About Bad Breath
Q. Can bad breath (halitosis) be cured?
Q. What is Halitosis?
A. Halitosis is bad breath and can be a crippling affliction affecting around 50% of the population either intermittently or chronically. Some patients tell us how their career paths have been thwarted because of it. One patient was asked to leave her job. Others tell us how they have become reclusive, withdrawing from society and public places like the cinema and public transport. Unfortunately, most people are unaware they have a problem as we cannot smell our own breath due to a phenomenon called acclimation (trust me), so of course they don't seek help. Some can't understand why they cannot form relationships despite being "attractive" in every other sense. Others become paranoid as they feel the world is against them for some unknown reason.
Q. So what causes it and why does it happen?
A. First, let me say the cause of halitosis was discovered in 1974 by a Canadian dentist/microbiologist, so don't believe all the self-proclaimed 'experts' who claim to have solved the mystery. I didn't and neither did they! Also, just as you don't need to know how a car engine works to drive a car, you don't need a degree in microbiology, physiology, chemistry or dentistry to understand halitosis.
So here it is:
Halitosis is caused by the breakdown of proteins in the mouth by anaerobic bacteria (those that don't like oxygen - in fact it kills them instantly). This breakdown causes the release of volatile sulphur compounds* or VSCs which are the noxious odours of bad breath. That's it. The source of the proteins is discarded cells from the lining of the cheeks, lips and gums, food we consume e.g. milk, eggs, meat, vegetables, fish and dead bacteria of which we have literally billions in the mouth. * VSCs are hydrogen sulphide, methyl mercaptan, dimethyl sulphide, and others.
Q. Why don't we all produce VSC and have bad breath?
A. Actually we all do produce VSCs, but some more than others. It is when the level of VSC production becomes "too high" that our breath becomes offensive to others. Some people do not know what a good day is, suffering all the time, others do not know what a bad day is, not suffering at all. The rest live in the grey area of some days good, some days bad.
Q. OK, so what determines whether we suffer or not?
A. Several factors, and it is when some or all of these factors come together that the level of VSC production becomes offensive. Broadly speaking: Saliva flow - The more the better. Saliva contains antibodies and oxygen, both of which combat bacteria, and oxygen breaks down VSCs. Saliva flow can be reduced by age, illness e.g. Sjogren's Syndrome, medication, salivary gland pathology or removal, smoking, stress, hormonal changes, alcohol, caffeine and fasting or skipping meals (if we don't eat, we don't salivate). Saliva pH - The lower the pH (more acidic) the more anaerobic bacterial activity, therefore more VSC production. Saliva thickness - The thicker the saliva the easier it "sticks" to the oral mucosa (skin surfaces) and stagnates. The bacterial balance - The more anaerobes (as happens in gum disease) the more VSC production. New research shows that the absence of Streptococcus salivarius (a good bug) allows anaerobes to proliferate and is associated with general health problems in children. Post-nasal drip and excessive mucus production - These "products" are protein-rich and stick to the back of the throat and tongue giving the familiar coated tongue. More "food" for the anaerobes. Advanced gum disease - Anaerobic bacteria thrive in the "gutter" around teeth. They "burrow" down the gum and multiply. From deep down in these "pockets" they are away from the protection of saliva so their activity increases - producing VSCs - we call this "gum breath". Occasionally the tonsils - When they become infected and inflamed, they can produce tonsilloliths - tonsil stones which smell putrid when squashed between the fingers. High protein diet - Dairy, fish, red meat and beans (be careful with e.g. Atkins Diet) Acidic foods - Coffee, coke, tomatoes, orange juice - they promote anaerobic activity. Lactose intolerance - The inability to digest the lactose means it prolongs the availability of the dairy products for the anaerobes to break down.
Q. What's the story with morning breath?
A. Morning breath is a concentrated manifestation of some of the causes listed previously. During sleep the saliva flow shuts down, the acidity level of the mouth increases and post-nasal drip can increase. Compounded with any of the other predisposing factors, the effect can be considerably exacerbated. Less saliva means fewer antibodies, less oxygen and reduced flushing of stagnant protein and bacteria. Post nasal drip means more "food" for the anaerobes. If alcohol has been consumed prior to sleep the situation will be worse still as it is an industrial desiccant (a drying agent) and will dry out the salivary glands as well as the brain. All in all it's anaerobic heaven and VSC production goes into overdrive. Come the morning, you open your mouth to wish the world a happy day and... Fortunately for most people, stimulating saliva flow by tooth brushing or eating breakfast is enough to bring the level of VSC production down to acceptable levels, for others things improve but remain too high.
Q. But I thought that halitosis came from the stomach?
A. No, that's a huge myth. Bad breath does not come from the stomach. Two "valves" above the stomach prevent the contents from 'escaping' except when we burp or vomit. Although this release does not smell very pleasant it is not bad breath, merely the odour of recent food and drink e.g. garlic, beer, coffee, fish.
Q. I reckon my mouth is pretty clean. My dentist tells me that I don't create too much plaque (bacteria) or tartar, but I still suffer from halitosis. How do you explain this?
A. Interestingly, "dirty" mouths don't necessarily mean bad breath, and "clean" mouths don't always mean fresh breath. Because the physiology and microbiology acts on a microscopic level it is not necessary to have a visible build up of proteins and bacteria for sufficient VSCs to be produced and cause bad breath. This is the situation I am in. As a dentist I know how to, and do, maintain a clean mouth, yet I am still afflicted by the problem. It is a result of the way my body works, unfortunately.
Q. So you have bad breath?
A. No but I would have if I did not control it. I undertake a simple daily regime and the problem stays away.
Q. OK, so now we know the causes, what's the "cure"?
A. Well, this is the really exciting part, it's really simple and works in 99% of cases. First we need to remove as much of the stagnant protein and bacterial deposits as possible. This is achieved by a high level of oral hygiene. Correct brushing, correct flossing and tongue scraping. Our Home Treatment Pack contains detailed information on these techniques. Once the physical barrier to the anaerobes is removed, we send in the cavalry - a chlorine dioxide based mouth rinse. Chlorine dioxide kills anaerobes and destroys VSCs instantly. (Do not confuse chlorine dioxide with chlorine in bleach, just as sodium chloride is not bleach, it is table salt). Chlorine dioxide is a powerful oxidising agent and a highly potent antibacterial, antiviral and antifungal agent. It is totally safe even if swallowed in the quantities we are talking about. It's action is greatest on those compounds containing sulphur i.e. volatile sulphur compounds. So, I repeat, chlorine dioxide kills the anaerobic bacteria that "produce" VSCs and destroys the VSCs which are the cause of bad breath, instantly, upon contact.
Q. Do all breath treatments contain Chlorine dioxide?
A. If they did you probably wouldn't be on this website. No, they do not, in fact very few do and you probably haven't heard of them. My favoured chlorine dioxide product range is CloSYS. The range includes a mouthrinse, a toothpaste and a spray. I like CloSYS because: 1) It is a total oral health solution. Anaerobic bacteria and VSCs being responsible for bad breath and gum disease. CloSYS helps eliminate/control these problems. 2) It works. I know because my patients tell me it does and just how much it has changed their lives. 3) It does not contain alcohol. Alcohol is an industrial desiccant (drying agent) and dries out the mouth. If saliva is your best friend in combating bad breath, why would you dry your mouth out? Also alcohol retained in the mouth is associated with oral cancer. Note: One very popular mouthwash contains up to 28% alcohol! Check it out next time you're at the supermarket. 4) It has a high pH (i.e. very low acidity). Teeth are at risk from decay when the pH drops below 5.5 and an acidic environment enhances anaerobic activity. Note: One very popular mouthwash has a pH of 4.3! Check it out. 5) It is unflavoured so it does not affect your taste and destroy your enjoyment of food and drink. You can keep it in your mouth for a whole minute (or longer) without your eyes watering, ears smoking or your mouth setting on fire. If the mouthwash isn't in your mouth for long, it's not working for long. 6) It has a long shelf life because it is stabilised. 7) It doesn't contain Sodium lauryl sulphate (soap - as found in shampoo). Nearly all other toothpastes and mouthwashes contain SLS which interferes with the action of chlorine dioxide and is associated with the development of mouth ulcers. 8) It breaks down the odours of garlic and other strong smelling food so a quick swish after lunch and you're ready for close range business.
Q. What about strips, lozenges, gum, mints etc - don't they work?
A. Like other mouthwashes, no they don't. They simply cover a bad odour with a stronger, more pleasant one, but only for a few minutes.
Q. I live in Woop Woop, I don't/can't get to Sydney, what can I do?
A. 99% of our patients have experienced a resolution of their symptoms by simply following the ‘At Home Regime’. You don't need to spend money on a consultation, or possible travel and accommodation expenses, (I once had a patient travel from Cairns). Of course, you should continue (or start) to see your dentist on a regular basis to ensure there is no underlying problem like periodontal (gum) disease or impacted wisdom teeth creating areas of stagnation leading to decomposition of proteins resulting in the production of Volatile Sulphur Compounds.