Bad breath, or halitosis, is a common complaint in the dental office. That rotten-egg smell that comes from your mouth – sometimes referred to as VSCs, or volatile sulfur compounds – can be caused by gum disease. Another culprit is bacteria, or plaque, which can grow on the surface of the tongue and teeth. Food debris mixes with bacteria and salivary salts, forming a cement-like substance called calculus, which can be embedded between the teeth. Other causes include dry mouth syndrome (xerostomia) as well as issues within the digestive tract that can send foul-smelling gases into the mouth. Let’s look at a few of these problems and their solutions.
Brush (And Rinse) Away Bad Breath
For most people, the best way to treat bad breath is through proper brushing, flossing and using a tongue scraper. Since most bad breath bacteria are anaerobic (without oxygen), they die in the presence of oxygen. Brushing your teeth with toothpaste, flossing and then scraping the film off of your tongue are all ways to scrub off bacteria and expose them to oxygen.
Mouth rinses such as Listerine, chlorhexidine gluconate and chlorine dioxide are chemical ways to kill the germs that cause bad breath. Alcohols can kill bacteria, and the ingredients in mouth rinses that have eucalyptol, menthol and thymol are all effective ways to reduce bacterial levels.
Foods can also cause bad breath. In fact, onion, garlic and certain vegetables contain oils that can remain on your tongue and between your teeth. You can even smell them through the pores in your skin. You can try a breath mint, but most do very little to get rid of these smells after you eat the food.
How Else Can I Treat Bad Breath?
Here is a rundown of the most common causes, along with steps you can take to kick your bad breath to the curb.
Cause: Bad teeth and cavities
Solution: Go in for a comprehensive examination and x-ray visit. Your dentist can fill holes in teeth that trap food and bacteria, which could be the source of bad odor.
Solution: If a tooth dies, gases build up in the root and will drain out the bottom of the tooth. This is called an abscess, and it is like a pimple in the bone that will cause a fistula (or track) where the pus will drain into your mouth and cause bad breath. This looks like a red swelling and when touched, pus comes out. The dentist can perform a root canal to remove the gases and fill the root canal space with a rubbery material called gutta percha. This will allow your body to eliminate the cause of the abcess, and the pus and swelling will go away.
Dry mouth (xerostomia)
Solution: Dry mouth can cause a decrease in bacteria-killing saliva. Without normal saliva, bacteria can linger, grow and result in extremely bad breath. You can treat this with over-the-counter sprays, mouth rinses, gums and mints. These medications are called “salivary substitutes” and will help to lubricate the mouth and get rid of bad germs. You should also consider going for a consultation with an ENT (ear, nose, and throat) doctor.
Cause: Sinus infection or tonsillar abscess
Solution: Polyps, cysts or bacterial growths in the sinus or throat can lead to bad breath. A visit to the ENT or oral surgeon will help to determine if medication or surgery is needed to alleviate the bad breath due to these systemic infections.
Gum disease (periodontal disease or pyorrhea)
Solution: Treatment is to remove the bacteria that are present under your gums. This is first done with deep cleanings, called scaling, and root planing appointments where you are given anesthetic and a dental hygienist cleans the root surfaces. Then, antibiotic medications, like Arestin or Perio chips, may be inserted in the pockets between the tooth and gums to further kill the bacterial causes of halitosis. Mouth guards with medicine called Perio Protect are additional ways to introduce germ-killing medicines where they are needed most.
Severe periodontal disease
Solution: In instances where the bone is too severely eroded, dental flossing can’t reach the deeper bugs. The pocket must be opened up, cleaned and the diseased gum tissue removed. This is called periodontal surgery.
Solution: Certain conditions like diabetes can cause ketoacidosis, which makes your breath smell fruity. Basically, your body doesn’t have enough insulin to break down sugars, so it breaks down fats instead. You will want to get to the hospital right away or call 911 because this can be life threatening. Other systemic causes of bad breath are lung disease, kidney disease, impacted bowel, sinus infection or cancer. When all causes of mal-odor that are obvious have been addressed, then you need to get medical consultation to rule out these systemic issues.
Cause: Film on tongue
Solution: The coating on the tongue is filled with papillae, which can trap food, bacteria and saliva and lead to bad breath. The bacterial will grow in these deep hills and valleys and a tongue scraper will remove the coating, expose the bacteria to air and mechanically scrape off the germs that cause bad breath.
Gastroesophogeal reflux disorder (GERD)
Solution: With GERD, the valve in the stomach doesn’t work properly, and digestive gases escape up the esophagus into the mouth. The treatment is to see your physician for an evaluation, diagnosis and possible medication to treat this disorder.
Solution: People who smoke will have a higher incidence of gum disease, bone loss, yeast infection and cancer, all of which can lead to bad breath. The tar, nicotine, smoke and other components of cigarettes lead to decreased blood supply. Hence, the best way to treat bad breath is to quit smoking. Discuss medications like Chantix or Nicotrol, as well as behavior modification and other smoking cessation techniques with your doctor.