Halitosis (Bad Breath)

by Dr. Christopher Chang, last modified on 9/21/11
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Halitosis (also known as bad breath) most often is caused by volatile sulfur compound producing bacteria in the oral cavity (85%). Such bacteria exist on the gums, teeth, tonsils, adenoids, and tongue. Other (less common) causes of bad breath also include reflux, sinus infections, pneumonia, bronchitis, kidney failure, metabolic dysfunction, cancer, etc. The most recalcitrant cause of halitosis (in people with excellent oral hygiene) is due to bacterial overgrowth in the back part of the tongue (lingual tonsils). Adenoids is another location often neglected as a cause of halitosis.

To treat benign halitosis, there are some things one can do at home to resolve the issue before seeing a physician and/or dentist.

Brush your teeth daily! Poor dental hygiene leads to caries as well as gingivitis which both lead to halitosis.

Floss your teeth daily! To understand the benefit in flossing, smell the floss after flossing your teeth.

Brush your tongue daily, not just in the front, but in the back! Use a tongue brush or scraper. Toothbrush works, but not as well.

Not only rinse, but GARGLE your mouth twice a day. When gargling, try to focus the gargle on the back part of the tongue where it curves down into your throat (stick your tongue out while gargling). Rinsing and gargling before bedtime works best as the residue from the mouthwash remains in the mouth for a longer period of time.

Saline flushes (not sprays) to the nose twice a day (ie, Neilmed sold over the counter in many pharmacies is what we generally recommend) address nasal/sinus/adenoid sources of halitosis.

Maintain proper hydration as dry mouth can exacerbate bacterial overgrowth.

Researchers found that eating 6 ounces of yogurt a day containing live Streptococcus thermophilus and Lactobacillus bulgaricus reduced levels of odor-causing compounds, such as hydrogen sulfide, in the mouth.

These are some suggested ingredients in toothpaste (based on reference below):

Triclosan

Tin fluoride, sodium fluoride

20-65% bicarbonate and Zinc salts

Hydrogen peroxide

Bicarbonate

These are some suggested ingredients for mouth rinses (based on reference below):

Zinc chloride

Listerine

Chlorine Dioxide

Cetylpyridinium Chloride

Chlorhexidine

What can our physicians provide beyond these measures?

Endoscopic evaluation of the adenoids and lingual tonsils.

Surgical procedures to remove the tonsils (lingual or palatine) and/or adenoids if they are contributing to the halitosis.

If you have problems with tonsil stones, tonsil cryptolysis may be an option.

Evaluate for more sinister causes of halitosis (ie, cancer, infection, tumors, etc).

If halitosis is affecting your quality of life, please contact our office for an appointment.

References

The relationship between oral malodor and volatile sulfur compound-producing bacteria. Otolaryngol Head Neck Surg. 2006 Nov;135(5):671-6. Link

Coblation lingual tonsillectomy. Otolaryngol Head Neck Surg. 2006 Nov;135(3):487-8. Link

Lingual tonsillectomy using bipolar radiofrequency plasma excision. Otolaryngol Head Neck Surg. 2006 Nov;134(2):328-30. Link

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Halitosis (Bad Breath)