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From InteliHealth
Dental http://www.intelihealth.com/IH/ihtIH?t=25029&p=~br,IHW|~st,333|~r,WSIHW000|~b,*| What Is It?Bad breath (also known as halitosis) is breath containing an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. In many patients, the millions of bacteria that live in the mouth are the primary culprits of bad breath. The mouth's warm, moist conditions make an ideal environment for these bacteria to grow. About 80 percent of bad breath is caused by something in the mouth. Some types of bad breath, such as "morning mouth," are considered to be fairly normal, and they are usually not health concerns. The "morning mouth" type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor. In addition, bad breath can be caused by the following:
SymptomsA person may not always know that they have bad breath. This phenomenon is based on the fact that odor-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Socially, the worst symptom is simply having bad breath and not realizing it. Others notice, however, and react by recoiling at the smell as you speak. Other associated symptoms depend on the underlying cause of bad breath:
DiagnosisA dentist or physician may notice the patient's bad breath while the patient is discussing his or her medical history and symptoms. In some cases, depending on the smell of the patient's breath, the dentist or physician may suspect a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes mellitus. A urine-like smell, especially in a person who is at high risk for kidney disease, can sometimes indicate kidney failure. Your dentist will review your medical history for medical conditions that can cause bad breath and for medications that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any associated symptoms described above, including when the bad breath was noticed and by whom. Your dentist will perform a physical examination, which will include an examination of your teeth, gums, oral tissues and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth. Once the physical examination is finished, your dentist may refer you to your family physician if systemic problems are the most likely cause. In severe cases of gum disease, your dentist may recommend that you be seen by a periodontist (dentist who specializes in gum problems). There may be a need for diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sjögren's syndrome. Depending on the suspected illness, these tests may include blood tests, urine tests, X-rays of the chest or sinuses, or other specialized testing. Expected DurationThe duration of bad breath depends on its cause. For example, when the problem is due to poor dental hygiene, proper dental care will begin to freshen the mouth immediately, with even more impressive results after a few days of regular brushing and flossing. Periodontal disease and tooth abscess also respond quickly to proper dental treatment. Bad breath due to chronic sinusitis may be a recurring problem, especially if a structural abnormality of the sinuses is the underlying cause. Bad breath due to systemic illness may be a long-term problem that can often be controlled with proper medical care. PreventionBad breath due to dental problems can be easily prevented. Daily maintenance calls for brushing your teeth, tongue and gums after meals, flossing, and rinsing with mouthwashes approved by the American Dental Association. Regular visits to the dentist (twice a year) should be made for dental examinations and for professional teeth and gum cleaning. Bad breath can also be combated by drinking plenty of water every day to encourage saliva production. An occasional swish of the mouth with water can loosen food particles. Other products that keep breath fresh and prevent plaque from forming include sugar-free gum, sugarless lozenges, raw carrots and celery. TreatmentThe treatment of bad breath depends on its cause. When To Call A ProfessionalCall your dentist promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth. Also, call your doctor if your bad breath occurs together with a fever, sore throat, a postnasal drip, a discolored nasal discharge or a mucus-producing cough. Even if you have none of these associated symptoms, call your dentist or physician if your bad breath persists despite a good diet and proper dental hygiene. If you are a diabetic or have chronic liver or kidney disease, ask your doctor how bad breath can be a sign that your underlying medical condition needs immediate medical attention. PrognosisOnce halitosis has been diagnosed, the prognosis for fresh breath is usually excellent as long as you adhere to your dentist's or physician's treatment plan. Additional InfoAmerican Dental Association National Institute of Dental and Craniofacial
Research
Bad Breath By Marvin Goldfogel, DDS From Discovery Health http://health.discovery.com/diseasesandcond/encyclopedia/2282.html Bad breath refers to an unpleasant, unusual, or offensive odor to the breath. What is going on in the body? Bad breath can be caused by factors within the mouth, which are referred to as local factors. It may also be caused by systemic factors, which means bodywide diseases or conditions. What other signs and symptoms are associated with this symptom? A person who has bad breath may not be aware of the odor. However, his or her acquaintances and the healthcare provider are generally aware of the problem. What are the causes and risks of the symptom? Following are some local causes of bad breath: · poor oral hygiene · smoking · tooth abscess · impacted wisdom tooth · certain foods, such as garlic · not eating for a long time · alcohol · mouth or throat infections, such as strep throat · gingivitis, which is an inflammation of the gums · periodontitis, or an inflammation of the structures supporting the tooth · sinus infection · cold or flu · nose infection · overgrown tonsils catching food, which is common in children
Some systemic, or bodywide, causes of bad breath include the following: · drugs and medications · kidney disease · lung abscess, or pus pocket within the lungs · bronchitis · conditions that cause dry mouth, such as Sjogren's syndrome · stomach or bowel problems · constipation · poorly controlled diabetes · liver disease · certain kinds of cancer · infection with the AIDS virus What can be done to prevent the symptom? Prevention of bad breath starts with good oral hygiene. People should brush twice a day with fluoride toothpaste and floss teeth daily. Removable dentures should be taken out at night, cleaned, and soaked overnight. Mouthwash is not an effective treatment for bad breath, since it hides the real cause. Mouthwash can also irritate the tissue in the mouth. Mouthwash and breath mints are only temporary solutions and may mask more serious problems. Also, some breath mints may contain sugars, which can cause cavities. Someone in good health may have bad breath at times, such as in the morning after a long sleep. However, a person with persistent bad breath should see a healthcare professional. How is the symptom diagnosed? It is difficult to self-diagnose bad breath. If bad breath is suspected, an examination by a healthcare professional might be needed. If an underlying disease or condition is suggested by a history and physical, further tests may be ordered. What are the long-term effects of the disease? Bad breath itself has no long-term effects. However, underlying disease, such as diabetes, can cause significant problems if it goes untreated. What are the risks to others? Bad breath is not contagious and poses no risk to others. However, an underlying disorder such as AIDS may be highly contagious. What are the treatments for the disease? If improving home oral hygiene does not remove the bad breath, a healthcare professional should be seen. Once the cause of bad breath is found, the problem is usually solved quickly. What are the side effects of the treatments? There are no side effects to good oral hygiene. What happens after treatment for the disease? Once bad breath is eliminated, there should be no further treatment. How is the disease monitored? Any new or worsening symptoms should be reported to the healthcare provider.
Ooh, That Smell: What to Do if It's Coming From You Dentists Discuss Treatments for Bad Breath By Denise Mann WebMD Medical News http://my.webmd.com/content/article/1728.85994 Aug. 9, 2001 -- Though there may never be an easy way to tell someone they've got bad breath, there are better ways to diagnose and treat the condition today than ever before. Call it what you like -- malodor, halitosis, or just plain bad breath -- it stinks and no one wants it. Yes, more than 90 million Americans suffer from it, and it could be a sign of a health problem. "Bad breath can be embarrassing and it can be masking gastric problems, sinus infections, or ... severe gum disease," says Mark Wolff, DDS, PhD, director of operative dentistry at State University of New York at Stony Brook, who discussed advances in treating bad breath at the recent annual meeting of the American Academy of General Dentistry in New York City. Today, he says, dentists are much more capable when it comes to treating bad breath. About 75% of bad breath stems from the mouth, he tells WebMD, and is caused when decay and debris produce sulfur compounds that cause foul odor. Better treatment begins with improved detection. And that starts with new devices, such as the Halimeter, that can detect the amount of sulfur-producing bacteria in the mouth. "Licking the back of your hand, letting it dry, and smelling it is still a powerful tool to see if you have bad breath, but now we can quantify it," says Wolff. Along with good oral hygiene, some of the most promising treatments are mouthwashes, toothpastes, and other oral products that contain both chlorine dioxide and zinc. "Zinc stops an enzyme from breaking down an amino acid that makes the sulfur -- and by doing this stops the process for a longer period of time -- while the chlorine dioxide kills the already formed bacteria," Wolff tells WebMD. "These products pack a one-two punch." His advice to people with bad breath? "Look for a product containing zinc and chorine dioxide," he says. Often such products can eliminate bad breath for up to eight hours. Another breeding ground for odiferous bacteria is a dry mouth, he says. An as-yet-unpublished study from SUNY Stony Brook found that when mouths are dried out, there's a sixfold increase in such sulfur compounds. The dryer the mouth, the less saliva, and the worse the breath, Wolff explains. Alcohol as well as some medications -- including antidepressants, asthma drugs, antihistamines, and some blood pressure medications -- may dry the mouth out, he says. "You have to get to the bacterial source and turn it off," he says. Try tongue rakes that gently scrape bacteria off the tongue, he says, and clean between the teeth with floss. Daniel Lippiner, DDS, a periodontist and halitosis specialist in Manhattan, agrees that the first step toward treating bad breath is to isolate the cause. "Treatment is dependent on what's found and what the reasons are," he says, "If the cause is gum disease then we treat the gum disease -- if it's caused by calcium deposits on the tonsils that are bad smelling, we can remove them from the folds of the tonsils."
The
Sweet Smell of Success: By Denise Mann WebMD Medical News http://my.webmd.com/content/article/1728.62385 Jessica brushes her teeth after every meal, gargles with mouthwash, flosses religiously, and pops Altoids, the 'curiously strong breath mint,' in between. But much to her and her husband's chagrin, Jessica still has terrible breath. Nov. 21, 2001 -- Jessica brushes her teeth after every meal, gargles with mouthwash, flosses religiously, and pops Altoids, the "curiously strong breath mint," in between. But much to her and her husband's chagrin, Jessica still has terrible breath. Bad breath, or halitosis, affects an estimated 60 million people in the U.S., and Americans spend approximately $10 billion a year trying to banish bad breath. Don't despair, says Louis Malcmacher, DDS, a general dentist in Cleveland. Research on the causes of bad breath has paved the way toward more effective treatments. "There is new help for bad breath because we have finally been able to identify the source of the problem and the treatments are based on research," he tells WebMD. But effective treatment starts with a trip to the dentist, he says. The cause of some cases of bad breath is bacteria that live in the deepest pockets of the tongue and gums, so mouthwash and toothbrushing does not always get to them, he says. The bacteria produce volatile sulfur compounds, and if there is enough buildup of these sulfur compounds, the result can be bad breath. "Everyone has these bacteria," Malcmacher tells WebMD. "But with most people, it's more or less in check. However, the people with bad breath have a higher number of these bacteria in their mouths." Enter new treatments, including special mouthwashes available through your dentist, tongue brushes to get at plaque lurking in the crevices of the tongue, and sonic toothbrushes that zap away the plaque and bacteria hiding in the gums. "Your dentist has many new treatments including a specially form-fitted plastic mouth tray that will hold some peroxide right next to bacteria -- getting rid of bad breath," Malcmacher says. "Most patients see a huge improvement after two weeks, but for some, it can take anywhere up to three months. A lot of people are cured for good, but you can always get a recurrence, and then you just use the trays again." None of this is to say that good oral hygiene isn't essential. If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria that can cause bad breath. Many of these bacteria also can live on your tongue and further back in your mouth, so make sure you brush your tongue, he says. As for mints like Altoids, "they are mainly perfumes and they will mask the problem, but the mouth really needs a bath, not perfume," Malcmacher tells WebMD. Jay Golub, DDS, a dentist in Sunnyside Queens, NY, says that oftentimes bacteria and plaque lurk behind ill-fitting crowns and bridges where they can cause bad breath. "If they are changed to fit better, fewer bacteria will hide there," he says. "We flush the bacteria out, and the problem reverses itself." People who wear dentures that are not cleaned properly also can harbor food and bacteria, and cigarettes, cigars, pipes, and chewing tobacco also can be major cause of breath problems, he tells WebMD. Sometimes bad breath stems from the stomach. Acid from foods may travel up the esophagus, resulting in a bad taste and bad breath. Usually, over-the-counter acid neutralizers can help, he says. As for persistent bad breath or a bad taste in the mouth, that should not be ignored, Golub stresses, because it is one of the warning signs of gum disease. Bad Breath by Professor Mel Rosenberg Ph.D., Tel Aviv University (see Bad Breath) |
