My BEST Dentists Journal


How dental issues can cause bad breath?

Almost everyone experiences bad breath once in a while. But for some people, bad breath is a daily problem, and they struggle to find a solution. Approximately 30% of the population complains of some sort of bad breath. Halitosis (Latin for “bad breath”) often occurs after a garlicky meal or in the morning after waking. Other causes of temporary halitosis include some beverages (including alcoholic drinks or coffee) and tobacco smoking.

Some people may not be aware of their own halitosis and learn about it from a relative, friend, or coworker, causing some degree of discomfort and distress. In severe cases, bad breath may negatively impact personal relationships and a person’s quality of life.

What causes bad breath? And what can you do about it?

Bad breath can originate both inside and outside of the mouth. Bad breath is typically caused by bacteria present on the teeth and debris on the tongue. So it’s no surprise that most cases of halitosis are associated with poor oral hygiene, gum diseases such as gingivitis and periodontitis, and dry mouth, a condition in which the salivary glands cannot make enough saliva to keep your mouth moist. A visit with a dentist may help rule out periodontal disease and identify any mouth problem that could be contributing to bad breath.

Tonsillitis, respiratory infections such as sinusitis or bronchitis, and some gastrointestinal diseases may be responsible for a small number of cases of bad breath. Advanced liver or kidney disease and uncontrolled diabetes can also lead to unpleasant breath. In these cases, a person is likely to experience significant symptoms beyond bad breath, and should seek medical attention.

Sometimes people think they have bad breath, even when their breath is objectively fine. This is called “pseudo-halitosis.” Halitophobia, or fear of bad breath, is real and may persist despite reassurance from a doctor. People with pseudo-halitosis respond well to reassurance, and may benefit from speaking with a therapist or psychiatrist who has expertise in the field.

A person complaining of bad breath can be initially evaluated by a primary care physician (PCP). The doctor will begin with a thorough medical and dental history and an oral exam. Tests may be done to confirm the presence of halitosis by measuring the strength of bad breath on a predefined scale, and by using instruments to detect specific compounds related to halitosis. The intensity of malodor is usually assessed by the doctor smelling the air that the person breathes out through the nose or mouth, or from judging the odor of a tongue scraping, a length of dental floss, or a dental appliance such as a night guard.

Your PCP may refer you to a dentist if there is evidence of dental or gum problems, which is the cause in the majority of people with bad breath. Visits with other medical specialists are warranted when an underlying medical problem requires attention.

Tips to improve bad breath

Here are some helpful tips to improve bad breath:

Brush your teeth at least twice a day, after meals, with a fluoridated toothpaste.

Avoid tobacco smoking and chewing tobacco-based products.

Rinse and gargle with an alcohol-free mouthwash before bed.

If you have dry mouth, make sure to drink enough fluids throughout the day and use over-the-counter moisturizing agents, such as a dry mouth spray, rinses, or dry mouth moisturizing gel. If you don’t see any improvement, you may want to schedule a visit with an oral medicine specialist. Oral medicine doctors provide comprehensive care for mucosal diseases, salivary gland disorders, orofacial pain conditions, and oral complications of cancer therapies, among other things.

Visit your dentist regularly. Remember, oral causes are responsible for most cases of bad breath!

by Harvard School of Dental Medicine

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Hidden dental dangers that may threaten your whole body

A growing number of older adults have something to smile about: research shows they're keeping their teeth longer. While that makes chewing and talking easier and staves off malnutrition and the discomfort of dentures or missing teeth, it also means you need to be more vigilant than ever about preventing dental problems — including some that can have life-threatening complications.

Tooth decay

One in five adults ages 65 or older has untreated tooth decay (a cavity). This develops when food and bacteria form plaque that sticks to teeth and produces toxins that break down a tooth's outer layer (enamel).

Bacteria also can infect the root of the tooth and form a small pocket of pus (an abscess). "If the infection doesn't find a way out, it may travel to another space in the head. It wants the path of least resistance, so it may infect the jaw. But it can also travel to the brain and cause death, although this is fortunately rare," warns Dr. Lisa Thompson, a geriatric dentistry specialist at the Harvard School of Dental Medicine.

Gum disease

Two out of three adults ages 65 or older have gum disease (also called periodontal disease). This is inflammation of the gums that can lead to tooth loss and many other problems. The disease starts with plaque buildup that irritates the gums. This early stage (gingivitis) causes swollen gums that bleed easily.

If untreated, gingivitis can extend below the gum line. The body's own immune system is thought to fuel the condition, as white blood cells — called to attack the bacteria — eventually damage gum tissue as well. "It can infect the gums all the way down to the ligament that holds the teeth in the bone, penetrate the ligament, destroy bone, and cause tooth loss and abscesses," Dr. Thompson says. At worst, bacteria from gum disease may get into the bloodstream and infect the heart valves, a potentially deadly complication.

People with gum disease are more likely to have high blood pressure, diabetes, rheumatoid arthritis, osteoporosis, Alzheimer's disease, and pneumonia — although it is not proven that the gum disease actually causes these conditions.

Older adults face increased risks

Maintaining good oral health gets harder as we age. Sometimes that happens because we've suffered declines in other abilities. "You might have arthritis and decreased manual dexterity. That can make it difficult to brush or floss your teeth or properly care for dentures if you have them," says Dr. Thompson.

Another challenge: age-related physical changes in the mouth. The gums start to recede, exposing more of your teeth and creating new spaces that floss doesn't always reach. The teeth become less sensitive as the nerves inside them shrink and a secondary layer of dentin (porous material beneath the enamel) develops.

"You may not feel the same amount of pain in the tooth if there's a problem, and it can progress before you realize it," Dr. Thompson points out. And years of wear and tear can leave your teeth weakened or cracked and vulnerable to dental problems.

Chronic conditions also play a role in oral health. Uncontrolled diabetes can make gum disease worse. And many medications cause dry mouth. "You need saliva — which contains fluoride and electrolytes [like sodium and calcium] and moistens the mouth — to help clean and protect the teeth," Dr. Thompson says. A lack of saliva can lead to tooth decay in as little as three months after dry mouth begins.

What you can do

By staying on top of oral hygiene, you can ward off cavities and even reverse gingivitis. But it's going to take extra effort now. These steps can help keep your mouth — and the rest of you — healthy:

Brush your teeth at least twice a day and floss at least once. If you're still not removing enough debris, Dr. Thompson recommends adding an interdental brush to your routine. "It has a little cone-shaped bristle that fits between the teeth," she explains. "You can find it in the toothbrush aisle of any pharmacy."

If you have dry mouth, ask your dentist about a prescription toothpaste or mouth rinse with fluoride to help protect against cavities. Chewing gum with xylitol may also stimulate saliva production, which can help protect against cavities.

If you find brushing difficult because of arthritis, try an electric toothbrush or a toothbrush with an ergonomic handle.

Avoid smoking, which is a risk factor for gum disease.

If you have dentures, be sure to brush them daily and soak them overnight in a denture cleaner.

Don't skip check-ups and cleanings at your dentist's office (at least two to four times per year, depending on your gum health).

by Harvard School of Dental Medicine

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