ABS - Causes & Treatment

Bad Breath

Bad breath or halitosis has been a problem for mankind since the beginning of most of recorded history. Never before have there been effective treatments for this condition until now. Most people will notice the advertising media is saturated with products promoted to help with this condition. Most, if not all of them, really do not work very long and some make the problem worse. Alcohol based mouthwashes can, for example, dry out the tissues in the mouth and cause the tissues to secrete plasma proteins which worsen the condition over time. Odors coming from the stomach are almost never the cause of chronic bad breath. It is estimated that nearly 60 million people suffer from chronic halitosis in the United States. It is also estimated that nearly ten billion dollars a year are spent to treat the condition; most of it wasted.

It is estimated by many experts in the field that 85% to 90% of the bad breath conditions come from sources in the mouth. It is not correct to say that it is primarily caused by gum diseases as some will tell you. Gum disease can be and is a significant cause of halitosis for many but recent research has confirmed that the vast majority of bad breath originates from accumulated bacterial plaques and food coated on the back of the tongue. Since significant numbers of patients can have gum disease as a contributing factor to halitosis, it is important that a dentist diagnose a person’s condition to see if that is the cause. Not only is professional treatment needed but a person can improve the resistance of their mouth to gum disease by applying the advice given by their dentist or hygienist and by taking and using the products they recommend for your care. Controlling gum disease may also improve the health of your heart, kidneys and help prevent pre-term births for expectant mothers.  These bad breath gases (VSCs) are not just offensive but are actually toxic and can promote the body's production of inflammation and a protein called high sensitivity C-reactive protein (hs-CRP) known to be a promoter of heart disease and blood clots.  

With the help of a gas measuring machine called a Halimeter dentists and other health care providers who possess the machine and know how to use it can measure gases coming from the putrefaction of bacteria in the mouth called volatile sulfur gases or VSCs. These are compounds containing sulfur and include hydrogen sulfide and methyl mercaptan, the two most plentiful bad breath gases in human exhaled air. Hydrogen sulfide is the "rotten egg" smell. With this machine health professionals can more easily locate where the gases are coming from and can see if the measurements are actually decreasing over time with treatments.  Other gases (VOCs) or volatile organic compounds) that can cause bad breath are the polyamines such as putrescine and cadaverine.  

The usual treatment of the condition includes the use of compounds containing some kind of chlorine dioxide or combination of chlorine dioxide and chemically altered forms of oxychlorine species and also some use zinc compounds. The VSCs are then chemically changed into harmless compounds with no odor by the use of toothpastes and mouth rinses containing those oxchloride species. Treatment should also include tongue scrapping with specific instruments to remove the coating of white plaque. This not only removes the odor causing agents but lowers the overall bacteria count in the mouth which can have positive effects on the health of the gum tissues.

If periodontal disease is present as a cause, some of the pockets around the teeth must be cleaned out to rid the source of bacteria putrefaction causing odor and disease there. The periodontal disease must be treated by a dentist or periodontist. Support for this treatment may include suppression of bacteria induced collagenase enzymes which destroy collagen in the gum tissues. I believe that can be helped by removing the VSCs in the gum tissue.  Chlorine dioxide products have the ability to reduce VSCs and although the companies making these products do not claim it will help improve gum disease, I personally have observed it help my patients with gum infections. You can get information on these products from the Dentist Select web site at www.dentistselect.net .

Additional help with flushing out bacteria can be accomplished with mechanical irrigators, and the use of fine tipped canulas attached to the irrigators can be placed into the pockets around the gum to rinse them out.  The patient needs a dentists or hygienist to help teach them how to do this.  Adding the active chlorine dioxide rinses to the water adds even more effectiveness to this irrigation.

For more information please e-mail us or click on the United States map to locate a health professional who treats breath disorders nearest to you.

Richard D. Downs DDS

Bad Breath Self Examination

Do I have bad breath and how would I know? Many patients have asked me this question. They want to know how they could find out if they have bad breath before it is revealed to them by someone they love or work with. Even more embarrassing, is the thought that they would have offended someone with their breath and not know they offended them. The problem is, we are almost never able to smell our own bad breath because of a phenomenon called adaptation in which the olfactory (sense of smell) nerves in the nose become accustomed to our own smell. When this happens only those we interact with can let us know the problem exists or a dental professional can let you know about how much bad breath gases from the volatile sulfur compounds exist in your breath with a machine called a halimeter. Not all dentist have this diagnostic machine but more are adding it to their diagnostic equipment every day.

Four simple methods to help you test yourself for bad breath are as follows: 

1.  First take a piece of un-waxed, un-flavored white dental floss and floss between your upper and lower back molars. Examine the floss. Is it red or brown? Wait about 45 seconds and then smell it closely. Does it have a bad odor?

2.  The next test is to take a clean washcloth and then pull your tongue forward with one hand grasping the tongue with the washcloth. With the other hand and a clean white washcloth rub or scrape the furthest back portion of your tongue two or three times. Again, wait for about 45 seconds and then smell the portion of the cloth that was rubbed on the tongue. Does it have a bad smell?

3.  A third technique is to simply lick your tongue on your own clean wrist. Wait, then smell. This technique does not get back far enough on the tongue to be of best value but can be a quick test in a pinch for time.


What Causes Bad Breath Really?

Many products have been marketed for the treatment of bad breath. These products include;

which only temporarily treat the problem. What is not known about bad breath is that it is more than a simple annoyance. Bad breath most often starts at the back of the tongue and this huge accumulation of plague can affect the health of the gum tissues. Gum disease can also be a cause of bad breath. In minor cases, products such as mouthwash or toothpaste might help, but in most cases, this is not enough and can make the problem worse.

Although baking soda does kill some oral bacteria and inactivates acids, acids are not the problem in the depths of a periodontal pocket nor at the deeper layers of the bacterial plaque on the back of the tongue..  In the pocket and at the deeper layers of the bacteria at the back of the tongue where bad breath comes from,  the pH is alkaline, not acidic.  Neutralizing the acid on the surface of the bacterial plaque of the back of the tongue with baking soda serves to make the plaque more alkaline.  The baking soda does not reach the deeper layers of that plaque on the back of the tongue to do any killing.  The mild bacterial killing of baking soda in the gum tissue can be useful, but baking soda is not something I recommend.  It pushes the mouth into an alkaline pH, which is the opposite direction one wants to put the pH to prevent halitosis or gum diseases, which thrive in this basic and putrefactive environment. The mouth must have a neutral or slightly acidic pH to prevent bad breath.  Too acidic pH in the saliva might indicate too much plaque again and a tendency toward tooth decay.   The pH of the mouth is a complex and dynamic process and has no relation at all to the pH of the blood.

Peroxide is also less effective  in preventing halitosis.  Peroxides are oxygenating agents which can produce harmful free radicals and have been of concern to some health professionals when used for long periods of time in the presence of chronic inflamed tissue. It can promote the over growth of yeast infections in the mouth. Gum tissues are usually chronically inflamed and therefore are susceptible to negative effects of peroxides which can cause adverse cell changes to occur. Peroxides are also too quickly inactivated to do any antibacterial work at the concentrations they have in toothpastes.  The approach I tend to favor in treating halitosis and gum disease is not only bacterial killing but also the removal of  the VSCs that cause the odor. These VSCs  also increase the permeability of the gum tissue pocket lining promoting bacterial invasion.  I recommend oxidation of VSCs by chlorine dioxide contained in the products I recommend. In the more severe cases, I again recommend bacterial killing with active chlorine dioxide.  There are no other rinses I know of that both kill bacteria that cause bad breath but also inactivate the bad breath gases themselves than the chlorine dioxide compounds contained in Oracure from Dentist Select.  I therefore believe three of the ingredients that should NOT be added to toothpastes and mouth rinses are baking soda, peroxide and alcohol! Unfortunately, almost all major toothpaste and mouthwash makers are jumping on the misguided baking soda and peroxide band wagon. Some of the mouthwashes contain very high levels of alcohol, from 8% to 26%. Alcohols can be harmful and I strongly urge consumers to stay away from them. They certainly can make bad breath worse. They have also been shown to weaken and discolor cosmetic veneer cements, white fillings, crowns and onlays.

Smoking too can make bad breath worse. Smoking and chewing tobacco dry out the mouth and again produce adverse tissue dryness and plasma secretions which are broken down by bacteria into volatile organic compounds. Anything which dries the mouth can promote bad breath, including some prescription drugs, alcohol consumption and some systemic diseases like sjogrens syndrome and glandular diseases. Dry mouth can be caused by sinus congestion and nasal blockages. Rhinitis and nasal drainage also cause bad breath. Even dieting and diabetes can cause odor. These types of problems may require a physician's help but these products can still be of some help to these individuals. Remember again, the vast majority of halitosis comes from the mouth.

What Can Be Done?

Bad breath or halitosis can be a serious handicap on your social or business life. It is a source of embarrassment and shame. Bad breath cannot be cured. It can be controlled. However, you no longer have to let bad breath affect your lifestyle. Using the latest technology, researchers have developed the halimeter, a device that can actually measure the extent of your halitosis problem. This instrument along with the organoleptic test (smelling your breath with the nose), can quantify the bad breath gases so that the doctor can determine if the treatment is reducing the odors over time. Halimeters are a help to diagnosis but cannot take the place of the actual smelling of the breath in diagnosis and treatment. Some dentists also use a culture test for bacteria and others will use a microscope to help identify which bacteria are causing your problem. Not all these techniques need to be used to properly diagnose and treat a person.

Odors Coming From the Tonsils

Even though most odors come from oral causes, there are some who have odors coming from the tonsils and sinus areas. Many of those who write to me have expressed a need for information and treatment about tonsils with deep indentations in them which get filled with food and plaque that harden into a very foul smelling ball which is almost stone-like in some. These are sometimes cause by a condition called chronic cryptic tonsillitis and should then be addressed by an otolaryngology physician. Sometimes chronic cryptic tonsillitis must be treated by surgical removal of the tonsils.   Some otolaryngologists have used a laser to close these crypts and smooth the tonsils so that the crypts are no longer so deep and harbor less bacteria.  This has helped some people. Most of the time these tonsilloliths are not associated with chronic cryptic tonsillitis.  They also are usually not the cause of bad breath..  These tonsilloliths can also be treated with limited success by the use of the water flosser irrigator. Below is a typical letter from a patient who suffers from such a condition and then the response I wrote back to him.

Please be advised that I have found quite a number of patients who have had their tonsils removed by physicians for this and other bad breath problems. I have not had anyone who has had tonsils removed for bad breath report to me that it has helped.  I am sure it may have helped some, even though I have not heard any patient say so yet.  Removal of tonsils is usually NOT indicated in trying to improve bad breath and is a dangerous and unnecessary operation for most people.

The following is an inquiry from California:

I was wondering if anyone has looked into the tonsils as a factor in bad breath. It seems that food particles get trapped in the tonsil crevices. The particles remain there for who knows how long. The particles seem to harden, and take on an awful odor. This is detected when one of the particles comes loose - sometimes after a cough or gag. The taste and smell of these particles is awful. Even my six year old boy coughed one up the other day. He removed several mushy particles from his mouth and was concerned because of the terrible taste and smell. I recognized it immediately as the stuff that gets trapped in the tonsils. Why haven't I heard any of these studies mention this problem? Not even the recent TV story on the subject. Surely, numerous people have encountered this problem. I would think it has to be a contributing factor in bad breath. If so, what if anything can be done about it? Thanks.

The response is:
Yes, these have been known about for a long time and some people have a problem with them such as yourself. Most people do not. They can be helped by some people with a water irrigation machine such as the Water Pik irrigator or Hydrofloss. These machines pulses water and can be directed to blast out the crypts in the tonsils. Not all these crypts can be seen and irrigated.  Even better, one can place the anti-halitosis Oracure Oral Cleanser in the water holder on the machine and get both the effect of the water blast and also the chlorine dioxide to deodorize the area. In the section of this ABS site called "Causes and Treatment" you will see a reference these products. You can click on those product words which will show you a picture of the products.  Most of the time these tonsilloliths do not cause bad breath and can be left alone.

Richard Downs

Odors and Dentures

A number of Internet writers have asked about how those who have dentures can control the odors. This is an important question because many people have strong odors with dentures. Not only do the dentures themselves tend to get bacteria and organic material in the microscopic pores and spaces between denture base and teeth, but the denture surface that is in contact with and holds the denture to the lower jaw or roof of the mouth can collect a great deal of bacteria, yeast, fungi, food particles and shedding cells from the tissue surface. These break down into the volatile organic compounds, (VOCs) which are very similar to the bad breath compounds that people with natural teeth have.

I recommend people with dentures leave them out of the mouth for at least four hours each day. In addition to that, brush the roof of mouth, cheeks, gums with sodium chlorite based toothpaste, as I instructed people with teeth to do. Use the Halicure tongue scraper daily. Rinse the mouth with Oracure mouth rinse for at least one minute. Clean your dentures with a denture toothpaste or chlorine dioxide toothpaste and then place them in a container submerged in Oracure for 15 minutes.  

After rinsing off your dentures, place a thin film of rinse on the tissue contact side of the dentures and place them into the mouth. This rinse wiill not only hold down odors by oxidizing them, but will also help to heal wounds and sore spots under the denture and help prevent the growth of bacteria, yeast and fungi under the dentures. If you have red tissue under your denture, you may have a fungal infection and this can cause odor and soreness. You should see your dentist to get a proper diagnosis. If you do have a candida infection, active chlorine dioxide will help.  Not only should your rinse with it but place the denture in the liquid to kill the fungi on it.  The Oracure rinse will help allot when placed in the denture just before placing in the mouth. .

Digestive Enzymes and Nutrition:


Pro biotics and digestive enzymes can have a positive effect on bad breath by allowing us to have better gum tissue health and also properly digest foods that enter our blood stream and can enter our lungs with different odors. Antioxidants such as vitamin C and Co Q10 are also good for gum tissue health.  A diet high in sugar is not only bad for teeth and gum tissue but will eventually contribute to bad breath.

Foods such as garlic and onions have highly volatile odors which can be passed directly through the lining of the intestine into the blood stream and exhaled air. Digestive enzymes will do nothing to stop these odors. The only way to control them is to not eat these types of food. Oracure rinse will eliminate the odors on hands (if poured on them) and the surfaces of the mouth, but will not help with the odors coming from the lungs. Pro-biotics become more important as we get older because the production of these bacteria decrease as we age. 

Some people have found that the elimination of all dairy products can help with the control of bad breath odors. A few others have found the elimination of all soy products to help. Diary products can thicken mucous in the mouth and contribute to the anaerobic environment bacteria love in producing VSCs. It also supplies lots of protein used in the breakdown by bacteria to VSCs. Some people are lactose intolerant. Some are gluten intolerant, which is found in wheat products. These intolerances should be confirmed by testing from a physician. It is important that all people interested in halitosis control and good health drink a great deal of water to wash away thick mucous and bacteria and to keep the mouth flowing freely with saliva. This decreases mouth pH and increases oxygen, both of which help control halitosis.

A fiber supplement and cleanser product with Cascara Sagrada or sacred bark, fiber and digestive enzymes is commonly used to treat chronic constipation and as a nutritional supplement to support the colon, gallbladder and digestive system. A source of fiber, digestive enzymes, vitamin A, Vitamin B2, vitamin B5, calcium, magnesium and potassium can stimulate secretion of digestive fluids, increase the flow of bile and cleanse the intestine. It has been used to help support treatment of sluggish gallbladder, digestive problems, enlarged liver, intestinal parasites, jaundice, colitis, hemorrhoids and a variety of skin problems.

Patient Home Care Instructions (Twice Daily)

Basic Care

Intermediate Care (If you purchased the the mechanical water flosser

Advanced Care for Those With Gingivitis, Periodontitis and Severe Halitosis (Take your Intestinal cleanser, enzymes, probiotics and antioxidant food supplements if the doctor has prescribed them to you.  You should use active chlorine dioxide like Oracure.) (Active chlorine dioxide and stabilized chlorine dioxide are not the same thing. Make sure you are using the active form.  You will know this if you have only one bottle of rinse instead of two.  Active chlorine dioxide must be mixed each time you use it. It is in a two bottle system only)

Let the American Breath Specialists help you!

At the American Breath Specialists we can help! By following our simple program we accurately diagnose and can therefore successfully treat chronic halitosis. Our program contains:



Dr. Richard Downs 1996. Last updated 4-26-2010