Bad Breath
Thursday, January 5, 2006

Dear Dr. Mady: I have been experiencing problems with extremely bad breath for the past four months. My dentist said my teeth are not the cause of the problem. As a matter of fact, he said that my oral hygiene is superb. Can bad breath come from somewhere other than my teeth?-Joe B. in Moncton

Dear Joe: Items like mouthwashes, toothpastes, breath mints, breath strips and gum are a multi-billion-dollar a year business, especially in North America. This is mainly because bad breath is bad news for business, relationships and self-confidence. The first impression is often an important one and bad breath leaves a bad impression. What does concern me is the fact that bad breath can also be a sign of poor health.

Bad breath can be a sign of problems in the mouth, sinuses, lungs, airways, stomach or even kidneys. If someone has persistent bad breath, their physician should entertain the fact that there may be other causative factors. I have seen infections in the lungs that cause halitosis (bad breath).

The reason bad breath is so devastating, is due to the embarrassment that it causes. In ancient times it was known as a disease and sometimes even a curse. For many, it just means it is time to floss and brush your teeth. For others it is a chronic problem caused by an underlying sickness or for no known reason.

It is a common belief that someone with halitosis does not brush their teeth and that they have poor oral health. This is actually false. Most individuals with bad breath have impeccable oral hygiene. The culprits of bad breath are bacteria that function in an oxygen-deprived environment in our mouths. These bacteria ingest protein particles and metabolize them and in the process they produce sulfur gases. These sulfur gases have a rotten egg-like smell that causes halitosis.

Gum disease starts with a plaque build-up on teeth and gums. These bacteria are oxygen-loving and they too create sulfur gases. This is why people with periodontal disease have bad breath. For those with a chronic problem unrelated to oral bacteria, they must seek the help of their physician to “dig a little deeper” to try and diagnose the real underlying cause.

The fact is that low-carb diets do cause bad breath, because the large protein intake is very desirable to anaerobic bacteria that cause bad breath. As the body burns fat, ketones are released b through the breath and the urine and these ketones smell. So if you are on a low-carb diet, drink lots of water and this will lessen the chances of bead breath.

Another fact is that your tongue is a rug-like haven for bacteria to metabolize into sulfur gases. Tongue scraping is one of the absolute best ways to decrease bad breath in addition to brushing your tongue when brushing your teeth.

It is a myth that if you have a bad taste in your mouth, that you will have halitosis. You could have a bad taste in your mouth and no odor whatsoever in your breath. On the other hand, if you have no taste in your mouth, you could have very bad breath. Sometimes you can even get used to the smell and not even notice it yourself, but others surely can.

While performing oral hygiene at home, always include flossing, because floss gets in between teeth where your brush can not and removes food debris and bacteria that fester into halitosis. The bottom line is that if you understand all these facts and are performing good and proper home dental care and are still experiencing long-lasting bad breath, you need to act now. Ask your dentist or hygienist to review your hygiene practices and ask if they have a toothpaste and mouthrinse containing chlorine dioxide. If that doesn’t help, call your physician and I am sure that with warranted diagnostic testing that you will increase your chances of a cure for this “disease”.

Thursday, February 6, 2003

Dear Dr. Mady: For years I have been battling bad breath and I don’t even have gum disease. I have tried every type of product available and nothing works for longer than a few minutes. Why might my breath be so rotten and is there any products that you know of that may help me?-James in South Windsor

Dear James: Your mouth, like anyone else’s is a localized community of many kinds of bacteria and micro-organisms. These bacteria exist not only on your teeth, but also on your gums, cheeks and tongue. When they feed on food debris left in your mouth, a reaction occurs and the result is their expulsion of terrible smelling compounds including sulfur. It is these sulfur compounds that give breath it’s worst odor.

Most toothpastes and mouthwashes sold over the counter today, merely mask these odors temporarily. Many work for even less than an hour. It is analogous to spraying air freshener in a room full of decaying dairy products. After a few moments, the smell just becomes quickly unmasked again and you are back to where you started. The results of bad breath can be devastating and can have a large affect on one’s self-esteem and interpersonal relationships.

The key is to talk to your dentist or hygienist and discover what products are available that can assist in eliminating these volatile sulfur compounds as opposed to only covering them up. I have found that there are certain oral health care products available today, including toothpastes, rinses and breath sprays, that contain a main ingredient known as Chlorine Dioxide. This ingredient basically attacks the sulfur gases directly at the molecular level and diffuses them almost immediately and for many hours. Believe it or not, chlorine dioxide is used in many city water supplies to help purify water before it reaches the population. It’s odor-fighting capabilities are truly remarkable and it is harmless.

To assist you in your battle against bad breath, you must also review the methods of oral home care that you perform daily. If you are like most individuals, you probably floss less than you should and rarely brush or scrape your tongue.

When we don’t floss, we miss greater than one-third of our total tooth surfaces. This means that bacteria in between the teeth and under the gums are missed and become vulnerable. Flossing should be performed once a day, because it takes about twenty-four hours for bacterial plaque to develop. If you have periodontal disease with even deeper pockets between your gums and teeth, the situation is even worse.

Did you know that most of the bacteria that cause bad breath hide deep in the crevices of your tongue? If you look at your tongue with a great amount of magnification, it actually looks hairy or like a shag rug. It is at the base of these fibres that the sulfur compounds develop and brushing the tongue alone does not even reach them. There are certain types of tongue scrapers that can be purchased and if used properly once or twice every day, in combination with a chlorine dioxide containing paste and/or rinse, the results should be phenomenal. If you are unable to locate a good tongue scraper, a tablespoon works fairly well. Ask your dental health care professional to demonstrate the method during oral hygiene instruction, the next time you are there. They even say that a clean tongue allows you to enjoy your food better because the taste buds become more exposed.

If fresh breath all day long is what you long for, investigate these techniques along with chlorine dioxide. I know you will be shocked by the results, so don’t try and mask your bad breath but attack it at its source!


This column is reprinted with the permission of the author and The Windsor Star. "Ask the Dentist" is written by Windsor dentist (and ECDS member), Dr. David Mady Jr.. The column appears the first Thursday of each month in the Windsor Star. Readers with questions can write to "Ask The Dentist", c/o The Windsor Star, 167 Ferry St., Windsor Ontario, N9A 4M5



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