Sometimes bad breath is the sign of a bigger problem

By Amy Bertrand
St. Louis Post-Dispatch

Breath mints, breath strips, mouthwash, toothpaste. It’s a multi-billion-dollar-a-year industry. Why? Because bad breath leaves a bad impression. But the truth is, it could also be a sign of bad health.

“Bad breath could be because of a problem in the sinuses, mouth, lungs, kidney or airways,” said Dr. Prabhakar Swaroop, a gastroenterologist at St. Louis University Hospital. “If someone comes to me with persistent bad breath, I start looking for other causes of it.”

He said that recently, a patient complained to him of having bad breath. After several tests, it turned out that the patient had an infection in his lungs. “The halitosis led us to that.”

Halitosis is another word for bad breath. It can be an embarrassing problem for those who have it.

“It’s such a devastating disease,” said Susanne Cohen, a dentist for 21 years in the St. Louis area and co-owner with her father of a company that makes Smart Mouth, a mouthwash that promises to eliminate bad breath 24 hours a day with regular use. “When they walk into a room you can smell them. It’s so embarrassing; it affects their social life, their business, even their love lives.”

In the United States, more than 25 million people seek treatment from dentists for bad breath, according to an Encyclopaedia Britannica entry written by dentist Marvin Cohen, Susanne Cohen’s father and a leading expert on halitosis.

He said the problem is so serious, ancient civilizations used to refer to it as a “curse.”
While for many people bad breath just means it’s time to brush your teeth after that morning cup of coffee, for others it’s a chronic problem caused by an underlying illness or by no known reason.

“A lot of people think that if someone has a chronic bad-breath problem, they don’t take care of their teeth,” said Susanne Cohen. “They assume bad odor is associated with lack of adequate dental health. But that’s not necessarily true. Many if not most people who have chronic halitosis have immaculate care. They’ve been afflicted for so long and spent so much time trying to find a cure.”

What is bad breath?

The culprits of bad breath are gram-negative anaerobic bacteria, microorganisms that live and function in an oxygen-deprived environment. These organisms naturally exist in the mouth, said Susanne Cohen. The bacteria ingest protein particles and metabolize them, producing sulfur gases.

“That rotten-egg smell,” said Swaroop.
This is what causes bad breath.

Gum disease, on the other hand, is caused by plaque, which is another form of bacteria, an aerobic or oxygen-loving kind, on the teeth. That bacteria can also cause sulfur gases. Thus, you often find that along with periodontal disease comes bad breath.

“But for those who have a chronic problem, it can’t be explained by periodontal disease,” said Cohen. “Is it something in their saliva? The truth is, nobody knows.”

Bad-breath myths
Myth: Low-carb diets don’t cause bad breath.
Fact: Because you consume so much protein in low-carb diets, this protein is food for the anaerobic bacteria that cause bad breath. Certain chemicals, called ketones, are released in the breath as the body burns fat. There are only two ways to excrete ketones, Swaroop said, through urine and through breath. That’s why, if you are on a low-carb diet, it’s important to drink lots of water.

Myth: People who have chronic bad breath practice poor dental hygiene.
Fact: Many chronic bad-breath sufferers do an excellent job of brushing and flossing, mainly because they are overly concerned about their breath.

Myth: Tongue scrapers are just another ploy to get you to spend money.
Fact: Scraping your tongue is one of the more important things you can do to fight bad breath. On the surface of the tongue are little hairlike projections called papilla, said Dr. Darren Bremer, a dentist in Wentzville, Mo. “Those papilla are an ideal place to trap food, and then the bacteria adhere there. Air flows over and causes the offending odor.” However, most experts say running a toothbrush over your tongue works just as well. Just make sure you go back as far as a tongue scraper would.

Myth: People who have a bad taste in their mouth will also have bad breath.
Fact: A bad taste is not necessarily indicative of bad breath. People can have a very bad taste in their mouths with no detectable odor. Similarly, people can have no bad taste in their mouths and still have extremely offensive bad breath. They get used to the smell. “If you smell the same perfume again and again you get immune to that smell,” said Swaroop.

Myth: Medications don’t lead to bad breath.
Fact: Some antidepressants and antihistamines can cause bad breath, said Swaroop. “They make the mouth dry and promote bacterial growth on the tongue.”

Myth: Flossing is important for your gums, but it doesn’t have much to do with bad breath.
Fact: If food is trapped between your teeth, it becomes a breeding ground for the bacteria that cause bad breath. “Normal brushing just cannot do it alone,” Bremer said.

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