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Jul 26, 2017

This is a guest post by Dr. Val Jones who works with our Doctors Online partners at eDocAmerica.

Almost everyone has had (or knows someone who has) bad breath. Termed "halitosis" in medical jargon, bad breath has a number of identifiable and often correctable causes. Unfortunately, the flavored gums, mints, and mouthwashes available in the local pharmacy provide only temporary improvement and do not generally address the underlying cause. Let's look at some of these causes and possible solutions.

What causes bad breath? Most often, the odor is caused by the decay of food particles and bacteria that produce a sulfur-containing compound.

What are the leading causes of bad breath? 

Dental disease --- Poor dental hygiene frequently leads to the production of plaque, a sticky film that attaches to teeth.   Plaque contains millions of odor-producing bacteria and contributes to the development of dental cavities and gum disease.

Odor-producing food---Onions, garlic, certain spices are common culprits. In addition to the unpleasant odors from the mouth, they can also have a "double whammy" effect after eating.  Once absorbed into the blood stream, these odors can enter the lungs and be released through breathing.

Infection---Several sources of infection affecting the nasal passages and throat can be responsible for bad breath. These include sinus infections, tonsillitis, and gingivitis (gum) disease. With sinus infections, there may be a foul-smelling post-nasal drainage responsible for breath odor.  Tonsils have numerous crevices or pits that can trap mucous, bacteria and other debris.  This trapped material can solidify into foul smelling "stones".   Infection of the gums (gingivitis) is caused by odor-producing bacteria.   

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Dry mouth---A major role of saliva is to clear food particles and bacteria from the mouth. When this function is diminished, odor-producing bacteria can proliferate. Reasons for having too little saliva range from mouth breathing, to certain medications (e.g. antihistamines), to an autoimmune disease called Sjogren's syndrome. "Morning breath" is thought to result from dry mouth after sleeping with the mouth open.

Gastroesophageal reflux---With gastroesophageal reflux (GERD) stomach acids travels back up the swallowing tube (esophagus) and into the throat and mouth. Symptoms of GERD include heart burn and regurgitation of food or sour liquid into the mouth.

Using tobacco products---Dipping snuff, chewing tobacco or smoking cigarettes can leave an unpleasant odor in the mouth.  Additionally, use of these products may contribute to the development of gum disease.

What can be done to prevent bad breath? 

When bad breath has an identifiable cause underlying its development, addressing the specific condition should result in improvement.   Avoidance of foods with strong odor and stopping smoking are two steps that can be taken to address these "self-induced" causes.  Treatment of sinusitis may involve the use of antibiotics, corticosteroids or decongestants. Tonsillar stones can be prevented by regular gargling with salt water or the use of a water flosser to remove the debris before they have the opportunity to harden.  Regular dental hygiene is the key measure in preventing periodontal disease like gingivitis. Established gum disease may require specialized dental care. 

When dry mouth is the cause of bad breath, management can range from drinking more fluids to medications to increase saliva production. In someone with adequate saliva production, taking in extra fluids or sucking on sugarless candy may be enough.  Sjogren's syndrome is associated with inadequate saliva production and may require treatment with an artificial saliva preparation (e.g. Biotene) or an oral medication (e.g. Evoxac) to increase saliva production. Management of GERD can involve the use of antacids, acid blockers, and life-style measures such as avoidance of spicy foods and elevation of the head of the bed.

When there is no underlying condition leading to bad breath, prevention hinges on practicing good dental hygiene.  Most dental authorities recommend brushing teeth twice daily, with careful attention to the gum line as well as all tooth surfaces.  In addition, flossing at least once a day will help to prevent plaque formation.  Since the surface of the tongue can also harbor odor-producing bacteria, brushing the tongue or using a tongue "scraper", a plastic tool that scrapes away bacteria that builds on the tongue, can help. In addition to personal dental hygiene, seeing a dentist periodically for teeth cleaning is also a good practice to adopt.

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