Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Halitosis is a general term denoting unpleasant breath arising from physiologic and pathologic causes in the oral cavity and from systemic sources. The oral cavity is by far the most common source of bad breath.

Among the factors that increase mouth odor are reduced saliva flow, poor oral hygiene, caries, gingivitis, periodontitis, and mouth ulcers. Some factors that decrease odor are increased saliva flow, tooth brushing, dental prophylaxis, tongue prophylaxis, antiseptic mouth washes, eating of food, and drinking abundant amounts of water. The putrefactive action of germs on protein material such as shedding oral lining cells and food debris produce volatile substances in the mouth. Prolonged periods of decreased saliva flow and abstinence from food and liquid cause dehydration and intensify the problem, as the malodorous material remains in the mouth. The end products of protein breakdown both in the mouth and systemically are indole, skatole, tyramine, cadaverine, putrescine, mercaptans, sulphides, and other compounds, most of which smell bad.

Since 90% of bad breath originates in the oral cavity or neighboring areas (nose, pharynx, tonsils, sinuses), one would begin the treatment of halitosis with these structures. Any inflammation of these tissues, ulcers, abscesses, sinusitis, or excessively coated tongue should be eliminated. Do not forget that certain mouth washes such as Listerine can cause a whitish thickening of the lining of the mouth and tongue (Oral Surgery, Oral Medicine, and Oral Pathology 48(6): 517-27, Dec. 1979). Later this thickened lining sheds more profusely than normal lining, providing substances for putrefaction. The tongue can shed quite a lot of lining cells enabling the bacteria in the mouth to break down the protein, giving off the malodorous chemicals mentioned above. The tongue should be brushed well with a coarse toothbrush and the gums checked carefully for periodontal disease (pyorrhea).

Decaying food particles in the mouth, in the crevices of the teeth, and lodged in the furrows of the tongue, nasopharynx, and above the soft palate provide much material for bad odor. Dental floss used after each meal, or at a minimum of once daily will remove many of these particles of decaying food. The teeth should be brushed with a different brush than the one used to brush the tongue. Use a soft bristle brush, the angle of the bristles directed in a 45-degree angle with the gum margin. To remove food particles from the crevices in the back of the mouth and from the nasopharynx, one should gargle after the teeth have been brushed.

All of the above factors are listed under the general topic of "oral halitosis." The second most common source of bad breath is "circulatory halitosis." Substances produced in the body and brought to the lungs for elimination include things that usually should be eliminated by either kidneys or digestive tract, including lead, mercury, products of metabolic intoxication, garlic, onion, and alcohol.

The third large cause of bad breath is "respiratory halitosis." Any kind of bacterial growth in the respiratory tree can produce bad breath. This includes chronic bronchitis, smoking, and upper respiratory tract infections such as the common cold. A destructive lesion of the lung such as tuberculosis or a lung abscess can produce bad breath.

The fourth large cause of bad breath is "digestive halitosis." Volatile materials produced in the digestive tract are absorbed into the blood and brought to the lungs for elimination. One of the ways that we are able to measure the amount of fermentation that occurs in the colon is by measuring the amount of certain gases that are excreted in the lungs. If one has retained fecal material in the colon, bad breath is almost certain to occur. Eating slowly and only of the quantity of food that can be properly processed by the gastrointestinal tract will go far toward eliminating this kind of halitosis. A charcoal poultice used over the liver each night can do much to eliminate bad breath. Taking charcoal by mouth, swishing it around to bathe across the teeth, is quite helpful.

The treatment of bad breath includes primarily the elimination of the causes. Brush the teeth, gums, and tongue daily and preferably after each meal. Gargle with hot water and use dental floss and a toothpick as needed. Drink plenty of water, enough to keep the urine almost colorless. This habit will promote adequate salivary flow needed for the cleansing of the teeth and oral cavity and will eliminate waste products by means of the kidneys, skin, and intestines.

Stress is a common cause of bad breath. Since exercise neutralizes stress, a brisk walk in the open air, head held high and shoulders back and down, will go far toward eliminating this problem as a source of bad breath.

Correcting faulty eating habits, chewing well, avoiding nervous tension at the time of meals, avoiding combinations of many different types of foods such as fruits and vegetables at the same meal, or milk-egg-sugar combinations, both of which promote fermentation in the bowel, all help correct bad breath. Constipation must be banished as well as all sources of intestinal putrefaction. Be certain that there are no chronic illnesses or metabolic disturbances, and you will have sweet breath.