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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.
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 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. Stabilized chlorine dioxide has the ability to reduce
VSCs and although the company making these products does not
claim it will help cure gum disease, I personally have observed
it help my patients with gum infections. Another product which
can help with reducing collagenase activity in the gum tissues is
the drug Periostat. You can get information on that product and a
very good explanation of periodontal disease by going to their
web site..
Additional help with flushing out bacteria can be accomplished
with special ionizing mechanical irrigators, which automatically
pulse water with an electric charge, 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 cannot feel the
electric charge. The patient needs a dentists or hygienist to
help teach them how to do this. The ionized water helps cause the
roots of the teeth to attract less plaque. Adding the stabilized
chlorine dioxide and zinc acetate 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
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.
4. The best home method for checking your halitosis is the small test kit called the Halitox test (ALT, Inc), which stands for Halitosis Linked Toxin. The kit is a small test tube of harmless bio-chemicals which will turn yellow brown when you place some cotton tipped applicator of tongue scraping into the vial. The cost is $19.95 plus $4.00 for shipping and handling for a package of two test vials to: Richard Downs DDS, 3430 Dodge Street, Dubuque, Iowa 52003. Be sure to include the address to ship it to.
Proper use directions for use of Halitox include. 1. Use one of the swabs in the kit to rub on the back of your tongue. 2. Place the cotton swab into the vial. 3. Wait about 30 to 45 minute and check the color change with the chart that is included with the kit. The density of the color change will indicate the level of sulfur compounds and polyamines on the back of the tongue. These are the most common causes of bad breath.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 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 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 slightly acidic pH to prevent bad breath.
Peroxide is also ineffective 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. 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 primarily bacterial killing but instead the preservation of natural bacterial balance and then oxidizing, (not oxygenating), 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 and zinc ion therapy contained in the products I recommend. 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 25%. Alcohols can be harmful and I strongly urge consumers to stay away from them. They certainly can make bad breath worse
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. 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 physicians help but these products can still be of some help to these individuals. But remember again, the vast majority of halitosis comes from the mouth.
Bad breath or halitosis can be a serious handicap on your social or business life. It is a source of embarrassment and shame. However, you no longer have to let halitosis 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.
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. These tonsilloliths can also be treated with limited success by the use of the hydro magnetic 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
hydro magnetic irrigator. That machine 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 rinse with zinc acetate in the water holder on the machine and get both the effect of the water blast and also the stabilized chlorine dioxide to deodorize the area. In the section of this ABS site called "Causes and Treatment" you will see a reference to this irrigator and the other 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
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 stabilized chlorine dioxide toothpaste, as I instructed people with teeth to do. Use the tongue scraper daily. Rinse the mouth with zinc mouth rinse for at least two minutes. Clean your dentures with a denture toothpaste or stabilized chlorine dioxide toothpaste and then place them in a container submerged in Full Strength Zinc rinse or the Multiuse Deodorizer for four hours. The later mentioned liquid usually used to deodorize the house and is safe for soaking dentures. It has a high level of stabilized chlorine dioxide.
After rinsing off your dentures, place a thin film of gel (non-fluoride gel) on the tissue contact side of the dentures and place them into the mouth. This aloe vera and stabilized chlorine dioxide gel will 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. The gel will help allot.
Digestive enzymes become more important as we get older because the production of these enzymes decrease as we age. Digestive enzymes are also completely destroyed in all foods that are cooked. If digestive enzymes are lower than normal, our bodies must divert nutrients to make digestive enzymes that would ordinarily be use to make intracellular enzymes such as catylase and SOD, which protect cells as antioxidants. This lowers antioxidant protection. Lower digestive enzyme levels also upset body pH balance causing us to be more acidic, thus more prone to disease and weight gain. Lower digestive enzymes can lead to excess gas formation and putrefaction in the intestines. For some people this can contribute to bad breath gases traveling through the blood stream to the lungs and exhaled. This is not a large contributor to halitosis in most people.
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. Zinc 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.
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.
Fiber Cleanser is a product with Cascara Sagrada or sacred bark, fiber and digestive enzymes and is commonly used to treat chronic constipation and as a nutritional supplement to support the colon, gallbladder and digestive system. It is a source of fiber, digestive enzymes, vitamin A, Vitamin B2, vitamin B5, calcium, magnesium and potassium, company literature states that natural properties found in Cascara Sagrada 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.
Basic Care
Intermediate Care (If you purchased the hydro magnetic irrigator
Advanced Care for Those With Gingivitis, Periodontitis and Severe Halitosis (Take your Intestinal cleanser, enzymes and antioxidant food supplements if the doctor has prescribed them to 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:
