Bad Breath (halitosis)

Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

Emergencies
Even though you are careful, you may occasionally damage your appliances. Wires and brackets can become loose or break. Typically, this is not an emergency situation. If the patient is not in discomfort, you can call the office and make an appointment to come in when it is convenient. If the patient is in pain, please call for an immediate emergency appointment.

We want our patients to be informed of problems that may occur and understand how to solve them, at least temporarily, until it is possible to return to our office.

Loose Bracket
If a bracket comes loose from the tooth, call our office so we can determine if an emergency appointment is indicated. If the patient is comfortable and if it will not cause any problems or delay in treatment, additional time can be allowed to reattach the bracket at the next regularly scheduled appointment. If it is causing discomfort, we will schedule an immediate emergency appointment. If the loose bracket is still attached to a wire, leave it in place and apply wax to keep it from moving on the wire if it is bothersome. If the bracket comes completely out, place it in an envelope and bring it to your next appointment.

Broken Archwire
If a main archwire breaks (the one that goes all the way around the outside of your braces), you should leave it in if it is not uncomfortable and seems stable. If it is bothering you, you can do whatever it takes to make it more comfortable until you can visit the office to have the wire replaced. You can try such things as removing the offending piece, clipping an irritating piece with a small wire cutter or nail clipper, tucking the wire under a bracket, etc. Use wax as needed and call our office for an appointment.

Loose Wire
Try to place the wire back in the bracket. Place wax if there is any discomfort and call for an appointment.

Poking Wire
Sometimes a poking wire can be safely turned down so that it no longer causes you discomfort. Try to tuck the wire back in and out of the way with the blunt end of a toothbrush, pencil eraser or some other smooth object. If you are unable to take care of a poking wire, apply wax and call our office for an appointment.

Soreness
Periodic soreness of the teeth or surrounding tissues during treatment is to be expected. If you experience this normal discomfort, it can usually be relieved by rinsing your mouth with a warm salt water solution (one teaspoonful of salt in a cup of warm water). A mild over-the-counter pain reliever (Motrin, Tylenol, etc.) can be taken as directed.

Lost or Broken Retainers
Contact our office as soon as possible to arrange for repair or replacement of the retainer. If the retainer is cracked or has a broken wire but still fits comfortably, you should continue to wear it until you can bring it in for repair or replacement. If, for example, you break or lose your upper retainer, make sure you continue to wear your lower retainer (or vice versa), as this will help reduce the shifting potential of the teeth until you can be seen in our office.

Accidents Involving Teeth
For serious mouth injuries, the patient should initially be seen as soon as possible at the emergency room or by his/her family dentist. Once the initial trauma has been resolved, contact our office for an emergency appointment so we can repair any damage to the appliances and evaluate the affected teeth.

Please Remember
If you are involved with contact sports, we recommend you use a mouthguard. Use only an orthodontic mouthguard (not one you boil and adapt). We will be happy to supply you with one and they are also available wherever mouthguards are sold.

Our office is generally open Monday through Thursday. We can usually get you in to repair a problem quickly. In some instances, we will make you comfortable and then schedule another appointment at a later date if more involved treatment is necessary to remedy the problem. In case of an after-hours emergency, call our office and follow the instructions on the answering machine.

 

An estimated sixty-five percent of Americans have bad breath. Over forty-million Americans have "chronic halitosis," which is persistent bad breath. Ninety percent of all halitosis is of oral, not systemic, origin.

Americans spend more than $1 billion a year on over the counter halitosis products, many of which are ineffective because they only mask the problem.

What causes bad breath?

Bad breath is caused by a variety of factors. In most cases, it is caused by food remaining in the mouth - on the teeth, tongue, gums, and other structures, collecting bacteria. Dead and dying bacterial cells release a sulfur compound that gives your breath an unpleasant odor. Certain foods, such as garlic and onions, contribute to breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor. Dieters sometimes develop unpleasant breath from fasting.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Gum disease is caused by plaque - the sticky, often colorless, film of bacteria that constantly forms on teeth. Dry mouth or xerostomia may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor. Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues. Bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

  • Diabetes - acetone, fruity

  • Liver failure - sweetish, musty

  • Acute rheumatic fever - acid, sweet

  • Lung abscess - foul, putrefactive

  • Blood dyscrasias - resembling decomposed blood

  • Liver cirrhosis - resembling decayed blood

  • Uremia - ammonia or urine

  • Hand-Schuller-Christian disease - fetid breath and unpleasant taste

  • Scurvy - foul breath from stomach inflammation

  • Wegner`s granulomatosis - Necrotic, putrefactive

  • Kidney failure - ammonia or urine

  • Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor

  • Syphilis - fetid

Bad breath may also be caused by medications you are taking, including central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Caring for bad breath

Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices.

Controlling periodontal disease and maintaining good oral health helps to reduce bad breath.  If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

Improperly cleaned dentures can also harbor odor-causing bacteria and food particles. If you wear removable dentures, take them out at night and clean them thoroughly before replacing them.

If your dentist determines that your mouth is healthy and that the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment. If the odor is due to gum disease, your dentist can either treat the disease or refer you to a periodontist, a specialist in treating gum tissues. Gum disease can cause gum tissues to pull away from the teeth and form pockets. When these pockets are deep, only a professional periodontal cleaning can remove the bacteria and plaque that accumulate.

Mouthwashes are generally ineffective on bad breath. If your bad breath persists even after good oral hygiene, there are special products your dentist may prescribe, including Zytex, which is a combination of zinc chloride, thymol and eucalyptus oil that neutralizes the sulfur compounds and kills the bacteria that causes them. In addition, a special antimicrobial mouth rinse may be prescribed. An example is chlorhexidine, but be careful not to use it for more than a few months as it can stain your teeth. Some antiseptic mouth rinses have been accepted by the American Dental Association for their breath freshening properties and therapeutic benefits in reducing plaque and gingivitis. Instead of simply masking breath odor, these products have been demonstrated to kill the germs that cause bad breath. Ask your dentist about trying some of these products.