Bad Breath…of Fresh Air
Garlic is food for the gods! Should I also include goddesses? (In Hollywood they no longer say actors and actresses; everyone is an actor. So to be more equal opportunity, shouldn’t I just say gods?)
Back to garlic, I love garlic– overall. I cook with it a lot! But like some women retain water during their menstrual cycles, I retain garlic. Vampires hate me. If I have a garlic-heavy meal, I’m like a walking hummus bowl for days. What happens when you have bad breath?
Halitosis is the fancy-schmancy way of saying, “Girl, your breath stinks! Whew!” It isn’t a new concept. Halitosis has been whispered about for centuries in most religions and cultures: the Greeks and Romans, the Talmud, Islam, and book of Genesis. Hmm, provides a new perspective to “Turn the other cheek.”
What is the prevalence of halitosis? There isn’t good documentation to really know, but it probably varies according to culture, religion, and socioeconomic class. A co-resident of mine in internal medicine brushed his teeth only once a day and never flossed, and he didn’t think his breath smelled bad. Well– perhaps on Mike Rowe’s show, Dirty Jobs, he wouldn’t be considered to have halitosis.
On the flip side, 25 percent of people are considered to be halitophobic– consumed with fear they have bad breath when they don’t. (Isn’t Isaiah Washington halitophobic– or was that homophobic?) I remember on the Red Carpet at one event the stars were carrying free samples of Listerine Breath Strips. (I wonder if Tom Cruise uses breath fresheners, or would that be blasphemous to his religion? “Dr. Hong, you are so glib. Don’t you know…”)
The oral cavity (mouth, tongue, etc.) is the source of halitosis about 85-90 percent of the time. Anaerobic bacteria just love to eat substances left over in the mouth, in particular amino acids. This leads to the production of smell gases called volatile sulfur compounds (VCS). If you don’t know what sulfur smells like, smell a rotting egg or drive by a sewage treatment plant. (It puts a new spin on having a “potty mouth” like Kathy Griffin.) Bacteria love to produce VCS in mouths that lack oxygen, have neutral to alkaline pH, and are low in carbohydrates, especially between the teeth.
So those who hate to floss are more likely to have halitosis. Brushing the teeth and the back part of the tongue can reduce halitosis.
People with gingivitis and periodontal disease usually have halitosis. In my practice, I can often tell a patient has poor teeth as soon as he says, “Ah” because of the anaerobic smell. It doesn’t bother me personally, but as a physician I’m concerned about facial bone disease, abscesses, and systemic infections that can develop from poor dentition.
I have “busted” more than a few patients on their tobacco use because of their breath. Smokers or heavy drinkers are more at risk for head and neck cancers, so once in a while halitosis can be a sign of cancer.
Tonsils rarely cause halitosis, but I’ve been asked a million times, “Doc, what’s that funny stone-like white thing around my tonsils? When I spit it out, it smells like death.”
These are called tonsilloliths. Unlike the monolith in 2001: A Space Odyssey, tonsilloliths are clumps of anaerobic bacteria and VCS that look like hardened lint balls. There isn’t much you can do about them except gargle. Surgery to close up the tonsillar crypts isn’t recommended overall.
There are so many other causes of halitosis– in particular sinus infections and allergies– but you’ll have to check that out on DrJohnHong.com because I’ve run out of room in this article.
Whew, I’ve gone on so long, I’m out of bad breath.
(c) Dr. John Hong, Inc.
Notes below:
Halitosis is the medical term for bad breath. Interestingly bad breath has been discussed in most religions and cultures for centuries: Greek & Roman writers, Talmud, Islam, Book of Genesis.
Prevalence of halitosis is not known but it definitely is worst upon walking up from bed. One study showed only 20-40% of people suffer from morning breath and only 27% in China, but I think a lot of that is cultural. But it seems 25% of people who fear they have halitosis actually have halitosis (halitophobics)
There are a lot of causes of halitosis including the nasal passages, tonsils, mouth and throat. But it is the mouth that is the source of bad breath 85-90% of the time. That is why you should floss because usually comes from bacteria between the teeth. Also brushing is so key to clean the teeth but also the back part of the tongue. Bacteria metabolize amino acids and other products to produce smelly gases, in particular hydrogen sulfide and methylmercaptan. These volatile sulfur compounds (VCS) thrive on mouths low in carbohydrates, neutral to alkaline pH (meaning pH 7 or more) and lacking oxygen. Bacterial infections causing gum disease stink. Tobacco stinks up the breath.
Sinus infections and nasal smells are more cheese-like in nature, vs. the sulfur smells of the oral cavity. Nasal polyps can harbor smells, as well as other physical deformities (cleft palate, abnormal facial bones). Sinus infections can smell fishy. Those with allergies can have postnasal drip that accumulates on the back part of the tongue
Tonsils – how many people have told me they get white junk back there which they spit out. These small white particles (tonsilloliths) form in the crypts of the tonsils in about 7% of people. They consist of anaerobic gram negative bacteria, and that in turn makes the VCS which smell. But not sure if it really is a cause of halitosis though when spit out they do stink. Laser cryptolysis is a surgical procedure to close up the tonsillar crypts to prevent tonsilloliths, but controversy if it is worth doing this painful procedure.
Systemic illness can lead to halitosis: kidney failure, liver failure, bronchitis, pneumonia, cancers, metabolic dysfunction, biochemical disorders. GI disease usually isn’t a cause unless you burp a lot or have severe GERD. H. pylori, a bacteria associated with peptic ulcer disease, when found on the back of the tongue is associated with halitosis, but more studies need to be done if treatment is effective.
Cancer of the oral cavity, throat, nasopharynx can cause halitosis. People at risk for head/throat cancer are smokers and drinkers.
Other causes of halitosis include mouth breathers, being overweight, menstrual periods, garlic & onions (yummy though!!), but mostly poor dental hygiene and dental health. Garlic is exhaled which is why you can’t brush it totally away.
Diagnosis is difficult but machines are being made to measure the VCS levels. ENTs usually are the specialists who work on halitosis.
Treatment of halitosis vary by cultures: mastic, parsley, cloves, guava, and eggshells (though I would worry about GI infections from the last one). For most people it comes down to brushing and flossing everyday, clean the back part of the tongue, rinsing and gargling, eating fiber, brief gum chewing, and drink plenty of water. If there are allergies or infections, treatment of this. See the dentist (and possibly the periodentist) and ENT. But really there are no “bad breath” experts so watch out from being scammed.
