Do you have bad breath?

How is your breath, not sure? No doubt at some point each of us has unwittingly had bad breath (halitosis) only to subsequently be embarrassed by the reactions of those around us.

For any individual the exact status of one's breath can be difficult to ascertain. The reason for this lies in the fact that the oral cavity, the source of our breath, is connected to our nose by way of an opening which lies in the back of our mouth (back in the region of our soft palate). Since noses tend to filter out and ignore background odors, it filters out and ignores our own bad breath. This means it is quite possible for a person to have bad breath, yet not be aware of it.

So, how can you tell if you have bad breath?

Is there a way a person can test his own breath?

There are ways to accurately smell your own breath, however you have to take a slightly indirect route.

Try this technique. Lick your wrist, wait about five seconds while the saliva dries somewhat, and then smell it. What do you think? That's the way you smell. Or, more precisely, that's the way the end of your tongue smells (your tongue's "anterior" portion). How was it? Did you pass this first check?

Now do this experiment, it will check the odor associated with the back of your tongue (your tongue's "posterior" aspect).

Take a spoon, turn it upside down, and use it to scrape the very back portion of your tongue. (Don't be surprised if you find you have an active gag reflex.) Take a look at the material that has been scrapped off, usually its a thick whitish material. Now, take a whiff of it. Not so bad? Pretty nasty? This smell, as opposed to the sampling from the anterior portion of your tongue, is probably the way your breath smells to others.

The fundamental cause of bad breath is...

How academic researchers test for bad breath.

Organoleptic judging of bad breath.

The problem one encounters with organoleptic testing is that it does not provide an evaluation of bad breath that is totally objective. Factors other than breath odors can and do influence organoleptic evaluations. In fact research has shown that factors such as hunger, menstrual cycle, head position, and the degree of attentiveness and expectation can each influence a judge's interpretation of what they smell.

As for quantifying the organoleptic measurement itself, what exactly does constitute a weak, strong, or average level of bad breath? Will each judge involved in the research be able to make equivalent comparisons? Complicating things even more, as we all know when we are repeatedly exposed to a bad odor our sense of smell acclimatizes to the odor and therefore our sense of smell loses much of its sensitivity. Bad breath that seems exceedingly objectionable at the beginning of testing may seem quite less so as the evaluation continues.

Using gas chromatography to evaluate bad breath.

While gas chromatography is probably the best way to test for the compounds associated with bad breath it has not been widely utilized in studies for several reasons. Gas chromatographs are relatively expensive and need personnel with special training to operate them. The equipment is not portable and a significant amount of time is needed to make each breath measurement.

Using Halimeters to judge bad breath.

Since Halimeters test for a fewer number of compounds than gas chromatographs (sulfides only), and in fact test for no individual compounds at all but instead just sulfides as a class, Halimeters provide for a less definitive evaluation of a person's bad breath than gas chromatographs can. Additionally, compounds such as ethanol (alcohol) and essential oils (both being compounds commonly found in mouthwashes) interfere with a Halimeter's ability to make a measurement. The advantages of using a Halimeter for a study rather than a gas chromatograph are that a Halimeter requires no special training to use, is portable, breath measurements can be made quickly, and the apparatus itself is comparatively inexpensiv

The BANA test.

The bacteria in question have the characteristic of being able to produce an enzyme that degrades the compound benzoyl-D, L-arginine-naphthylamide (abbreviated BANA). When a sample containing these bacteria is placed with the BANA compound they break it down and the result is a compound that has a different color.

Utilizing chemiluminescence in detecting bad breath.

What causes bad breath? - Conditions and circumstances which can cause or aggravate bad breath.

On our preceding page you discovered that the most common fundamental cause of bad breath (halitosis) is related to the presence of oral bacteria. There are, however, other factors that also influence the odor of one's breath, and in fact the quality of a person's breath depends on a number of variables. The next part of this discussion details some specific issues and conditions related to the presence of bad breath. Take notice that many of them directly correlate to:

How do foods cause bad breath

Everyone knows that certain foods have a reputation for causing bad breath, possibly the two most notorious ones are garlic and onions. When foods are digested their component molecules are absorbed by our bodies and subsequently carried off in our blood stream. Some of these molecules, which can have very unique and unpleasant odors, will be released into our lungs as our blood flows through them. As we exhale our breath will carry these offending molecules out of our bodies.

While this type of bad breath can be annoying or embarrassing this is not the type of breath problem we discuss on the subsequent pages of this site. Bad breath related to the consumption of certain foods will resolve on its own in a day or so as your body completes the process of breaking down and utilizing or else excreting the offending molecules. You can control this type of bad breath simply by avoiding or minimizing your consumption of these foods.

How does smoking help to cause bad breath?

Once again, this is not the precise type of bad breath we address on this site's pages. Short of quitting smoking there is no effective way to totally eliminate smoker's breath, although immaculate oral hygiene can help to reduce it.

As a contributing factor, the act of smoking does have a drying affect on oral tissues. Decreased moisture in the mouth limits the washing and buffering effect of saliva on oral bacteria and their waste products. Mouth dryness is addressed as a topic just below.

It's a known fact that persons who smoke have a tendency to have more problems with periodontal disease ("gum disease") than those who don't. The causative agents of periodontal disease are bacteria. Gum disease, as it relates to bad breath, is discussed in more detail below.

How does xerostomia (dry mouth) contribute to causing bad breath?

This same souring effect is often noticed by teachers, lawyers, and anyone else whose mouth has become dry after having to speak for a prolonged period of time. Additionally, those who breathe through their mouth, are fasting, or else are under stress will usually notice they have a comparatively dry mouth and problems with breath odors. From a physiological standpoint, persons with chronically dry mouths, a condition termed "xerostomia", tend to have more difficulty keeping their breath pleasant.

The moisture in our mouth helps to cleanse it. The presence of moisture encourages us to swallow. Each swallow we take washes away bacteria, as well as the debris and food particles on which they feed. Moisture also dilutes and washes away the waste products created by the bacteria that live in our mouths.

Saliva is a special form of mouth moisture, it's the body's natural mouth rinse. Beyond the washing and diluting effect that any moistness will produce, saliva also contains special compounds that kill oral bacteria and also buffer the effects of bacterial waste products.

When our mouth dries out all of the benefits which moisture can produce are lessened. The net result is that conditions for bacterial growth are enhanced while the neutralization of bacterial waste products is reduced. 

Some persons have chronically dry mouths, this condition is termed "xerostomia". Xerostomia can be a side effect of the medication a person is taking. Antihistamines (allergy and cold medications), antidepressants, blood pressure agents, diuretics, narcotics, or anti-anxiety medications are each known to produce xerostomia.

As a person ages they may find that mouth dryness becomes more and more of a problem. It seems that with age our salivary glands tend to work less effectively, and the composition of our saliva changes too. Both of these factors result in less effective salivary cleansing and buffering.

Compounding the problems associated with mouth dryness, long term sufferers of xerostomia are known to have an increased susceptibility to periodontal disease ("gum disease"). Periodontal disease is a causative factor of bad breath.

Can periodontal disease (gum disease) cause bad breath?

Periodontal disease is second only to the accumulation of bacteria on the tongue as being the most common fundamental cause of a person's bad breath. Since periodontal disease is usually more of a problem for person's over the age of 35 or so, the older we get the more likely that the source of our bad breath is related to conditions associated with our gums.

Periodontal disease is a bacterial infection located in the tissues that surround teeth. Advanced forms of this disease can result in serious damage to the bone that holds the teeth in place. Often as this bone damage occurs spaces between our teeth and gums (termed "periodontal pockets") develop which provide ideal locations for bacteria to live. It is often the waste products from the bacteria which reside in these periodontal pockets, pockets which are often so deep that a person cannot effectively cleanse them, which can be the source of a person's bad breath.

How can sinus conditions help to promote bad breath?

Sinus conditions can certainly have an affect on the odor associated with a person's breath. Upper respiratory infections and allergies can both promote the flow of postnasal drip onto the back portion of the tongue (by way of an opening in the area of a person's soft palate). This discharge often has a foul taste and smell. What's worse, oral bacteria will feed upon this discharge and create their own odiferous waste products which in turn adds to a person's breath problems.

As a compounding factor, persons with sinus conditions will often have stuffed up noses and therefore must breathe through their mouth. The drying effect of mouth breathing will create an environment that promotes bad breath. Sinus sufferers are also likely to take antihistamines, a type of medicine known for causing mouth dryness.

What types of dental conditions can cause bad breath?

For our discussion here the term "dental conditions" refers to those types of untreated dental pathology that are not typically the most common causes of bad breath for most people. Any active infections in the mouth, such as those associated with abscessed teeth or a partially erupted wisdom tooth, can cause bad breath. Teeth having extensive untreated decay can trap enough debris and bacteria that they become the source of foul odors. Your dentist can identify and treat these problem dental conditions if they exist.

Can untreated medical conditions cause bad breath?

Can bad breath be caused by dentures?

Remove your dentures and place them in a baggie. Seal the baggie shut and let it sit for about four or five minutes. Now, crack the baggie open and take a whiff. For better or worse, the odor you smell is representative of what your breath smells like to others.

What really is the fundamental cause of bad breath?

http://www.animated-teeth.com/bad_breath/t3_causes_of_halitosis.htm

For the majority of people (85 to 90% of those who have bad breath [halitosis]), the single most frequent cause of their breath odor problem is related to conditions in their mouth. More specifically, bad breath is usually caused by the bacteria that live in a person's mouth. Bacteria, just like people, go through their lives consuming foods and excreting wastes. The wastes of some oral bacteria are sulfur compounds and it is primarily these odoriferous wastes which usually lie at the root of a person's bad breath.

Have you ever smelled a rotten egg? The stink associated with rotten eggs is produced by the sulfur compound hydrogen sulfide. The smell emanating from feed lots and barnyards is one produced by the sulfur compound methyl mercaptan. The odor you assoicate with the ocean is due in part to the presence of dimethyl sulfide. All of these compounds are excreted as wastes by the bacteria that live in our mouths.

Together these compounds are commonly referred to as "volatile sulfur compounds" (VSC's). The term "volatile" describes the fact that these compounds evaporate readily, even at normal temperatures. The extreme volatility of VSC's explains how these compounds have the ability to offend those around us, instantly.

While volatile sulfur compounds are the principle causative agents of bad breath, the bacteria which live in our mouths also produce other waste products and some of these have their own unpleasant odors too. A few of these wastes are:

What type of oral bacteria produce the waste products that cause bad breath?

A person's mouth can be home to hundreds of different species of bacteria. And on going in our mouths at all times is a constant battle for living space between the types of bacteria which do create waste products which cause bad breath and those that don't. It is the precise balance between these types of bacteria which will determine the quality of a person's breath.

Plaque accumulation (the whitish film that forms at and below the gum line on teeth and also on the tongue) can tip the scales in favor of the odor causing bacteria. You might be surprised to learn that a layer of plaque as thin as 0.1 to 0.2 millimeters (about the same thickness as a dollar bill) becomes depleted of oxygen, precisely the type of environment in which anaerobic bacteria flourish. So, as more and more plaque forms the bacteria that cause bad breath gain available living space and proliferate, thus increasing the amount of odor causing compounds which escape with each breath.

What is the food supply for the anaerobic bacteria that cause bad breath?

Even without an obvious source, like our just having eaten a cheeseburger, it's not hard for the anaerobic bacteria in our mouths to find a snack of proteins anytime they want. There are always "natural" protein food sources floating around in our mouths such as dead skin cells or one of the many protein compounds found in saliva. And then, especially for those who are not diligent with brushing and flossing, there is always the leftover food debris from yesterday's meal, and the meal before that..., and the one before that...

High protein foods.

Where do the bacteria that cause bad breath live?

Tongues.

If you'll remember back to our experimentation at the beginning of this discussion, although the smell emanating from the anterior portion of our tongue can be unpleasant it usually it isn't the source of our breath problems. The most common odor-producing region of the tongue is its posterior (back) portion.

Go to a mirror, stick your tongue out and take a look at it. On many people's tongues you can actually see a whitish coating on its surface. The further back (towards your throat) you look the whiter this layer appears.

The surface texture of a person's tongue can affect the amount of coating that accumulates. People whose tongues are deeply grooved or furrowed will have more potential to accumulate the white coating than those with smoother tongue surfaces.

It only takes a coating that has a thickness of 0.1 to 0.2 millimeters (about the same thickness as a dollar bill) to provide an environment depleted of oxygen. This type of environment is referred to as being "anaerobic" and it is precisely the type of environment in which the bacteria that cause bad breath flourish.

Research has shown that there is a direct correlation between the amount of coating that exists on a person's tongue and the total number of anaerobic bacteria that are present. And as you can probably guess, when the anaerobic bacterial count on a person's tongue is reduced there is usually a direct correlation, an improvement, in the odor emanating from their mouth.

Periodontal sources.

Even in a relatively healthy mouth bacteria can and do find anaerobic (oxygen deprived) environments underneath the gum line both around and in between teeth. These anaerobic environments are even more numerous and available in the mouths of those persons who have suffered the ravages of periodontal disease ("gum disease").

This is because periodontal disease often results in damage to the bone that surrounds the teeth. This in turn leads to the formation of deep spaces that lie between the teeth and gums (termed "periodontal pockets"). The deep recesses of periodontal pockets can be difficult, if not impossible, to clean effectively and they are ideal anaerobic environments for the growth of bacteria which cause bad breath.

Oral malodor: philosophical and practical aspects.

Bosy A.

J Can Dent Assoc. 1997 Mar;63(3):196-201.

http://www.ncbi.nlm.nih.gov/entrez/PubMed&list_uids=9086681&dopt=Abstract

Although oral malodor or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodor, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment. The mouth air of chronic malodor sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodor with mints and chewing gum, compulsive brushing, and repeatedly rinsing with commercial mouthwashes. While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor. Proteolytic activity by microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodor. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air. Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodor over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodor research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.