I often get asked by my patients what they can do about their bad breath. The answer is: depends on the cause.
Bad breath, also known as halitosis, is a source of anxiety for a lot of patients. Treatment can be simple or complex, and shedding light on the cause will not only help find the solution, but it may also unveil more serious medical problems.
Some ‘simple’ causes of bad breath
Some ‘simple’ causes of bad breath could be: diet, smoking or chewing tobacco, dehydration, lack of dental hygiene (either home care or lack of visits to the dentist), cavities, and gum disease.
Smoking and chewing tobacco may be obvious sources of bad breath for people, but the truth is that these can cause halitosis in various ways. Smoking decreases blood flow to the gums, decreasing their regenerative power. It also decreases the overall immune system of the individual.
In a healthy person, gums can regenerate every 7 days. This is not the case in individuals who smoke, and over time the gums can’t ‘win’ the fight from bacteria that is present in the mouth.
Both soft (gums) and hard tissue (bone) start to degenerate, resulting in gum disease. Hence in individuals who smoke, the halitosis results from not only the chemicals in cigarettes but gum disease as well.
In individuals who are immunosuppressed, the body is also not able to heal itself like a healthy individual. There are many illnesses that cause an individual to be immunosuppressed.
Some of these include cancer treatment, uncontrolled diabetes, and HIV/AIDs. The best way to have healthier gums in these patients is to strengthen the immune system.
For instance, a diabetic person with controlled blood sugar has a similar immune response to a completely healthy individual.
Keeping bacterial load down is key for people with immunosuppression, making it extra important to have routine dental cleanings.
As mentioned, advanced gum disease (also known as periodontitis) is a source of halitosis. Gum disease may be genetic in origin (‘run in the family’), result from poor oral hygiene, or be due to any of the systemic sources listed above.
There are also specific types of gum disease that have characteristic odours. For instance, patients who have ANUG (acute necrotizing ulcerative gingivitis) describe a metallic taste in the mouth.
Less obvious causes of halitosis
A less obvious cause of halitosis is xerostomia or dry mouth. Xerostomia has many causes, dehydration being the most obvious one. People also have a drier mouth with age, as salivary glands become less active.
Many drugs in the market, including those for depression, acne, epilepsy, and asthma are also notorious for causing dry mouth. The best thing for these patients is to stay hydrated, if changing medication is not an option.
Keto diets have become very popular in recent years. People who are truly following a strict diet develop what is called a “ketone” breath. Ketone breath smells like chemicals, specifically nail polish; it is referred to as “acetone breath”.
The only way to treat this is to bring the patient out of ketosis, which goes against what the individual is trying to attain. Diabetic patients may also develop ketone breath if their body is undergoing ketoacidosis. This is a life-threatening state, and in this case, the acetone breath can be a sign that the patient requires immediate treatment.
For individuals who have dealt with tonsil stones, they are very familiar with the halitosis associated with it. Removing the tonsil stones with q-tip can temporarily help with the odour. However, in recurrent cases, tonsillectomy with an ENT surgeon may be the best option.
Some of the less common causes of halitosis are digestive tract issues like GERD (gastroesophageal reflux disease), and liver or kidney failure. To avoid systemic causes of halitosis, it is pertinent for all patients to be seeing their family physician for an annual checkup.
Lastly, for individuals who have full or partial dentures, keeping the dentures clean is key to having fresh breath. Dentures, no matter the type or size, should be taken out and kept out every evening. If the patient has implant supported dentures, it is critical that the implants are cleaned, just as natural teeth.
To summarize, the best way to minimize halitosis is for patients to maintain good systemic health, keep up their oral hygiene, minimize the culprits in the diet, and to stay hydrated.
Patients can also try to gently brush their tongue at night to decrease “morning breath”. For individuals who cannot get hydrated by increasing their fluid intake, xylitol gum is a fantastic natural way to increase salivary flow and can be found in most health food stores.
For more information on halitosis or any other dental needs, contact us at Yankee Valley Dental!