Halitosis

Though it may wound your pride, your darling grandchild may actually be doing you a favor by announcing so bluntly: 'Yuck -- you have bad breath.' Strangely enough, people who have halitosis are usually the last to know. The good news is, you don't have to put up with it any more.

'There's a way to control it,' says Dr. Barry Cash, a dentist who's operated the Fresh Breath Center in Toronto since 1995. 'It's certainly not a cure -- it's like having diabetes --there's only control for the disorder, not a cure for it. But as long as you maintain whatever program you're on, you'll be able to keep it under control.'

It starts with careful brushing and daily flossing to remove food particles and plaque. A WaterPik or electric toothbrush can be particularly useful for people with restricted hand coordination. A tongue scraper removes the gunk that's accumulated on the back of your tongue; then you rinse with an appropriate mouthwash.

Mouthwashes ineffective
Over-the-counter potions though, generally won't do the trick. In the U.S., anxiety over bad breath has spawned a mouthwash industry with sales worth $850 million, in spite of the fact that they're largely ineffective because they don't get to the root of the problem.

Most bad breath originates in the mouth, so if the verdict of your nearest and dearest is your current program of oral hygiene isn't doing the job, it's time to consult a mouth specialist, your dentist. After carefully examining the teeth, gums and the rest of the oral cavity, the dentist may suspect the source of the problem lies elsewhere and refer you to a medical practitioner. Problems in the airways, lungs or even liver disease or other serious illness can promote halitosis; bad breath that arises suddenly and gets worse usually indicates the presence of an infection.

When chronic foul breath is the sole complaint, it's most likely the mouth is the source of the problem.

Sulphur compounds the culprit
But phew! Just what is it that smells so darned bad? The offending odor occurs when sulphur-containing amino acids (the building blocks of protein) are broken down by anaerobic bacteria (germs that thrive in an oxygen-free environment), producing a mix of malodorous gases. These volatile sulphur compounds (VSC) include hydrogen sulphide, methyl mercaptan and dimethyl sulphide.

The protein that supplies the amino acids attacked by the bacteria comes from several sources in your mouth: dead cells from the lining of your mouth, food particles, bacteria (dead or alive), blood-derived compounds including white blood cells. People with periodontal disease tend to have higher levels of VSCs than those with healthy gums, but they're not the only ones with the condition.

Treatment of gum disease and repair of broken teeth will help maintain the fresh mouth. Your dentist will also start you off with a thorough cleaning of all the tissues of the mouth.

Tongue collects bad gases
'The tongue is a major area where the gases can collect,' says Cash. 'If you've ever seen the tongue under a microscope, you know it's certainly not a smooth, flat part of the body -- it's got these fissures in it. The papillae (taste buds) stick up and the gases will sit in there.'

To determine the area of greatest concentration of odors, Cash uses an instrument called a Halimeter that measures these gases in parts per billion. Later, after the patient has been on a treatment program, a repeat test can confirm how well it's working or whether some adjustment needs to be made to control unexpected periods of bad breath.

Using a straw that's connected to tubing, the instrument pumps away a sample of the patient's mouth breath, measures the VSC content and provides a reading. (For the most accurate response, the patient is asked to refrain from eating before testing, cleaning teeth or using breath fresheners, and is required to avoid the use of perfumes or aftershaves that could interfere with the instrument.)

Since the action of anaerobic bacteria produces the offending VSCs, regulation of the problem is directed at controlling these organisms.

Bad versus good bacteria
'They're the bad bacteria,' notes Cash. 'You want the aerobic bacteria [that live in an oxygenated environment to flourish over the anaerobic bacteria. The products we use are actually antimicrobial. They'll destroy the anaerobic bacteria.'

Most control programs include the use of a toothbrush and a tongue scraper (to strip debris off the tongue), as well as a mouth rinse and a gel product formulated to provide oxygenation. These products are purchased through your dentist.

'The gel is basically used at night when the mouth is stagnant," explains Cash. 'It keeps the mouth oxygenated and it actually promotes salivation so that you don't have a dry mouth when you wake up. We suggest people use it underneath their dentures, for the oxygenation process at night.'

Smoker's breath
Ever wonder why a smoker's breath is so unappealing?

'Smoking causes xerostomia, which is drying of the mouth,' says Cash. 'Dryness promotes the growth of bad bacteria that will cause odors. I tell my patients that smoking is probably one of the worst things for your gums, though you never read about it because of the concern about smoking related to the heart and lungs and blood vessels... Nobody ever talks about the deleterious effects of smoking on the mouth.'

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