Bad Breath

Halitosis is a common problem with many causes. This vexing problem can be broken down into three main sources, the determination of which is needed in order to resolve.....external, intraoral, and extraoral.

Causes of Bad Breath

External Causes - This is the most widespread cause of transient bad breath. Many foods and drinks can cause mild to severe halitosis (garlic, onions, cheeses, alcohol, etc,). Most people are aware of these culprits and they cause little chronic problem. Smoking is a real breath killer, which can only be controlled by quitting.

Intraoral Causes- The mouth itself is by far the most common source of halitosis. The culprits here are bacteria producing volatile sulfur compounds (VSCs). These bacteria are found throughout the mouth but are most common on the surface of the tongue and in the tissue pocket below the gum line adjacent to each tooth. These bacteria thrive with poor oral hygiene and gum disease states (periodontitis and gingivitis). Dry mouth conditions can aggravate halitosis as well.

Extraoral Causes- Many medical problems can have bad breath as a side effect. These include but are not limited to diabetes, gastric reflux, sinusitis, tonsillitis, liver disease, colds, lung disease, and esophageal disease.


Controlling the mouth bacteria that produce VSCs is the key to tackling halitosis.

The CariFree System is quite effective at reducing VSC producing bacteria as well as preventing and treating tooth decay. Many patients report experiencing much fresher breath while using these products. The Treatment Rinse seems to be particularly effective. There also are CariFree products to help dry mouth sufferers. These products can be ordered directly online.

Regular dental care is paramount to controlling bad breath, as halitosis will never disappear in the presence of periodontitis or tooth decay.

Once periodontal contributors are controlled or ruled out, an effective daily oral hygiene program is simply the only way to control most cases of bad breath. The steps below must be performed every day...

Brushing Properly- Proper tooth brushing involves not only removing the plaque from all tooth surfaces, but also gently cleaning below the gum line as well. Many newer toothbrushes are designed to do this, but it has been my experience that most patients have neither the dexterity nor the patience to perform the dental gymnastics required. Electric brushes are a simple and effective solution (The Braun Oral B or Sonicare are good choices). These gismos are far superior at plaque removal in the hands of most people, particularly below the gum line where VSC producing bacteria hide and thrive.

Flossing Properly and DAILY! - Halitosis will never go away without daily flossing. It also must be done effectively, getting below the gum line and removing the plaque hiding there. The gum pockets between the teeth are the second largest reservoir of VSC producing bacteria, after the tongue. Have your dentist or hygienist coach you in proper technique at your next check up. If other interdental cleaning devices have been recommended to you (proxabrushes, stimudents, etc.) be sure to use these daily as well.

Tongue Cleaning- Simply brushing the tongue is not enough. You must clean your tongue with a proper tongue-cleaning device. Many of these cleaners be found at drug stores or dentist's offices. These tongue cleaners are designed to scrape the plaque from the tongue instead of brushing. In addition they remove the outermost layers of dead skin (think exfoliation!). This tissue contributes to bad breath both through its own breakdown and that it makes a great environment for the VSC producing bacteria. It is also important to clean as far back on the tongue as possible. This is achieved by sticking the tongue out as far as possible while scraping.

Mouthwash- A good antibacterial mouthwash after the above hygiene practices helps kill the remaining VSC producing bacteria and slows their regrowth. Listerine and generic equivalents are perfect for this. For more resistant cases the prescription mouthwash Peridex works even better. The mouthwash should remain in the mouth for a minute if possible, thoroughly swishing between the teeth, over the tongue, and a bit of a gargle in the throat. Some newer formula mouthwashes claim to be able to breakdown VSCs and may also be helpful.

If the above regimens are strictly followed and no resolution of the halitosis is achieved, a medical consultation would be prudent to look into possible medical causes. The great majority of bad breath is caused by bacteria in the mouth, but medical causes play a role in a significant number of cases.

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