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Everything You Need to Know About Bad Breath


Last updated Wed 10 January 2018 By Tim Newman Reviewed by Christine Frank, DDS

What is bad breath? Treatment Causes Symptoms Home remedies Diagnosis


Bad breath affects an estimated 25 percent of people. There are a number of possible causes of halitosis, but the vast majority come down to oral hygiene. It is also known as halitosis or fetor oris. Halitosis can cause significant worry, embarrassment, and anxiety but it is relatively easy to remedy. This MNT Knowledge Center article will discuss the potential origins of bad breath, diagnosis and how to treat it. Fast facts on bad breath Here are some key points about bad breath. More detail and supporting information is in the main article. Bad breath is estimated to affect 1 in 4 people globally. The most common cause of halitosis is bad oral hygiene. If particles of food are left in the mouth, their breakdown by bacteria produces sulfur compounds. Keeping the mouth hydrated can reduce mouth odor. The best treatment for bad breath is regular brushing, flossing, and hydration. What is halitosis? a woman with bad breath Although bad breath is associated with certain diseases, oral hygiene is the most common cause. Bad breath is a common problem that can cause significant psychological distress. There are a number of potential causes and treatments available. Anyone can suffer from bad breath. It is estimated that 1 in 4 people have bad breath on a regular basis. Halitosis is the third most common reason that people seek dental care, after tooth decay and gum disease. Simple home remedies and lifestyle changes, such as improved dental hygiene and quitting smoking, can often remove the issue. If bad breath persists, however, it is advisable to visit a doctor to check for underlying causes.


The best method to reduce halitosis is good oral hygiene. This ensures that cavities are avoided and reduces the likelihood of gum disease. It is recommended that individuals visit the dentist for a check-up and cleaning twice a year. The dentist may recommend a toothpaste that includes an antibacterial agent or an antibacterial mouthwash. Alternatively, if gum disease is present, professional cleaning may be necessary to clear out the build-up of bacteria in pockets between the gums and teeth.


 Potential causes of bad breath include:

Tobacco: Tobacco products cause their own types of mouth odor. Additionally, they increase the chances of gum disease which can also cause bad breath.

Food: The breakdown of food particles stuck in the teeth can cause odors. Some foods such as onions and garlic can also cause bad breath. After they are digested, their breakdown products are carried in the blood to the lungs where they can affect the breath.

Dry mouth: Saliva naturally cleans the mouth. If the mouth is naturally dry or dry due to a specific disease, such as xerostomia, odors can build up.

Dental hygiene: Brushing and flossing ensure the removal of small particles of food that can build up and slowly break down, producing odor. A film of bacteria called plaque builds up if brushing is not regular. This plaque can irritate the gums and cause inflammation between the teeth and gums called periodontitis.

Dentures that are not cleaned regularly or properly can also harbor bacteria that cause halitosis.

Crash diets: Fasting and low-carbohydrate eating programs can produce halitosis. This is due to the breakdown of fats producing chemicals called ketones. These ketones have a strong aroma.

Drugs: Certain medications can reduce saliva and, therefore, increase odors. Other drugs can produce odors as they breakdown and release chemicals in the breath. Examples include nitrates used to treat angina, some chemotherapy chemicals, and some tranquilizers, such as phenothiazines. Individuals who take vitamin supplements in large doses can also be prone to bad breath.

Mouth, nose, and throat conditions: Sometimes, small, bacteria-covered stones can form on the tonsils at the back of the throat and produce odor. Also, infections or inflammation in the nose, throat, or sinuses can cause halitosis.

Foreign body: Bad breath can be caused if they have a foreign body lodged in their nasal cavity, especially in children.

Diseases: Some cancers, liver failure, and other metabolic diseases can cause halitosis, due to the specific mixes of chemicals that they produce. Gastroesophageal reflux disease (GERD) can cause bad breath due to the regular reflux of stomach acids. Rarer causes of bad breath As mentioned earlier, the most common reason for bad breath is oral hygiene, but other situations can also be to blame. Rarer causes of bad breath include: Ketoacidosis: When the insulin levels of a person with diabetes are very low, their bodies can no longer use sugar and begin to use fat stores instead. When fat is broken down, ketones are produced and build up. Ketones can be poisonous when found in large numbers and produce a distinctive and unpleasant breath odor. Ketoacidosis is a serious and potentially life-threatening condition. Bowel obstruction: Breath can smell like feces if there has been a prolonged period of vomiting, especially if a bowel obstruction is present. Bronchiectasis: This is a long-term condition in which airways become wider than normal, allowing for a build-up of mucus that leads to bad breath. Aspiration pneumonia: A swelling or infection in the lungs or airways due to inhaling vomit, saliva, food, or liquids.


 The specific odor of breath can vary depending on the cause of the problem. It is best to ask a close friend or relative to gauge your mouth odor, as it can be difficult to assess it yourself. If no one is available, one way of checking the odor is to lick your wrist, leave it to dry, and then smell it. A bad smell on this area of the wrist is likely to suggest that you have halitosis. Some individuals are concerned about their breath even though they may have little or no mouth odor. This condition is called halitophobia and can lead to obsessive mouth-cleansing behavior.


Oral hygiene is the key to most bad breath issues. Other lifestyle changes and home remedies for bad breath include: Brush the teeth: Be sure to brush at least twice a day, preferably after each meal.  Floss: Flossing reduces the build-up of food particles and plaque from between the teeth. Brushing only cleans around 60 percent of the surface of the tooth. Clean dentures: Anything that goes into your mouth, including dentures, a bridge, or a mouth guard, should be cleaned as recommended on a daily basis. Cleaning prevents the bacteria from building up and being transferred back into the mouth. Changing toothbrush every 2 to 3 months is also important for similar reasons. Brush tongue: Bacteria, food, and dead cells commonly build up on the tongue, especially in smokers or those with a particularly dry mouth. A tongue scraper can sometimes be useful. Avoid dry mouth: Drink plenty of water. Avoid alcohol and tobacco, both of which dehydrate the mouth. Chewing gum or sucking a sweet, preferably sugar-free, can help stimulate the production of saliva. If the mouth is chronically dry, a doctor may prescribe medication that stimulates the flow of saliva. Diet: Avoid onions, garlic, and spicy food. Sugary foods are also linked to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue. If breath odor persists despite controlling these factors, it is recommended that an individual visits a doctor for further tests to rule out other conditions.


 Often, a dentist will simply smell the breath of a person with suspected halitosis and rate the odor on a six-point intensity scale. The dentist may scrape the back of the tongue and smell the scrapings as this area can often be a source of the aroma. There are a variety of sophisticated detectors that can rate odor more precisely. They include the following: Halimeter: This detects low levels of sulfur. Gas chromatography: This test measures three volatile sulfur compounds: Hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. BANA test: This measures levels of a specific enzyme produced by halitosis-causing bacteria. Beta-galactosidase test: Levels of the enzyme beta-galactosidase have been found to correlate with mouth odor. The dentist will then be able to identify the likely cause of the bad breath. Written by Tim Newman 

Posted by Dr. Marty Frankel at 11:05 AM  
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Dr. Marty Frankel, DDS


The Dental Diet

The Dental Diet
I have just finished reading a very interesting and informative book called The Dental Diet. It is written by Dr. Steven Lin an Australian dentist who came to the realization that although he was helping his patients by repairing dental disease, he was not getting to the root cause of the disease and therefore over time he was seeing a gradual aging and deterioration of people's mouths. He was helping people control disease but was not satisfied in that he felt he was not creating healthy mouths. In his research he discovered some very intriguing facts about how to eat for a healthy mouth, and as it turns out a healthy body as well.



Researchers have discovered that over the last few hundred years, our human jaws have gotten smaller than evolution would normally cause. This has been attributed to agricultural and industrialization. Our hunter gatherer forefathers ate much courser foods and thereby exercised their jaws and jaw muscles. Industrialization and processed foods, cooking of food, do not exercise the jaws in the same way, and as a result our jaws have gotten smaller. One of the outcomes of this fact is that more people require removal of their wisdom teeth which do not have enough room to erupt into the mouth. Smaller jaws tend to sit further back in relation to the skull and can impact our airways and contribute to the development of sleep apnea. As a result of this fact, one of the recommendations in the Dental Diet is to eat harder foods such as apples that require chewing and that excercise the muscles of mastication.


The second element of the a dentally good diet is to eat foods that give the mouth the nutrients it needs (with a focus on Calcium and fat-soluble vitamins). The fat soluble vitamins aid the body in using and distributing calcium to the proper tissues, among their other roles. Fat soluble vitamins include Vitamin D2, Vitamin A, and Vitamin K2. Vitamin D2 helps the absorption of Calcium, but Vitamin K2 helps transport the Calcium to the target tissues such as teeth and bone. It also keeps calcium out of the blood vessels which is important in the prevention of atherosclerosis.


There has been much research in medicine about creating a proper bacterial balance in the "gut". Since food enters the body through the mouth it is important to consider that the foods we eat will also impact the balance of bacteria in the mouth. There are basically 2 types of bacteria that reside in both the mouth and the gastro-intestinal tract. There are the "good" slow-metabolizing bacteria and the "bad" fast metabolizing bacteria. The fast bacteria feed in particular on carbohydrates such as sugars, grains, and their combinations such as cookies, cake, ice cream, soft drinks, etc. When these bacteria feed on those foods they produce acids which can either eat holes into the teeth (cavities) or the gums (gum pockets and loss of bone support for the teeth). These foods contribute to a proliferation of these fast-metabolizing bacteria. In this regard, it is good to consider eating probiotic foods which are for the most part fermented foods such as saurkraut, kombucha (fermented tea), kefir or yogurt, certain cheeses, to name a few. These foods help replenish and feed the friendly microbes which help prevent the harmful bacteria from taking over. There are also prebiotic containing foods which help feed the bacteria in the gut that we need to stay healthy.


The foods we eat are digested and the nutrients and bacteria are delivered to the rest of the body. They can affect the genetic expression of our genes which in turn can affect how our bodies operate. This is a very complex process and much too large in scope for this short article. Scientists are really just "scratching the surface" with their knowledge of these processes. Suffice it to say that the expression of our unique genetic makeup can be affected in a large part by the foods we choose to eat. Imbalance in these messages can predispose us to various chronic diseases (for example) such as tooth decay. Eating a dentally healthy diet as it turns out, is also very beneficial for our overall health. Once again this highlights another important connection between our mouth and the rest of our body. This is a very short summary of a very detailed and interesting book.

If you would like more information about the Dental Diet please leave a comment or question below. I will do my best to provide an answer to your question. 

Yours for glowing health ...

Dr. Marty Frankel - Smiles by Design                                                                                            3030-3080 Yonge Street,                                                                                                          Toronto, ON M4N 3N1                                                                                                                   416-770-8526