Bad breath plagues just about everyone at one time or another. People snicker about it, but bad breath can be a devastating social disability. More than a few people have been denied employment, failed in business and relegated to low social status because of it. This page is presented so that you, the reader, can begin to sort out the cause of your problem, and decide on a course of treatment.
The first, rather short section of this page will help the reader to focus on the specific cause of their problem. Even if you narrow the focus of your problem to one area, however, it may be wise to read the other sections in order to fully understand the scope of the problem and to rule out the possibility that your bad breath stems from multiple causes.
There are essentially four sources of bad breath:
Nearly 90% of all cases of bad breath originate from the tongue. The next largest category is odor originating from the gums, especially if the gums are red, swollen and bleed easily. By properly cleaning all the structures in your mouth, most people reading this article will eliminate the source of their problem!
These structures include the the top surface of the tongue, (especially the very back of the tongue), the teeth, and the gums. Since this type of bad breath is the most common, its diagnosis and treatment will be covered extensively.
The term for odors from the mouth is Fetor Oris (not halitosis)___Fetor means "a strong offensive smell" and is a generic term. Oris means "from the mouth". Fetor oris is a strong 0ffensive smell originating specifically from the mouth.
If you are young and generally healthy, the chances are good that your problem falls into this category. Learning how to properly clean your teeth and most importantly, your tongue, will most likely cure you of the problem.
The structures in the mouth that can harbor bad breath are:
The tongue (especially the back of the tongue)
This includes the nasal cavities, sinuses, throat, tonsils and the larynx (voice box).
The term for bad breath from the upper respiratory tract is ozostomia
Ozostomia is the second most common type of bad breath, and is most commonly associated with post nasal drip, but can be associated with infections of the various organs in the upper respiratory tracts as well, including sinusitis, sore throat and laryngitis.
Bad breath originating from the lungs is either a temporary phenomenon caused by consuming certain foods or drugs, or it is a chronic problem caused by disease processes.
Stomatodysodia is the term for bad breath caused by outright disease processes in the lungs, such as various infections, emphysema, bronchitis or lung cancer.
Halitosis is the term for bad breath that results from:
1. Physiologic processes elsewhere in the body and carried to the lungs by the bloodstream
2. Odors originating in the stomach and caried to the mouth by vomiting
80% of all bad breath originates from bacterial overgrowth within, or upon structures in the mouth. If you are young, healthy, and do not suffer chronic sinusitis, tonsillitis or laryngitis, chances are good that this section is the most relevant to your problem.
When someone has bad breath caused by structures in the mouth, the chemicals you actually smell are sulfur compounds created by anaerobic bacteria. Anaerobic bacteria grow in the absence of oxygen and they most easily colonize areas where there is some mechanism to limit exposure to oxygen. As a class, the chemicals these anaerobes produce are called Volatile Sulfur Compounds (VSC's), and they include such beauties as hydrogen sulfide (rotten egg smell), methyl mercaptan (smells like rotten cabbage, and is the chemical added to natural gas to give it a recognizable odor) and dimethyl sulfide (smells like decayed vegetables). There are over 400 types of bacteria found in the average mouth. Several dozen of these can cause bad breath when allowed to flourish. They metabolize proteins such as dead tissue cells, blood and mucous. Proteins are made from building blocks called amino acids, and the digestion of these amino acids supply the bacteria with energy. Some of the amino acids contain sulfur, and these sulfur compounds are converted to VSC's as a waste product.
A healthy mouth contains many different kinds of bacteria. In any given part of the mouth, they establish a sort of balance between the competing species of bacteria depending on the conditions there. A healthy mouth does not smell bad because the conditions in all parts of it encourage a balance of bacteria that does not cause odors. We call a healthy balance of bacteria a normal flora, or a "normal floral pattern". There is a very wide range of floral patterns which are healthy. Everyone has a slightly different floral pattern. But when conditions in any area of the mouth change due to disease or other factors such as dehydration or the presence of fermentable substances such as blood, dead cells and shreds of food, the balance of bacterial species shifts, allowing the overgrowth of anaerobic bacteria at the expense of the rest of the normal floral organisms. Thus odors begin to emanate from that area due to the production of VSC's.
Before discussing the actual structures of the mouth that must be treated in order to cure fetor oris, It is necessary to understand that there are several chronic or temporary conditions can shift the balance of microbial flora toward an overgrowth of the bacteria which produce VSC's:
This is the technical term for dry mouth. Dry mouth dehydrates and concentrates the layers of salivary protein and mucous that coat the structures of the mouth. This concentration of mucous, saliva and food detritus makes for overgrowth of all sorts of different bacteria in different parts of the mouth. In some areas of a dry mouth, anaerobic bacteria overgrow and produce serious amounts of volatile sulfur compounds. Other areas favor the overgrowth of aerobes which produce their own volatile waste products which can smell and taste nearly as bad as the vsc's produced by the anaerobes. The most common type of bad breath caused by dry mouth is morning breath, which is a result of breathing through the mouth while sleeping. Some people tend to develop chronic dry mouth due to conditions such as Sjögren's syndrome. Elderly people are also prone to dry mouth due partly to the ageing process, but mostly to the numerous drugs they consume which tend to cause dry mouth.
Certain drugs tend to cause dry mouth and thus are a prime cause of chronic bad breath. These include both prescription and non prescription drugs as well as both legal and illegal drugs.
Prescription and over-the-counter drugs that cause dry mouth include, but are not limited to:
antihistamines(the older types like Benedryl)
antidepressants (old style types like Elavil, Flexaryl etc)
anticholinergics (often used as decongestants as well as surgical drying agents like atropine and scopolamine )
anorexiants (diet pills)
antihypertensives (blood pressure meds),
antipsychotics (psychiatric drugs)
diuretics ("water pills")
Some drugs actually cause Halitosis (odors not originating in the mouth, but resulting from metabolic processes elsewhere in the body). Recovery room and operating room personnel can all attest to the incredibly bad breath (originating from the lungs) exhaled by patients recovering from general anesthetic agents after operations. Phenergan is an antihistamine used as a sedative and to control nausea and vomiting in patients recovering from the DT's (Delirium Tremens caused by chronic alcohol addiction). Patients on this drug have a halitosis which can permeate entire hospital wards. Note that this type of bad breath is temporary, and only happens during sedation. It is not permanent since once the drug has left the bloodstream, the odor stops.
Illegal recreational drugs may also cause chronic dry mouth and thus are a source of bad breath.
Illegal drugs have the added liability of lifestyle issues which interact with the dry mouth and make the bad breath much worse. Addicts and other recreational users often neglect their oral hygiene and use huge amounts of sugar leading to massive tooth decay. In addition, poor oral hygiene combined with poor nutrition causes gum disease. Both of these conditions are major causes of bad breath.
The drugs most likely to cause problems in this category are the metabolic stimulants: Cocaine, Crack, Ecstasy and Methamphetamines.
Heroine and Marijuana are not metabolic stimulants, however they predispose users to high sugar use and poor oral hygiene, and thus are associated with bad breath due to tooth decay and periodontal disease. For much more on the way drugs effect your mouth, click here.