BAD  BREATH 

Bad breath is a condition that can be embarrassing and a social handicap to
those who suffer from it.  Fortunately now that more is known about the causes of the problem, meaningful help can be given in the majority of cases.

Basically bad breath originates locally (in the mouth) or systemically 
(from causes not associated with the mouth).

LOCAL  CAUSES

Plaque

If plaque is allowed to accumulate around the teeth near the gum line the adjacent gums will become reddened (inflamed) and bleed easily when brushed. 
If nothing is done about this condition the toxins from the plaque will gradually destroy the attachment that exists between the gum and the root of a tooth.  If this attachment is destroyed a small space or pocket develops which is then filled up with plaque.

The plaque in these pockets can produce an offensive odour.  Old fillings and
cavities filled with food debri can also give rise to a disagreeable odour.

To eradicate bad breath caused by plaque, plaque must be removed thoroughly by various methods. 
Removing plaque from the gum line area is done by using a soft toothbrush and dental floss. 
The toothbrush is placed on the tooth and aimed at the gum line at an angle of 45 degrees.  It is then either jiggled or moved in tight little circles. 
Plaque between the teeth is removed with dental floss.
Flossing should be carried out at least once a day.
Follow this procedure by rinsing the mouth with an antiseptic mouthwash. 

Remember if the gums bleed, it is a sign to brush more - not less! 
The bleeding will disappear after four to five days as long as one perseveres.

A trip to the dentist is also essential to remove any rough edges on fillings 
or to repair any cavities that may be present. 
Just as importantly the dentist will use special instruments to clean the plaque and calculus (hardened plaque) from the pockets between gum and tooth. 
If the pockets are not deep, this conservative cleaning will be all that is required.  However deep pockets may have to be eradicated using a surgical approach. A referral to a specialist Periodontist will usually be recommended.

Sleep

During sleep there is a reduction in the flow of saliva into the mouth which means that the important cleaning action of saliva is lessened. 

In addition the saliva that is present tends to stagnate.  These two factors 
give rise to the bad breath that is often noticed on awakening in the morning. 
Cleaning the teeth on arising should eliminate the malodour.

Smoking

 Smoking, causes bad breath and encourages the development of a condition known as "hairy tongue". 
This further aggravates oral malodour because the "hairy"surface of the tongue traps food debris and tobacco odour.  Smoking also decreases the flow of saliva thereby increasing the likelihood of a really bad breath.

Unclean Dentures

Unclean dentures can produce a most unpleasant smell.
Denture wearers should clean their dentures very thoroughly after every 
meal to minimise the problem. 
Dentures can be soaked overnight in 10% Bleach solution.
The dentures must be given a thorough rinsing in water before replacing in the mouth.
A build up of calculus can be removed by soaking overnight in lemon juice or  vinegar.
Often, a poor fitting denture will encourage build-up of debri and this results in odour.
In this case consult your dentist regarding a reline of you denture, or consider a new denture. 

SYSTEMIC CAUSES

Sinusitis and Tonsilitis

Chronic sinusitis or tonsilitis is often the cause of bad breath. A thorough examination by an ENT (Ear,Nose,Throat) specialist may be required.

Diet

It has long been recognised that foods such as garlic and onions
will cause bad breath, however, it may not be as widely known that "fad"
diets and improperly balanced diets can also give rise to this problem. 
An excess of certain items such as meat can also be a cause. 
Essentially what happens is that some parts of some proteins and fats, if taken in excess, are absorbed from the gastrointestinal tract into the bloodstream and are then transferred into the expired air via the lungs. 
The end result is bad breath. 

Halitosis from dietary causes, other than garlic or onions, will disappear
upon a return to eating well balanced meals.

Menstrual Cycle

The menstrual cycle has been linked with bad breath in women. 
The bacteria level in saliva increases during both menstruation and ovulation. 
It has been found that volatile sulphur concentrations in expired air increase up to four times the normal level around mid-cycle, at or near ovulation, and during menstruation.
It has been speculated that increases in volatile sulphur levels may be
related to increases in oestrogen levels.

Systemic Diseases

A variety of systemic diseases such as diabetes,
liver failure, kidney failure and tuberculosis often give rise to bad breath.

Drugs

The systemic administration of certain drugs can produce halitosis as a side effect.  Included in this category are drugs such as chloral hydrate, tranquilizers, amphetamines and anti-histamines. 

Sometimes the malodour comes from the drug passing into the blood stream 
and then being transferred into expired air via the lungs. 
Other drugs, for example tranquilizers tend to reduce the flow of saliva which in turn can lead to bad breath.

SUMMARY

If the cause of bad breath is systemic in origin, medical advice is required.
However, for bad breath of local origin the following applies:

At  Home:

Teeth and Gums:

Thoroughly clean the teeth at least three times daily. 
Use dental floss to remove plaque between the teeth. 
Do not rely on mouthwashes to treat the problem. 
They may mask bad breath for 20 minutes or so but they will not remove the underlying cause. 
There are some worries that the excessive use of some mouthwashes may
be harmful as they may upset the natural balance that exists between the 
various bacteria found in the mouth. 
Moderate use of antiseptic mouthwash is useful only when used as an adjunct to proper brushing and flossing.

Tongue cleaning:

In many cases of bad breath, the tongue is found to have a thick coating at the back.  In these cases, the tongue should be cleaned using a soft toothbrush. 
The tongue must be thrust forwards  as far as possible.
Use a soft brush (without toothpaste) and stroke brush from back of tongue forwards. 
Gagging reflexes will make this a difficult procedure for some people.

At the Dentist:

The dentist or Hygienist will thoroughly clean your teeth and point out any areas of plaque being missed by poor brushing technique. 
Disclosing tablets - available from your pharmacy will help identify plaque that you have missed.
Cavities should be repaired and other sites of food stagnation eliminated. 
(see articles on the troublesome triangle and wisdom teeth)