by Rob Lamberts, M.D.
Today I am going to turn my attention to a problem that is wreaking havoc all over our fair planet.
What to Do About Bad Breath
Today’s topic comes from a reader, who, for confidentiality’s sake, I’ll refer to as Hal. Hal writes:
Dear Dr. Lamberts,
I have a rather embarrassing problem. I suffer from terrible mouth odor. I regularly brush my teeth and floss, yet after almost every meal my mouth reeks. I was wondering if this is related to any other disorder or whether it could lead to any further disorders. I would really appreciate it if you could suggest some remedies.
Thanks for your bold honesty, Hal. I am sure there are a lot of others out there interested in the answer to this pervasive problem. Bad breath, called halitosis by people who like big words, is a very common problem. I make my living by having people open their mouths and say “ah.” Trust me; it’s a big problem (I'll be covering that other big problem, body odor, in another episode).
How Do You Know if You Have Bad Breath?
But before talking about how your bad breath can be treated, we first need to be sure of your diagnosis. That may seem obvious, but it’s not as easy as you think. You may have noticed that it’s very hard to smell your own breath. People cup their hands and blow out to check it, but often they are sadly mistaken at the freshness of their breath.
Why can’t you smell your own breath? The answer lies in the nature of the sense of smell. Your smell receptors in your olfactory bulb, which resides in your nasal canal, are very sensitive. But you wouldn’t want to smell every smell all the time; you just want to smell new smells. So your smell receptors turn themselves off when an odor persists. That can be bad news when it comes to your breath.
The funny thing is, nearly a quarter of people who seek medical attention for bad breath, don’t actually have bad breath. That is a condition called halophobia. So if you think you have a problem, find someone you trust to give you an honest assessment. If you can’t find anyone to give you this opinion, you probably have bigger problem than just your breath.
What Causes Bad Breath?
So once you’ve established that you do in fact possess the breath that launched a thousand ships, the next thing is to find out the cause.
The main cause of bad breath is the presence of bacteria in the mouth that put off foul-smelling substances. Bacteria put off these chemicals as a normal byproduct of life. Some of the more notorious chemicals cause the following aromatic smells:
The smell that makes you light a match when you leave the bathroom
Rotting of living flesh
Am I implying that breath odor has elements of rotting meat, stinky feet, rotten eggs, and… uh … other stuff? Yes, I actually am. The bacteria that produce these smells usually live in small numbers in your mouth-- but sometimes they get their numbers high enough to make their presence known. That’s when bad breath happens.
How to Get Rid of Bad Breath
The key to fixing the problem of bad breath is to locate its source. The most common source is the mouth itself: it’s the location of the smell-producing bacteria about 85% of the time. Since the mouth is regularly filled of food, the bacteria in there can get an all-you-can eat buffet under the right conditions. What gives the right conditions? Two things are at the core:
Poor oral hygiene
Brushing and flossing is the key to maintaining good mouth odor. But a decreased flow of saliva is not something most people consider. Saliva serves to rinse the mouth, clearing it of bacteria and leftover food. Without that, the breath gets bad quickly. A good example of this is our old friend “morning breath,” which happens because we don’t produce as much saliva during the night.
What About Bad Breath That Won’t Go Away?
The nasal passages, including the sinus cavities, are also a common source of bad breath. If you have bad breath that is difficult to treat, you may have a sinus infection brewing. But you don’t necessarily have to have the usual symptoms of sinus infection, as sinusitis can be present at low levels and be otherwise asymptomatic.
Oh yes, and small children with bad breath should have their nasal passages thoroughly examined, as they are sometimes used as a storage place for peas, meat, crayons, and other small objects. The decay of these or the infection caused by the blockage can cause significant bad breath. I hope this isn’t your problem, Hal.
What Are Other Causes of Bad Breath?
Another place where pungent aromas can be produced is the tonsillar area. The tonsils and adenoids are immune organs that serve to guard the oral and nasal canals from incoming threats. The adenoids are basically tonsils that live at the back of the nasal cavity – just above the soft palate. There is actually one more set of tonsils at the very back of the tongue, called lingular tonsils, that can play a significant part in bad breath.
The tonsils and adenoids are a lot like English muffins -- full of nooks and crannies. Bacteria like to hide in these nooks and feast on food that happens to come by. Most sources I read stated that tonsillectomy should not be performed solely for bad breath, but they also didn’t give any recommendations on how to fix this problem. In my opinion, those recommendations don’t take into consideration the agony of the patient (or the people around him). I think it is reasonable to get a tonsillectomy in this situation for chronic tonsillitis if other options are exhausted.
What Are Potentially Serious Causes of Bad Breath?
Some other less common, but potentially serious causes of bad breath include:
Problems with the esophagus and stomach
Generally, kidney and liver disease don’t first present with bad breath. But problems in the esophagus and lungs can be the cause of sudden, especially bad-smelling breath. All of these are uncommon, but if your bad breath comes on suddenly and no amount of brushing or mint eating can get rid of it, you should see your doctor.
The last significant cause of halitosis is diet. Obviously, diets rich in garlic, onions, and other pungent foods can lead to social isolation. But other diets, such as ones low in carbohydrates, can change the acidity of the mouth and make it more prone to bad breath.
What to Do for Bad Breath
So what can be done for bad breath? Here are my quick and dirty tips for dealing with bad breath:
Tip 1: Observe Good Oral Hygiene
Brushing your teeth and tongue are important. Brush frequently and thoroughly. Don’t forget to floss. The first person you should visit with this problem is your dentist, who may not only be able to identify and treat your problem, but will also quickly concur with the diagnosis.
Tip 2: Keep it Moist
Dry mouth can be caused by medications and certain medical problems. Check on any medications you are taking to see if they cause dry mouth. Chewing sugarless gum or sucking on breath mints will help not only by covering the smell, but they will increase the saliva, which can prevent the bad breath in the first place.
Tip 3: Consider Other Medical Problems
If you can’t fix the problem after doing the first two steps, you should go to your doctor and ask about sinus problems. I have successfully treated bad breath in patients using steroid nasal sprays and antibiotics. If your doctor says it’s not a problem with your sinuses, be sure to ask about other potential medical problems, like kidney and liver disease and problems with your lungs, stomach, and esophagus.
And if all else fails, you can join a monastery in the Himalayas.
That’s it for today. Thanks for the question. This may not be a life-threatening problem, but it certainly can be life altering.
If you have questions you want answered, send them to firstname.lastname@example.org. You can find me on Twitter as @housecalldoc and on Facebook under “House Call Doctor.”
Catch you next time! Stay Healthy!