We've all found ourselves chatting with someone whose bad breath could strip the skin from Superman's face. And, let's face it, we've all been on the other end of things where everyone in a ten metre radius seems to be unaccountably losing consciousness. In my own case, this tends to be after I've had a drink or two and it's easy to convince myself that people are collapsing in joyous response to my urbane wit (okay, maybe after more than two drinks).
The important point is that if we're aware of the problem, we can do something to cure it and make ourselves healthy again - and if we understand the causes of the problem, we can do the RIGHT something.
Essentially there are two types of halitosis (bad breath): short term and chronic (long term). (Get used to the brackets because, considering how much they annoy me, I do seem to use quite a lot of them)
Short term halitosis is caused by food and drink. I'm not talking about garlic or curry, which have aromas that don't know when to pack up and leave you in peace; I'm talking about things like coffee and cheese, which leave behind a rotten smell which is nothing like that of the original substance. So if you dunk lumps of cheese in your coffee, you have a problem - in more ways than one! (Sorry about the exclamation mark! I hate! exclamation! marks even more than brackets! but I didn't want anyone thinking there's a dangerous medical condition characterised by repetitive cheese dunking - although there might be!)
Chronic halitosis is caused by one or more of the following:
1. Poor oral hygiene - leading to food stagnation, plaque accumulation, tooth decay, gingivitis (gum infection) and periodontal disease (really bad gum infection causing loss of the bone that supports the teeth).
2. Persistent habits or behaviour such as smoking or dieting.
3. Post-nasal drip (catarrh)
4. General medical conditions
And I've got to tell you, Numbers 1 and 2 are way, WAY out ahead of 3 and 4. If you have chronic bad breath, the overwhelming odds suggest you are either not keeping your mouth clean enough or you are doing something to harm yourself. That, of course, is bad in one way but good in another because you can do something about it - if you know what to do.
By the way, while I'm smugly pontificating about harming yourself, let me bring your attention back to the part about bone loss in the list above. You've probably already worked out that if you lose enough bone, your teeth become loose. Lose enough bone and your teeth fall out, or become such a nuissance that you want them extracted. In the human body, nothing bad exists in isolation.
As this is a self-help piece and both post-nasal drip and general medical conditions require professional intervention, I won't go into them here. If you are meticulously doing everything I'm about to suggest and you still have a problem, see your dentist or your GP pronto.
ORAL HYGIENE ISSUES
Let's presume the odour is coming from within your mouth, rather than through your mouth from somewhere else. There are three possible sites:
1. Your gums
2. Your teeth
3. Your tongue
Gums
People talk about gum disease as if it were something you might catch if you're unlucky - like flu or Ebola virus. Sorry, but that's not how it is. In the vast majority of cases, if you have gum trouble it's because, over a long period of time, you haven't been doing something that you should have been doing. None of us likes to take the blame for our own shortcomings and would rather explain that we were late for work because an alien mothership vaporized the bus, than apologize because we couldn't be arsed to get out of bed this morning. Well, you might as well blame a bad hair day on 'computer problems'.
Healthy gums are firm, pink and stippled, like orange peel (apart from the 'pink' bit, which would tend to denote an unhealthy orange). So if any areas of your gums are squishy, red or shiny, you have a problem. Bleeding is another danger sign of gingivitis. Despite what some people might tell you, healthy gums are no more likely to bleed than are, say, eyes or nipples. No-one, outside of an action movie, would ignore blood pouring down their face or soaking through their shirt, but inside the mouth it's less visible, and it gets diluted by saliva and swallowed. It's easy to forget about this blood because it's not in your face (although, of course, it is literally in your face).
Okay, as you've probably gathered by now, we're talking about bugs. Even a healthy human mouth is crawling with bacteria. Many of these are harmless and some are beneficial - but the bad guys are tough and they rarely miss an opportunity to cause havoc. We give them that opportunity every time we leave food behind in our mouths.
Bacteria that live in the mouth digest this food debris and make plaque, a sticky gel that keeps the bacteria and their harmful products in contact with the teeth and gums. Over time, they use minerals from your saliva to build themselves a strong defensive 'bunker' - a hard shell known as calculus or tartar. Then they can really get to work destroying the attachment between your teeth and gums in a nice sheltered environment where your brush can't get at them.
Infected gums discharge a variety of smelly fluids (hands up anyone who'd like to see the next bunch of fame-starved saddos on 'I'm a Celebrity' drink a mug of pus).
Once tartar has formed, you need a hygienist to shift it for you. A dentist can also remove tartar but, speaking as a member of that profession, I have to admit a hygienist will make a much better job of it - and she'll show you how to stop the tartar building back up again.
Remember what I said about all the bad stuff being linked? Inflamed gums recede. So if you've spent a lot of money on veneers, crowns or bridges, those restorations are not going to stay looking good when your gums have shrunk away from them and there's bare root surface on show. This usually happens well before the teeth become lose and start to move around.
So, if you keep your teeth clean (especially in between - so you'll need floss or an interdental brush) you should have healthy gums and steer clear of gingivitis and periodontal disease. Antiseptic mouthwashes help, but they are not a substitute for physically removing plaque.
Which brings us nicely to the next 'stink site'.
Teeth
Tooth decay is the destruction of tooth structure by bacteria. It occurs when foods containing sugars (e.g. bread, cereals, milk, pop, fruit, cakes and sweets) are left on the teeth. Oral bacteria digest these foods and form plaque (remember that sticky gel that keeps the germs and their acid in contact with the teeth?) So while the bugs are destroying your gums, the acids are working on your teeth, dissolving enamel and digging holes. It's an efficient system.
Left untreated, these cavities get bigger and deeper, destroying tooth structure and killing the living part of the tooth (the pulp). When sufficient tooth structure has been destroyed the tooth will collapse. When the tooth dies, you will get an abscess - which, in case you don't know, is not fun.
And while all this is going on, food debris collects in the cavities. Unless you can remove all of it (which isn't easy because cavities usually make excellent storage bins for crap) the trapped food will rot - and add to the smell.
To prevent tooth decay:
• Cut down on acid drinks and sweet foods, especially sticky ones which remain on the teeth for longer.
• Brush your teeth as soon as you can after eating - but DO NOT brush for half an hour after an acid drink (like fizzy pop or fruit juice). The acid in the drink softens the enamel so the brush can rub some of it away. Instead, rinse your mouth with water and wait - and never have an acidic drink just before you go to bed.
• Brush at least twice a day with a fluoride toothpaste. This is especially important before you go to bed because you produce less saliva while you're asleep, and saliva is nature's defence against bacteria and acids.
• Clean between your teeth daily with dental floss or interdental brushes.
• If you don't live in a fluoridated water area, ask your dentist about fluoride supplements. Fluoride strengthens enamel, making it more resistant to acid attack.
• Chew sugar-free gum to stimulate saliva production.
• Ask your dentist about fissure sealants (a protective coating that can be applied to the chewing surfaces of back teeth.)
• Visit your dentist regularly so that problems can be found at an early stage when there has been less damage and treatment is simpler.
Research is constantly seeking new ways to prevent and treat tooth decay. One day it may be possible to restore everybody's mouths to 100% health with a single pill. Until then, follow the regime above.
The third bad breath site is the Tongue
If you were to magnify the surface of your tongue, you would see that it's a lot like a shag pile carpet (only available in a smaller range of colours). Bacteria and food debris collect between the filaments and can contribute to a bad odour.
Mouthwashes help but really only mask the problem. You need to brush - or gently scrape - your tongue. Special brushes and scrapers are available for this and most toothbrushes have a ridged area on the back of the head designed for this purpose (yes that's what they're for). It can take a bit of getting used to and you shouldn't try to go too far back (because, apart from anything else, vomit is highly acidic and bad for your teeth) but persistence will pay off.
Smoking
The link between tobacco and heart disease, stroke, emphysema and cancer (especially, lung and throat cancers) is common knowledge, but smoking also has direct effects within the mouth:
• Increased risk of developing oral cancer.
• Increased build up of plaque and tartar on the teeth.
• Increased risk of developing gum disease, the main cause of tooth loss because it destroys bone within the jaws.
• Increased incidence and rate of receding gums, uncovering the roots of teeth which become sensitive and are more likely to decay.
• Delayed healing following tooth extraction, periodontal treatment or oral surgery.
• Lower success rate for dental implant procedures. This can be so marked that many surgeons refuse to provide implants for smokers, preferring to concentrate on cases that are more likely to work.
• Inflammation of salivary gland openings.
• Discolouration of teeth and fillings.
• And of course, bad breath.
The mechanisms by which smoking (and other tobacco products such as snuff) cause so much harm are well known. If you want to find out about them, there's no shortage of information in print and on line.
Dieting
Low carbohydrate diets such as the Atkins are notorious for causing foul breath. Normally, the body burns carbohydrates as a source of energy but if these aren't available, it burns fats instead. This is an effective way to lose weight but the fat-burning process produces chemicals called ketones that are released in the breath.
So, in this case, the halitosis isn't an oral hygiene problem (unless you're also not cleaning well, of course) and the only cure is to introduce some carbs into your diet.
You can, however, reduce or at least mask the odour by:
• Drinking more water to dilute the concentration of ketones.
• Swishing water around in your mouth after you eat.
• Chewing sugarless gum.
• Sucking sugarless mints - especially those that contain Xylitol, which may kill bacteria and help prevent cavities.
• Chewing fresh parsley.
Ketones on the breath can also be a sign of uncontrolled diabetes. So, let me repeat, if you get an odour you can't account for, please don't ignore it. I'd hate to lose a reader.
Dr Tom D Nolan is the 'Dentist in Town' in Birmingham City Centre, UK.
Once you've been to The Dentist in Town, you'll never want to see a different dentist. If you do, we'll pay for your check-up.
Tom does a lot of cosmetic work for a lot of faces you'll recognize if you live in the UK. He runs half marathons for charity. His immediate goal is to stop moaning about how his knees won't allow him to play football any more (apart from with his 9 year old son - and even then, the tackles are starting to feel a little heavy)
Come and see what we're all about, and find other great articles, at:
http://dentistintown.co.uk
http://dentistintown.blogspot.com
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