Fall | Winter 2013/14 7

According to The Journal of the American Dental Association,halitosis is a common condition found in at least 50 percent of the adult popu-lation, with 25 percent of that group having chronic bad breath. And, “90 per-cent of bad breath is intraoral in origin, meaning it comes directly from withinthe mouth,” says Dr. Jerry Smith, ODA President-Elect (2013-14) and a dentistin Thunder Bay, Ont.

You Could Really Use a Mint!Dragon breath, bromopnea, oral malodour, halitosis.

Regardless of what you call it,

we’ve all had it on occasion – bad breath.

�

By Jennifer D. Foster

Some common causes of bad breath

• onions • garlic • alcohol •

8 youroralhealth.ca

CausesThe causes of halitosis are vast andvaried. Here are the most common:

Sinuses and tonsils Oral malodour can be caused by “ma-terials trapped in tonsils as part of ournormal defence system,” says Dr. RickCaldwell, ODA President (2013-14)and a dentist in New Liskeard, Ont.And “if your gums and teeth arehealthy and your mouth is clean, thecause could be a sign of a medical dis-order such as chronic sinusitis or arespiratory tract infection,” states Dr.Smith. “Your dentist can evaluate theproblem and refer you to a medicaldoctor, if necessary,” he says.

Gastric issuesBad breath may also come from gas-tric reflux and gastrointestinal issues,says Dr. Smith. As Dr. Caldwell ex-plains: “Semi-digested food that isforced back through the gastricsphincter can contribute to halitosis.This can be a particularly bad issue inpeople who have difficulty digestingcertain foods, like lactose or cornproducts.” And, he adds, “some peo-ple who have been infected with He-licobacter pylori, bacteria that thrive

in the wall of the stomach, can have atendency to have more reflux ofstomach contents. These refluxedacids allow the bacteria that producevolatile sulphur products to thriveand, thus, create more bad breath is-sues.” Luckily, this is not a commonsource of bad breath.

Food and tongueSome more common causes are spe-cific foods (onions or garlic, anyone?),alcohol and tobacco, says Dr. Cald-well. “The most common reason isbacterial breakdown of residual foodcaught in and around teeth.” And,adds Dr. Ian McConnachie, a pedi-atric dentist in Ottawa: “there are bacteria that metabolize food sourcesand create volatile sulphur com-pounds in the mouth that are partic-ularly trapped in the crevices on thesurface of the tongue, more towardthe back. They are a major cause ofhalitosis.”

Dental causesPoor oral hygiene and a build-up ofplaque are other sources of halitosis,says Dr. Smith. Other causes are den-tal decay, periodontal disease and thebacterial by-products produced ingum disease.

Health conditions and medicationsXerostomia (dry mouth) can alsocause bad breath, says Dr. Smith.Saliva helps cleanse your mouth andremove particles that may cause mal-odours, so when saliva production isdecreased, halitosis can occur. Ac-cording to Dr. Smith, some medica-tions may also lead to halitosis. Dr.Caldwell agrees: “Antidepressants andantihistamines may have dry mouthas side-effects. And some analgesicagents, like codeine, ibuprofen andnaproxen, can also produce signifi-cant dry mouth in some patients.”Other health-related causes can in-

clude diseases producing volatileproducts released from the blood dur-ing breathing, according to Dr. Cald-well. For example, “there is a fruitysmell in the breath in undiagnosed oruncontrolled diabetes,” he says. And,kidney disease can cause an ammonia-like or fishy-smelling breath, whileliver and lung disease can also producebad breath as a result of the chemicalsproduced.

Fall | Winter 2013/14 9

How do I get rid of bad breath?Treatments may vary from thestraightforward to the more complex. • A simple way to help keep halitosisat bay is to drink plenty of water.Keeping your mouth moist inhibitsthe growth of bacteria that con-tribute to bad breath in cases wherethe cause is food that is trapped inthe mouth. How? “Extra waterflushes away more food, so there’sless material for the bacteria tobreak down,” explains Dr. Caldwell.

• Regular dental cleanings, as well asthorough daily home care, are alsoeffective preventative measures.And it’s especially important tobrush the tongue, advises Dr. Mc-Connachie, because of all the mal-odour-causing bacteria thataccumulate on it regularly. But, ifdaily home care and regular dentalcleanings don’t solve the problem,“an oral examination, done by adentist, will identify areas of infec-tion or disease inside the oral cav-ity,” advises Dr. Caldwell.

• And “if the smell is coming fromareas of decay, restoration of the of-fending tooth/teeth is helpful,” hesays. “This could vary from a sim-ple restoration to root canal treat-ment, depending on the condition

of the damaged tooth. In cases ofgum disease, professional cleaningand any of a number of comple-mentary therapies, includingchlorhexidine rinses, certain med-ications and the use of an oral irri-gator, would be helpful.”

• For those with xerostomia, Dr.Caldwell says chewing sugarlessgum may be helpful to stimulatesaliva flow. But, he says, “some syn-dromes just don’t allow one to pro-duce saliva, and that’s whereartificial saliva might be helpful.”

Medical referralsIf you have any questions or concernsabout halitosis, its causes or treat-ments, don’t hesitate to see your den-tist. “He or she is an oral-healthdoctor, and if the cause is not intra-oral, than a referral to a medical doc-tor may be needed,” advises Dr. Smith.Dr. Caldwell concurs regarding anevaluation: “The oral cavity and thesmells detected can reveal a medicalproblem requiring treatment by aphysician.”

The bottom line? “Don’t ignore badbreath,” says Dr. Caldwell. “On occa-sion, it’s a sign of something more se-rious and, like most illnesses ordiseases, the sooner it is diagnosedand treated, the better the long-termprognosis,” he says. “Most of thetime, however, it’s minor and easilytreated by the dentist and his or herteam.” Now, that’s a breath of freshair! �

Visit youroralhealth.ca

for more tips for

fresh breath.