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Bad Breath: When Toothpastes and Mouthwashes Don’t Work
As a dentist I see many folks who still have an unpleasant breath odor even though their teeth and gums are healthy. In these cases the culprit is usually a bacteria which, although nonpathologic, produce a volatile sulfur compound (VSE). Normal brushing and flossing, even tongue brushing, just isn't enough to control this bacteria. They need something more.
If even over-the-counter agents such as Listerine® fail, you may need antimicrobial rinses and toothpastes. Your dentist can help. There are three main antimicrobial agents in use today: chlorhexidine gulconate, chlorine dioxide and herbal preparations. The dentist can help you eliminate oral causes of bad breath and make appropriate medical referrals where necessary.
Chlorhexidine gulconate is obtained at your pharmacy with a prescription. It is very effective but has two drawbacks:
1. Chlorhexidine can cause staining of teeth and dental work. The staining is temporary and polishes away easily but is enough of an aggravation that most folks will discontinue use.
2. Chlorhexidine rinses (as well as most over-the-counter rinses) contain a lot of ethyl alcohol. Current research indicates that chronic exposure of the mucous membranes to alcohol can be an increased risk factor for oral cancer. Also, the alcohol can dry the mucous membranes which may actually promote the growth of the odor-causing bacteria.
Chlorine dioxide is not dispensed at a pharmacy. In fact, chlorine dioxide is so safe that anyone can become a distributor. It is, however, highly effective against VSE's and the microorganisms which cause them. The Oxyfresh® rinses do not contain alcohol and do not stain teeth.
BreathRx® is an herbal line of products dispensed by dentists and some products are available at stores. The taste is strong, but not unpleasant. BreathRx seems to be very effective at elimination of VSE's and the bacteria which cause them. BreathRx products do not contain alcohol.
Treatment of Dental Causes
- Control of gum disease and decay
- Regular cleanings and check ups
- Frequent brushing
- Daily flossing
- Control of sulfur producing bacteria and VSE's
- Tongue scraping
- Antibacterial rinses and toothpastes
Non-Dental Causes
- Ingestion of Foods Such as Onion or Garlic -- These odors are actually pulled into the lungs where they can remain for hours. This is why the use of mouthwashes or breath fresheners after eating these foods are usually ineffective. However, in cases where food odors are the only cause, patients should find that their bad breath resolves in a matter of hours.
- Chronic Systemic Diseases -- Esophageal reflux, stomach ulcers, diabetes or even neoplastic diseases could cause bad breath.
- Chronic Inflammatory Sinus Disease -- Inflammation of the nasal and sinus mucous membranes can lead to growth of odor-causing bacteria resulting in bad breath. Diseases in the lungs or connecting passages could also certainly cause bad breath.
Dental Causes
- Infection of the Oral Cavity -- With the exception of food odors, infections of the oral cavity are by far and away the most common cause of chronic bad breath. This is so common that in cases where bad breath does not resolve quickly, or with the use of mouth washes, a trip to the dentist first is in order.
- Gum Disease and Decay -- Both decay and gum disease are caused by bacteria and can, obviously, cause bad odors. In fact, bad breath can often be the first symptom of these diseases!
- Sulfur-Producing Bacteria -- Some people who have healthy teeth and gums have, as a part of their normal oral bacteria, bacteria which produce sulfur compounds.
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