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Your Health

Getting up close and personal about halitosis


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Using a tongue scraper to clean the back one-third of the tongue can help rid the mouth of bacteria that causes halitosis.

If people always seem be in a hurry when you try to socialize or you notice that acquaintances back up as you move closer to converse, there may be a reason.

Approximately 50 percent of people have a problem with bad breath. One of the perpetuators of halitosis is that it’s a subject everyone has trouble mentioning to the offender. Mothers, best friends, spouses and paramours alike are collectively guilty when it comes to discussing bad breath. Why should this be such a social taboo, when you would be doing the person with halitosis a favor?

Generally speaking, most people with bad breath are unaware their breath stinks. This is due to their olfactory receptors being supersaturated with their mouth odor, causing them not to appreciate any difference between what is a pleasant versus an unpleasant odor.

To determine whether you have halitosis, go outside and breathe fresh air for a few minutes. This will allow your olfactory receptors to clear. Then lick the back of your hand and smell it after the saliva dries. If you find the odor unpleasant, continue reading.

Causes of bad breath

The most common cause of bad breath is poor oral hygiene – cavities, gingivitis and excessive plaque accumulation. This leads to an overgrowth of gram-negative anaerobic bacteria in the mouth, which produce volatile sulfur containing fetid products such as hydrogen sulfide, methyl mercaptan, dimethylsulfide and dimethyl disulfide. Cadaverine, putrescine, indole and skatole are also produced and contribute to breath smelling bad.

Following are other common causes of halitosis.

• Sinus infection

• Tonsillitis

• Nasal infections or chronic nasal congestion

• Mouth sores

• Medications – especially medications that cause dryness of the mouth

• Alcohol

• Cigarettes, chewing tobacco

• Coffee, onions, garlic, pastrami and diets high in fat and protein

• Bronchitis

• Pneumonia

• Diabetes – not well controlled

• Dehydration

• Gastroesophageal reflux

• Oral cancer

• Salivary gland abnormalities

• Oral appliances – dentures, braces, retainers

• Oral candidiasis – overgrowth of yeast in the mouth

• Dry mouth

There are very rare causes of halitosis that I have not listed such as gastric cancer. In this case, halitosis would be an unlikely initial presenting symptom.

Treating halitosis

The most effective way to treat bad breath is to thoroughly cleanse the back one-third of the tongue – this is where the majority of bacteria reside that produce the foul-smelling fermentation compounds. The front part of the tongue is constantly being cleansed when it moves against the hard palate. The back of the tongue only contacts the soft palate, and this is not an effective cleansing action.

Use an alcohol- or chlorhexidine-containing mouthwash and say “ah” while gargling so that the mouthwash reaches the back of your tongue. Mouthwashes that can help reduce odor-causing oral bacteria:

• BreathRx – contains chlorhexidine

• Crest Pro-Health – contains cetylpyridunuim

• SmartMouth – contains zinc, which has antimicrobial activity

Using a tongue scraper can also help. A scraper can be purchased over the counter at a drugstore. Another option is to use toothpaste that contains hydrogen peroxide. The oxygen released will make the environment less hospitable for the anaerobic bacteria.

If a tongue scraper isn’t your thing, brush the back of your tongue with your toothbrush. Be sure to wash your toothbrush in the dishwasher on a regular basis. Alternatively, mix a little hydrogen peroxide with your mouthwash and gargle with it.

You may need to have your teeth cleaned at a more frequent rate – perhaps every three to four months instead of twice per year. A plaque layer as thin as 0.1-0.2 mm becomes depleted of oxygen, creating the ideal environment for gram-negative bacterial overgrowth.

If you are unable to brush and floss after eating, then rinse and gargle with water or chew sugarless gum.

A word of caution: If you have bad breath accompanied by sinus pain, facial pain or discolored mucous when you blow your nose, you should see your doctor to be evaluated for a sinus infection.

If none of the above measures is effective, see your dentist or internist for a more in-depth evaluation. By the way, it is now known that having periodontal disease increases your risk for coronary artery disease. Chronic inflammation in the gums can also have a systemic effect, causing inflammation in other areas of the body. So, theoretically, you could actually die from having bad breath.

Dr. Patricia Wong is a dermatologist in private practice in Palo Alto. For more information, call 473-3173 or visit patriciawongmd.com.

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