Halitosis (Bad Breath)

Have you ever been plagued by recurring bad breath?  

There are many potential causes for halitosis (bad breath). These range from metabolic problems, to dietary consumption, to the most common cause, which is the production of "volatile sulfur compounds” (VSCs) by oral bacteria.

Breath disorders are a very common problem. Approximately 90% of all adults will complain at one time or another about a breath problem. These complaints can have more than just social consequences. Fortunately, almost all cases can be significantly improved or eliminated entirely!

Halitosis is the emission of unpleasant aromatic compounds from the breath. The cause must be accurately determined for an improvement to be realized.

First it must be determined if the halitosis has an oral or non-oral source.  Non-oral causes can involve multiple medical conditions, such as diabetes; liver failure; respiratory, sinus or tonsilar infections; and gastric reflux, for which a physician should be consulted. The most common non-oral cause for halitosis is odor that enters the breath through the lungs. The best example of this comes from the foods that are ingested. The by-products from these foods are absorbed, carried through the blood and excreted partially through the lungs. This is why patients complain of garlic or onion breath long after consumption and even after brushing and rinsing multiple times. Additionally, people on unusual diets may experience breath problems.

The most common oral source comes from the production of "volatile sulfur compounds" or "VSCs." These are mostly composed of three compounds: hydrogen sulfide, methyl mercaptan and dimethyl sulfide. VSCs are molecules that are the result of bacterial activities. They are very offensive and easily distinguished. VSCs have been measured as being 8 to 10 times greater in patients with periodontal disease.  They are produced by the bacteria that exist in the periodontal pockets and increase in proportion to the severity of periodontal disease. They are also produced by bacteria that can reside on the surface of the tongue.

Once the oral source has been determined, treatment can begin to disrupt the cycle. Two basic approaches may be used.

1. Mechanical intervention
   Mechanical intervention refers to the time-tested oral hygiene techniques of flossing, brushing, tongue scraping, rinsing and irrigating your mouth. If you have not had a professional dental cleaning in more than 3-6 months, if you notice any redness or puffiness in your gums or if you have ever experienced bleeding from your gums during brushing and flossing (Bleeding gums = gingivitis or periodontitis!!) you should consult with a periodontist, dentist or hygienist.
2. Chemical intervention.
   Chemical intervention refers to the use of mostly over-the-counter agents.  Proper selection of oral care products is essential, because these agents can either improve your condition or cause further harm.
   There are many commercially available products that make great claims about their effectiveness. Unfortunately, most of these products merely mask the VSCs temporarily. Their masking may last from 15 to 30 minutes, and then the problem resurfaces.
   
   Most commercially available products, if not all of them, are only a temporary fix that may actually make the problem worse. Alcohol based mouthwashes, for example, can dry out the tissues in the mouth and cause the condition to worsen over time. Peroxides release "free radicals" that damage tissues (the elimination of free radicals is the primary goal for using anti-oxidant vitamin supplements). Many products also have high concentrations of sugars, which will eventually lead to tooth decay.  Hence, it is important to not over-utilize breath mints.

Depending on your particular needs, both mechanical and chemical methods of intervention may be required to achieve your goal of eliminating halitosis. Some products may be advised for you that directly attack the VSC molecules. Other intervention may be necessary to attack the types of bacteria that cause periodontal disease. When used in conjunction with adequate oral hygiene measures, the proper products can help leave your breath fresh for hours and slow down the progression of periodontitis.

In summary, the majority of breath disorders are of oral origin, and most patients experience marked improvement after actively following the directions of their periodontist, dentist or hygienist.