throat from the tonsils, gastric reflux (GERD or heartburn) can cause bad breath via the irritation of tissue in the throat or via the smell of the gastric contents in general. 

Abnormal Metabolism: At times, systemic problems may cause bad breath. When the body goes into the metabolism of starvation, ketones are produced and let off in the breath. These are usually "fruity" in odor but can be foul as well. This is most commonly seen when we deliberately lose weight. While it means we are on a roll with weight loss, mindfulness of a possible problem is helpful. Ketones are also present when we are ill or in diabetics who are poorly controlled in their disease.  In type I diabetes, it can herald a potential diabetic crisis. 

Bad Breath Remedies

Floss! Fixing bad breath centers around fixing the underlying problem.  Perhaps the biggest help in preventing bad breath is flossing. Routine flossing mechanically removes the food particles from between our teeth before breakdown can occur. Flossing also improves the health of the gums, tightening those pockets and making it more difficult for food debris to get caught. 

Routine Cleanings: Occasionally, more significant gum disease requires the help of a periodontist, or gum specialist. Routine deep cleanings can help restore the health of the gums.  With any dental device or dentures, routine cleaning is important.

Water Pick: For problems with the tonsils, tonsillar stones can be dislodged with a water pick. 

Mouth Wash or Salt Water: Gargling with antiseptic mouth wash or salt water can also help to dislodge the stones and kill bad breath causing bacteria.

Tonsillectomy: If the problems persists beyond this, however, tonsillectomy (removing the tonsils) may be necessary. 

Antibiotics: When painful sinuses accompany bad breath, an antibiotic may be necessary to cure the infection. 

Neti Pot: Rinsing the sinuses routinely with a neti pot can also help prevent problems and flush out potential infection. 

Acid-Reflux Medication: If reflux is suspected as the culprit, a trial of medication (such as omeprazole or ranitidine both available without prescription) may be warranted.

Ask a Friend: Securing an early warning system may also be helpful.  Call it a "bad breath buddy," someone who can be brutally honest with you if you have bad breath.

Bad breath problems are common, more common than we may realize.  When the problem is chronic, solutions are usually quite easy to decipher and a step-wise regimen of prevention with flossing, gargling and perhaps addressing other underlying causes can fix the problem.

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