Bad Breath - Be Part
of the Cure!
The Causes of Bad Breath
Intra-Oral causes of Bad Breath
Making a Diagnosis
Treatment
Suwanee Dental
Care
can be your resource for ending bad breath!
How often have you seen
people avoiding direct conversation by covering their
mouth with their hand or turning their head away before
speaking?
Did you know that one of the main reasons people finally
go to a dentist is because they are worried about their
bad breath?
Today it is estimated that 25
million Americans suffer from chronic bad breath
(halitosis). Many of these people are unaware of their
offending breath until somebody has the courage to tell
them. But once they are aware that they have the problem,
they will usually do anything to avoid the embarrassment
that it causes. All one has to do is look at the millions
of dollars a year spent on various mouthwashes, flavoring
agents, mints and other masking substances, to see that
halitosis is a serious social problem.
Studies show that disorders of the oral cavity are responsible for most instances of bad breath. But it is clear when you look at the numbers, companies producing mints and sprays are the ones' carrying out bad breath treatment and not the dentist.
When is the last time you asked your dentist if he or she could help you get rid of bad breath ?
The Causes of Bad Breath
Bad breath is a condition that has many different causes and even though it is most often caused by oral problems, bad breath can also be a symptom of a serious disease. One of the best examples of this is diabetes. While an odor is not detectable in well- controlled patients, an acetone sweet fruity odor can often be detected in the uncontrolled patient. This odor can even be a sign of an impending coma.
It used to be thought that bad breath could originate directly from the contents of the stomach. We now know that this is not true except when belching or vomiting since odor and gas cannot escape when the esophagus is in a normal closed condition.
Instead, most of the odors which are not intra-oral in origin enter our breath through the lungs. The most common example of this is the odor which comes from some of the food we eat. The bi-products from ingested foods are absorbed, carried through the blood and excreted through the lungs. This explains why patients complain of garlic or onion breath long after they have eaten and even after they have brushed, flossed and rinsed.
Intra-oral causes of bad breath
It is thought that disorders of the oral cavity cause up to 85% to 90% of all the cases of halitosis. Some of the more common causes are: a dry mouth due to lack of flow of saliva during sleep, denture wearing, food retention, poor oral hygiene, dental decay, gingivitis, gum disease, an unclean tongue, and smoking. Most of these factors have in common an increase in bacteria in the oral cavity. These bacteria produce compounds like hydrogen sulfide, methyl mercaptan, dimethyl sulfide and dimethyl disulfide. Collectively they are known as volatile sulphur-containing compounds or VSC. These are the compounds responsible for bad breath.
Making a Diagnosis
Due to many possible causes
of bad breath, diagnosis of the origin of halitosis is
essential for its treatment. The first step to making a
proper diagnosis is the taking of a complete medical
history. Some of the questions you may ask are:
1) When is the last
time you visited the dentist? Someone who does not
go to the dentist regularly has a higher risk of
halitosis from decay and gum disease.
2) What are your oral
hygiene habits ? a) Brush daily b) Brush & floss
daily c)Brush, floss, and rinse daily This is an
important question because even patients who are very
meticulous about brushing and flossing may still suffer
from bad breath that is oral in its origin. This is
because the tongue is believed to be one of the main
sources of oral odor. Most people have never been taught
to brush their tongue.
3) Do you use an
over-the-counter mouth rinse regularly? a)Yes b) No
What brand? Although millions of dollars are spent
every year on over-the-counter mouthrinses and
deodorizing sprays, it is clear that most of them will
only mask bad breath temporarily. Furthermore, mošst of
these mouthrinses contain a high percentage of alcohol
which when used too frequently will tend to dry out the
mouths' tissue.
4) When you sleep do you
breath through your mouth? Dryness of the mouth is
almost always associated with halitosis.
5) Are you taking any
medication? Many medications can cause dryness.
Some also have a distinct odor of their own which enters
the breath via the lungs.
6) Have you been
experimenting with ethnic foods that use different spices
? I love spicy food. Many spices like garlic and
onions affect the breath. In the digestive system the
by-products of these spices are able to enter into the
bloodstream. From there they enter the breath by being
excreted from the lungs.
7) Are you on a special
diet?Dieting can make you prone to halitosis, When
a person doesn't eat they experience what has been called
"hunger odor". This may actually be caused by
the juices in the stomach. Dieters also burn stored fat
which gives off acetone. These odors enter the breath via
the lungs.
8) Do you drink
alcohol ? Remember alcohol tends to dry out the
oral tissues. Alcohol is also excreted into the breath
via the lungs.
9) Do you smoke? Smoking
encourages periodontal disease, decreases salivary flow
and causes a tongue condition which can trap food debris
and tobacco odor.
10) If you are a denture
wearer, how often and by what method do you clean your
dentures?a)Brush b) Soak How often?Dentures tend
to collect food more than natural teeth. It is also true
that since most denture wearers are older their salivary
flow seems to be less. Both these factors contribute to
an increase in halitosis for the denture patient.
11) How long have you
noticed the problem? The duration of the problem
can be significant in making a diagnosis. For example, a
long duration of symptoms is more consistent with
persistently poor hygiene while a short duration of
symptoms may suggest an infectious source like an
abscess.
12) Has your bad breath
been confirmed by others? It is very difficult to
determine for yourself if you have bad breath. Trying to
smell your own breath usually doesn't work and having a
bad taste in your mouth doesn't necessarily mean that you
have bad breath. Since most patients do not have access
to sophisticated measuring instruments, the only way they
can really tell if they have bad breath is to ask
somebody to check it for them.
After completing a history we will then do a complete intra-oral examination. Today, the technology exists to measure the level of volatile sulfur compounds right in the dental office with the use of an instrument called a Halimeter. This along with other new techniques will usually allow us to pinpoint the cause of your bad breath.
Treatment
Since most bad breath is
caused by oral factors, the elimination of these factors
should be the first step in the treatment approach. The
following steps are recommended:
1) Improve oral hygiene
techniques- Since improper oral hygiene is probably
the most common underlying factor in halitosis, the
institution of an effective home care program is
essential. In addition to conventional tooth brushing and
flossing, daily irrigation of the oral tissues and
regular scraping or brushing of the tongue is
recommended.
Since the tongue is a main
reservoir for bacteria which produce VSC one method to
control odor is to eliminate the bacteria that live
their. This can be accomplished by brushing the tongue
and using a solution which contains chlorine dioxide.
Studies have shown that sulfur molecules are oxidized by
chlorine dioxide. The reaction creates a powerful
deodorizing effect in which the volatile sulfur gas is
eliminated. This deodorizing agent along with brushing or
scraping will abrade the tongue and remove the bacteria.
This product is produced by a few companies and is called
RetarDex, RetarDent and Oxyfresh. The patient is provided
a supply of this product to use at home. RetarDent,
RetarDex and Oxyfresh come in a toothpaste, gel and
rinse.
Another hygiene technique
which has been found useful in controlling halitosis is
the use of a new type of oral irrigator. These special
units can ionize whatever solution you care to use to
irrigate the soft tissues. It has been shown that by
irrigating the soft tissues and the teeth with ionized
solutions you can inhibit the formation of plaque and
tartar. This technique is especially useful for patients
who have a hard time flossing properly.
And, don't forget about the
best plaque removal system yet developed, the
Rotadent. We carry these and other items
for our patients in our office for your convenience.
2) Control gum disease
(periodontal disease) - By eradicating periodontal
disease you will destroy one of the main sources of
bacteria that produce volatile VSC.
3) Perform all necessary
dental care- Restoring all existing areas of decay,
closing open contacts between teeth, extracting all
unrestorable teeth and correcting any other defects like
over contoured fillings and crowns that are impossible to
clean, will help to minimize the accumulation of the
bacteria and food debris that cause bad breath.
4) Increase salivary flow -
Eating smaller meals more frequently, drinking water with
a little lemon in it, chewing sugarless gum, and sucking
a sugarless citrus or mint candy, will all increase
salivary flow. This will enhance the mouths' natural
ability to clean thus reducing the number of oral
bacteria as well as their substrates and end-products
that could stagnate and putrefy in saliva. Patients who
suffer from severe dry mouth can use an artificial saliva
to moisten the oral cavity without any untoward adverse
reactions. Laclede companies products, Biotene and
Oralbalance are excellent.
5) Patients who wear
dentures, or partials need special home care
instructions.- Since food debris easily gets caught
around clasps and on denture teeth, it is important to
tell your patient to rinse out their appliances after
every meal. A good cleaning should be done at least once
in the afternoon and then prior to soaking them in a
disinfecting solution for the evening. Wearing dentures
during sleep when salivary flow is diminished will
enhance the process that causes bad breath.
6) Patients wearing
removable appliances also need to be given special oral
hygiene instructions.- Since these appliances are
usually worn 24 hours a day, it is imperative to take
them out after every meal and clean them. We recommend
that they also be soaked once a day in a good
disinfectant like CLEAN N' FRESH.
7) For people who eat
spicy food like garlic and onions, excellent oral hygiene
is not enough to stop bad breath -since the
metabolites these foods produce are absorbed, and
excreted through the lungs. One product which works well
to control this type of bad breath is Breathasure. This
simple product which is made of parsley and sunflower
seed oil in a gel cap seems to prevent the odor causing
by-products of these foods from entering the blood
stream. When all the previously described oral measures
have been taken and they fail to improve the halitosis
condition in a relative short period of time, systemic
disease or some other cause should be suspected.
Referral to a physician for a complete medical examination should then be made. Remember while halitosis is usually due to benign oral disorders it may be the first manifestation of a serious or even fatal disease.
References Veis,Rob: Halitosis, Being Part of the Cure, Practice Building Bulletin, Vol ll, No 3, 1994. Attia, E.L., Marshall,K.G.: Halitosis, Canadian Medical Association Journal, Vol.126, Number 11 1982, p-1285 Jonsson,Reynir: Halitosis: A Review, Canadian Dental Hygienist, Vol.19, Number 2, 1985, pp52-54. Lu,Dominic: Halitosis: An etiologic classification, a treatment approach, and prevention, Oral Surgery, Oral Medicine, Oral Pathology, Vol.54, Number 5, 1982, pp521-526. Kutchner, Mark: Halitosis: Diagnosis and Treatment, The California Dental Institute for Continuing Education, Vol 49 1994, pp 3-13. Murray, Mary: Kiss Bad Breath Goodbye, Readers Digest, September 1994, pp89-93. Rosenberg, Mel, McCullah, Christopher: Measurement of Oral Malodor: Current Method and Future Prospects, J. Periodontal, Vol.63 Number 9, September 1992, pp776-781. Smith, Desmond,: Even friends won't tell you, New Zealand Dental Journal,Vol. 81, Number 365, July 1985, pp97-98. Watt, Rosenfelder, Sutton: The effect of oral irrigation with a magnetic water treatment device on plaque and calculus. Journal of Clinical Periodontology. Vol 20, 1993 pp314-317.