Bad breath or halitosis has been a problem for mankind since the beginning of most of recorded history. Never before have there been effective treatments for this condition until now. Most people will notice the advertising media is saturated with products promoted to help with this condition. Most, if not all of them, really do not work very long and some make the problem worse. Alcohol based mouthwashes can, for example, dry out the tissues in the mouth and cause the tissues to secrete plasma proteins which worsen the condition over time. Odors coming from the stomach are almost never the cause of chronic bad breath. It is estimated that nearly 60 million people suffer from chronic halitosis in the United States. It is also estimated that nearly ten billion dollars a year are spent to treat the condition; most of it wasted.
It is estimated by many experts in the field that 85% to 90% of the bad breath conditions come from sources in the mouth. It is not correct to say that it is primarily caused by gum diseases as some will tell you. Gum disease can be and is a significant cause of halitosis for many but recent research has confirmed that the vast majority of bad breath originates from accumulated bacterial plaques and food coated on the back of the tongue. Since significant numbers of patients can have gum disease as a contributing factor to halitosis, it is important that a dentist diagnose a person’s condition to see if that is the cause. With the help of a gas measuring machine called a Halimeter dentists and other health care providers who possess the machine and know how to use it can measure gases coming from the putrefaction of bacteria in the mouth called volatile sulfur gases or VSCs. These are compounds containing sulfur and include hydrogen sulfide and methyl mercaptan, the two most plentiful bad breath gases in human exhaled air. Hydrogen sulfide is the "rotten egg" smell. With this machine health professionals can more easily locate where the gases are coming from and can see if the measurements are actually decreasing over time with treatments. Other gases (VOCs or volatile organic compounds) that can cause bad breath are the polyamines such as putrescine and cadaverine.
The usual treatment of the condition includes the use of compounds containing some kind of chlorine dioxide or combination of chlorine dioxide and chemically altered forms of oxychlorine species and also zinc compounds. The VSCs are then chemically changed into harmless compounds with no odor by the use of toothpastes and mouthrinses containing those oxchloride species. Treatment should also include tongue scrapping with specific instruments to remove the coating of white plaque. This not only removes the odor causing agents but lowers the overall bacteria count in the mouth which can have positive effects on the health of the gum tissues.
In addition to the stabilized chlorine dioxide used to control VSCs, the addition of zinc ions in the form of zinc acetate produce a synergistic effect with stabilized chlorine dioxide to produce much more effectiveness. The zinc ions actually combine with the cells of the surface of the tongue and mucosa to produce a storage supply of zinc ions which are released as VSCs come into contact with the tissues. This continuous release of zinc ions from the tissues produce a long term deodorizing action. In addition to that, zinc ions combine to inactivate other VOCs that the stabilized chlorine dioxide do not inactivate for a more broad range of effectiveness. Zinc acetate is a superior form of zinc compound in my opinion because it releases more zinc ions per molecule and is more stable in solution than products like zinc gluconate or zinc chloride. It also tastes much better. It is patented in the mouth rinses I recommend.
Recently this zinc acetate and stabilized chlorine dioxide rinse has been enhanced with twice the amount of zinc acetate and stabilized chlorine dioxide and has been combined with aloe, xylitol and lemon flavor. This product is called a Lemon Power Rinse by the manufacturer. It is the only product of its kind in the world. The xylitol will help reduce plaque in the mouth. The aloe will sooth tissues. The lemon flavor will stimulate saliva flow for those with dry mouth and this extra saliva flow is good for reducing mouth odors too.
If periodontal disease is present as a cause, some of the pockets around the teeth must be cleaned out to rid the source of bacteria putrefaction causing odor and disease there. The periodontal disease must be treated by a dentist or periodontist. Support for this treatment may include suppression of bacteria induced collagenase enzymes which destroy collagen in the gum tissues. I believe that can be helped by removing the VSCs in the gum tissue. Stabilized chlorine dioxide and zinc ions have the ability to reduce VSCs and although the company making these products does not claim it will help cure gum disease, I personally have observed it help my patients with gum infections. Another product which can help with reducing collagenase activity in the gum tissues is the drug Periostat. You can get information on that product and a very good explanation of periodontal disease by going to their web site.
Additional help with flushing out bacteria can be accomplished with special ionizing mechanical irrigators, which automatically pulse water with an electric charge, and the use of fine tipped canulas attached to the irrigators can be placed into the pockets around the gum to rinse them out. The patient cannot feel the electric charge. The patient needs a dentists or hygienist to help teach them how to do this. The ionized water helps cause the roots of the teeth to attract less plaque. Adding the lemon power rinse with its stabilized chlorine dioxide and zinc acetate or the professional strength zinc rinse to the water adds even more effectiveness to this irrigation.
What Causes Bad Breath Really?
Many products have been marketed for the treatment of bad breath. These products include;
- Alcohol Mouthwashs
- Cosmetic Toothpastes
- Baking Soda
- Sprays, mints and gums
which only temporarily treat the problem. What is not known about bad breath is that it is more than a simple annoyance. Bad breath most often starts at the back of the tongue and this huge accumulation of plague can affect the health of the gum tissues. Gum disease can also be a cause of bad breath. In minor cases, products such as mouthwash or toothpaste might help, but in most cases, this is not enough and can make the problem worse.
Although baking soda does kill oral bacteria and inactivates acids, acids are not the problem in the depths of a periodontal pocket nor at the deeper layers of the bacterial plaque on the back of the tongue.. In the pocket and at the deeper layers of the bacteria at the back of the tongue where bad breath comes from, the pH is alkaline, not acidic. Neutralizing the acid on the surface of the bacterial plaque of the back of the tongue with baking soda serves to make the plaque more alkaline. The baking soda does not reach the deeper layers of that plaque on the back of the tongue to do any killing. The bacterial killing of baking soda in the gum tissue can be useful, but baking soda is not something I recommend. It pushes the mouth into an alkaline pH, which is the opposite direction one wants to put the pH to prevent halitosis or gum diseases, which thrive in this basic and putrefactive environment. The mouth must have a slightly acidic pH to prevent bad breath.
Peroxide is also ineffective in preventing halitosis. Peroxides are oxygenating agents which can produce harmful free radicals and have been of concern to some health professionals when used for long periods of time in the presence of chronic inflamed tissue. Gum tissues are usually chronically inflamed and therefore are susceptible to negative effects of peroxides which can cause adverse cell changes to occur. Peroxides are also too quickly inactivated to do any antibacterial work at the concentrations they have in toothpastes. The approach I tend to favor in treating halitosis and gum disease is not primarily bacterial killing but instead the preservation of natural bacterial balance and then oxidizing, (not oxygenating), the VSCs that cause the odor. These VSCs also increase the permeability of the gum tissue pocket lining promoting bacterial invasion. I recommend oxidation of VSCs and zinc ion therapy contained in the products I recommend. I therefore believe three of the ingredients that should NOT be added to toothpastes and mouth rinses are baking soda, peroxide and alcohol! Unfortunately, almost all major toothpaste and mouthwash makers are jumping on the misguided baking soda and peroxide band wagon. Some of the mouthwashes contain very high levels of alcohol, from 8% to 25%. Alcohols can be harmful and I strongly urge consumers to stay away from them. They certainly can make bad breath worse!
Smoking too can make bad breath worse. Smoking and chewing tobacco dry out the mouth and again produce adverse tissue dryness and plasma secretions which are broken down by bacteria into volatile organic compounds. Anything which dries the mouth can promote bad breath, including some prescription drugs, alcohol consumption and some systemic diseases. Dry mouth can be caused by sinus congestion and nasal blockages. Rhinitus and nasal drainage also cause bad breath. Even dieting and diabetes can cause odor. These types of problems may require a physicians help but these products can still be of some help to these individuals. But remember again, the vast majority of halitosis comes from the mouth.
What Can Be Done?
Bad breath or halitosis can be a serious handicap on your social or business life. It is a source of embarrassment and shame. However, you no longer have to let halitosis affect your lifestyle. Using the latest technology, researchers have developed the halimeter, a device that can actually measure the extent of your halitosis problem. This instrument along with the organoleptic test (smelling your breath with the nose), can quantify the bad breath gases so that the doctor can determine if the treatment is reducing the odors over time. Halimeters are a help to diagnosis but cannot take the place of the actual smelling of the breath in diagnosis and treatment. Some dentists also use a culture test for bacteria and others will use a microscope to help identify which bacteria are causing your problem. Not all these techniques need to be used to properly diagnose and treat a person.
Odors Coming From the Tonsils
Even though most odors come from oral causes, there are some who have odors coming from the tonsils and sinus areas. Many of those who write to me have expressed a need for information and treatment about tonsils with deep indentations in them which get filled with food and plaque that harden into a very foul smelling ball which is almost stone-like in some. These are sometimes cause by a condition called chronic cryptic tonsillitis and should then be addressed by an otolaryngology physician. Sometimes chronic cryptic tonsillitis must be treated by surgical removal of the tonsils. Most of the time these tonsilloliths are not associated with chronic cryptic tonsillitis. These tonsilloliths can be treated with limited success by the use of the hydromagnetic irrigator. Below is a typical letter from a patient who suffers from such a condition and then the response I wrote back to him.
Please be advised that I have found quite a number of patients who have had their tonsils removed by physicians for this and other bad breath problems. This is usually NOT indicated and is a dangerous and unnecessary operation for most people.
The following is an inquiry from California:
I was wondering if anyone has looked into the tonsils as a factor in bad breath. It seems that food particles get trapped in the tonsil crevices. The particles remain there for who knows how long. The particles seem to harden, and take on an awful odor. This is detected when one of the particles comes loose - sometimes after a cough or gag. The taste and smell of these particles is awful. Even my six year old boy coughed one up the other day. He removed several mushy particles from his mouth and was concerned because of the terrible taste and smell.I recognized it immediately as the stuff that gets trapped in the tonsils. Why haven't I heard any of these studies mention this problem? Not even the recent TV story on the subject. Surely, numerous people have encountered this problem. I would think it has to be a contributing factor in bad breath. If so, what if anything can be done about it? Thanks.
The response is:
Yes, these have been known about for a long time and some people have a problem with them such as yourself. Most people do not. They can be controlled by some people with a water irrigation machine such as the hydromagnetic irrigator. That machine pulses water and can be directed to blast out the crypts in the tonsils. Even better, one can place the rinse with zinc acetate in the water holder on the machine and get both the effect of the water blast and also the stabilized chlorine dioxide to deodorize the area. In the section of this ABS site called "Causes and Treatment" you will see a reference to this irrigator and the other products. You can click on those product words which will show you a picture of the products.
Odors and Dentures
A number of Internet writers have asked about how those who have dentures can control the odors. This is an important question because many people have strong odors with dentures. Not only do the dentures themselves tend to get bacteria and organic material in the microscopic pores and spaces between denture base and teeth, but the denture surface that is in contact with and holds the denture to the lower jaw or roof of the mouth can collect a great deal of bacteria, yeast, fungi, food particles and shedding cells from the tissue surface. These break down into the volatile organic compounds, (VOCs) which are very similar to the bad breath compounds that people with natural teeth have.
I recommend people with dentures leave them out of the mouth for at least four hours each day. In addition to that, brush the roof of mouth, cheeks, gums with stabilized chlorine dioxide toothpaste, as I instructed people with teeth to do. Use the tongue scraper daily. Rinse the mouth with zinc mouthrinse for at least two minutes. Clean your dentures with a denture toothpaste or stabilized chlorine dioxide toothpaste and then place them in a container submerged in Full Strength Zinc rinse or the Multiuse Deodorizer for four hours. The later mentioned liquid usually used to deodorize the house and is safe for soaking dentures. It has a high level of stabilized chlorine dioxide.
After rinsing off your dentures, place a thin film of gel (non-fluoride gel) on the tissue contact side of the dentures and place them into the mouth. This aloe vera and stabilized chlorine dioxide gel will not only hold down odors by oxidizing them, but will also help to heal wounds and sore spots under the denture and help prevent the growth of bacteria, yeast and fungi under the dentures. If you have red tissue under your denture, you may have a fungal infection and this can cause odor and soreness. The gel will help alot.
Digestive Enzymes and Nutrition:
Digestive enzymes become more important as we get older because the production of these enzymes decrease as we age. Digestive enzymes are also completely destroyed in all foods that are cooked. If digestive enzymes are lower than normal, our bodies must divert nutrients to make digestive enzymes that would ordinarily be use to make intracellular enzymes such as catylase and SOD, which protect cells as antioxidants. This lowers antioxidant protection. Lower digestive enzyme levels also upset body pH balance causing us to be more acidic, thus more prone to disease and weight gain. Lower digestive enzymes can lead to excess gas formation and putrefaction in the intestines. For some people this can contribute to bad breath gases traveling through the blood stream to the lungs and exhaled. This is not a large contributor to halitosis in most people.
Foods such as garlic and onions have highly volatile ordors which can be passed directly through the lining of the intestine into the blood stream and exhaled air. Digestive enzymes will do nothing to stop these odors. The only way to control them is to not eat these types of food. Zinc rinse will eliminate the odors on hands (if poured on them) and the surfaces of the mouth, but will not help with the odors coming from the lungs.
Some people have found that the elimination of all dairy products can help with the control of bad breath odors. A few others have found the elimination of all soy products to help. Diary products can thicken mucous in the mouth and contribute to the anaerobic environment bacteria love in producing VSCs. It also supplies lots of protein used in the breakdown by bacteria to VSCs. Some people are lactose intolerant. Some are gluten intolerant, which is found in wheat products. These intolerances should be confirmed by testing from a phycisian. It is important that all people interested in halitosis control and good health drink a great deal of water to wash away thick mucous and bacteria and to keep the mouth flowing freely with saliva. This decreases mouth pH and increases oxygen, both of which help control halitosis.
Intestinal Cleanser is a product with Cascara Sagrada or sacred bark and is commonly used to treat chronic constupation and as a nutritional supplement to support the colon, gallbladder and digestive system. It is a source of vitamin A, Vitamin B2, vitamin B5, calcium, magnesium and potassium, company literature states that natural properties found in Cascara Sagrada stimulate secretion of digestive fluids, increase the flow of bile and cleanse the intestine. It has been used to help support treatment of sluggish gallbladder, digestive problems, enlarged liver, intestinal parasites, jaundice, colitis, hemorrhoids and a variety of skin problems.
Patient Home Care Instructions (Twice Daily)
- With the tongue scraper tongue scraper, place as far back on the tongue as you can see when you pull it forward with the other hand. Use a clean wash cloth to grasp the tongue. Scrape by pulling the scraper forward 2-4 times.
- Using a pearl size drop of toothpaste, brush your teeth, tongue, roof of mouth, cheeks and gums for 2-3 minutes. Angle the toothbrush bristles so that they slide under the margin of the gum into the sulcus. Do not dip brush in water while brushing.
- Spit out excess toothpaste, but do not rinse with water.
- Floss between all teeth with toothpaste present. Then rinse well.
- Using 1-2 capfuls of mouthrinse, swish vigorously for at least two minutes. (It is important that you do not sip the mouthrinse directly from the container as your saliva could activate all the remaining rinse making it useless for future use.)
- Finally, dip your toothbrush in the Gel and work the gel under the gum line and between the teeth. A proxabrush or perio aid can help push it between the teeth if you have them. Angle the brush at 45 degrees to push into the crevices between the gum and teeth. Leave the gel on the tissues. Do not rinse it off.
- Drink a lot of water, stay away from dairy products and use the xylitol breath mints to keep the mouth moist and reduce plaque formation throughout the day.
- Those with dentures can soak them in the rinse overnight.
- Repeat all steps in the evening. Add the denture soak step.
Intermediate Care (If you purchased the hydromagnetic irrigator
- Delay the application of the Gel above until after using the hydromagnetic irrigator.
- With the irrigator, place 2-3 capfuls of the mouthrinse in the reservoir and then half fill with warm water. Turn on the irrigator and rinse under the gum line and between all teeth and under bridges. When done rinsing, fill your mouth with the final amount of irrigation water and hold it in the mouth for approximately 10 minutes (or as long as you can). The longer the ionized water is in your mouth, the more effective it will be (up to a maximum of 15-20 minutes).
- Spit out excess and do not rinse with water.
- Apply the Gel as stated in the basic care section above.
- Refrain from rinsing, eating or drinking for 30 minutes.
Advanced Care for Those With Gingivitis, Periodontitis and Severe Halitosis (Take your Intestinal cleanser, enzymes and antioxidant food supplements if the doctor has prescribed them to you.)
- Instead of using a regular toothbrush, use the Rotodent ® toothbrush to clean all teeth with Toothpaste. Then floss the teeth with the toothpaste still on the teeth. Use the tongue scraper .
- Next, use the Rotodent toothbrush with Toothpaste on the tongue. Start at the back of the tongue and go from side to side while bringing it gradually forward.
- The irrigator with special fitted canula is used in the gum pockets but must be demonstrated by a dentist or hygientist.
- P.M. Repeat this same routine in the evening before bed.
- It is always wise to drink lots of water throughout the day to help with breath odor regardless of severity of the problem.