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                                                        DR. DAN PETERSON

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     Halitosis, known as bad breath, can affect any of us at any time.  
About 50% of the population suffers from halitosis.  
The hard news is that it is offensive to most people. 

Don't let bad breath interfer with your relationships with others!

What Causes Bad Breath?

     Most of the time (85%-90%) bad breath originates in the mouth.  It is caused by bacteria  in our mouth.  This bacteria is breaking down food debris which creates by-products called volatile sulfur compounds  (methyl mercaptan and hydrogen sulfide) which emit a smell similar to rotten eggs.  Because this bacteria needs an environment free of oxygen, they will live in areas that are difficult to reach-such as pockets around teeth; the grooves in the tongue  and especially on the back of the tongue.

     In some conditions, the odor may be caused by:

bullet  a systemic condition, such as diabetes
bullet  sinuses problems
bullet  troubles with the pharynx, lungs or stomach
bullet  respiratory tract infection  
bullet  dieting
bullet  postnasal drip
bullet  chronic bronchitis
bullet  gastrointestinal disturbance
bullet  liver or kidney ailment
bullet  poor dental hygiene Infrequent or improper brushing and flossing can leave food particles to decay
bullet  infections in the mouth - gum disease
bullet  respiratory-tract infections - throat infections, sinus infections, lung infections
bullet  external agents - Garlic, onions, coffee, cigarette smoking, chewing tobacco
bullet  dry mouth-  caused by salivary gland problems, medications or by "mouth breathing"
bullet  systemic illnesses - Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease
bullet  psychiatric illness - people may perceive that they have bad breath, but it is not noticed by oral-health-care  professionals orothers, this is referred to as "pseudohalitosis."


     It is important that the first step you take to solving a bad breath problem is to visit your medical doctor for an examination to ensure that the cause of your bad breath is not from a physical problem.  When you have determined that it is not caused by a medical condition you will than need to provide you dentist with a complete medical history and tell your dentist how you determined you had malodor.

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    Other factors  can cause bad breath, such as :

bulletalcohol containing mouth rinses
bulletdry mouth
bulletfoods like garlic, onion and spicy foods
bulletmorning breath
bulletpoor oral hygiene
bulletgum disease
bullet and certain medical disorders like radiation therapy 
bulletEtOH is a ketone produced from dieting

     These factors are not the main cause of bad breath, the main culprit is oral bacteria.

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What happens at a halitosis examination?

  1. A complete medical history 

  2. Interview is done. You will be asked: when, how long, and how often you have perceived a breath problem.

  3. Complete periodontal charting.  One reason for this is that if you have periodontal disease the odor will be coming from the periodontal pockets.

  4. X-ray survey to rule out any obvious problems that could be causing an odor problem.  These include food traps, open contracts, open margins, poorly fitting fillings, fistulas, impactions, dry mouth, pocketing, plaque accumulation and tongue coating.

  5. Special instructions will be given before your office visit:


Do not brush, floss or use mouthwash for 12 hours preceding your appointment.


No food or drink, except water for 5 hours before the appointment.


Tobacco and alcohol products must not be used for 12 hours


Onions, garlic and cabbage are forbidden for 48 hours.  These foods have odors which are picked up by the blood system and are exhaled through the lungs for several days after a meal


Do not use antibiotics for 3 weeks so as to not artificially change the micro-organism population in the body.


Perfumes, aftershaves and other scents are discouraged.

     Two ways can be used to determine odor at exam time:

  1. Use of the doctor nose.  An increase in VSC's will produce a characteristic unpleasant odor, the evaluation of which can be developed though experience and repetition.

  2. A Halimeter can be used which measures volatile sulfur compounds in parts per billion.  Readings below 100ppb are not detectable by the average human nose and are considered "normal".  Above 100 ppb, a noticeable odor begins to build and 300-400 ppb, the unpleasant odor can be smelled from several feet away

BreathRx products are designed to help control bad breath

Bad Breath Self Test

    The key to successful treatment, is the surface of the tongue!  The dorsal surface of the tongue in cross-section is like a shag rug-papillae forming deep crevasses which defy thorough cleaning.  What collects in this surface is plaque, sticky bacterial, cellular debris and food particles which becomes an anaerobic incubator of bad odors.

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     The first step in cleansing is debridement meaning scraping of the tongue! Due to the soft, uneven, tufted surface of the tongue using a toothbrush for this purpose is next to useless. To prove this point brush your tongue and then follow up by scrapping your tongue with a tongue scraper and notice the remaining material lift by the brush which speaks volumes about its inefficiency.

 The tongue scrapper much be somewhat flexible to follow the contours of the tongue yet rippled, ridges or "rake-like" in profile to do a proper job.  Several passes of this instrument scarped lightly over the tongue twice a day will effectively remove the majority of evil-smelling debris, food, and bacterial residue.

     Most over the counter products do not eliminate bad breath.  They only hide it temporarily .  Most mouthwashes contain alcohol which dries and damages soft oral tissue and ultimately leads to even faster formation of odor causing bacteria and gum tissue damage which makes bad breath worse  ADA reports that any mouth rinses containing more than twenty-five percent alcohol can increase the risk of oral and pharyngeal caner by about fifty percent!

                          More On: Helpful Hints For Bad Breath

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Top 10 Worst Home Remedies for Bad Breath

  1. Excessive mouthwash use...this produces sloughy, bad smelling tissue that is worse than you breath!

  2. Breath mints...long lasting sugar candies subject your teeth to acid attacks and increase your risk for cavities

  3. Chewing only masks bad breath

  4. Mint chew tobacco...smokeless tobacco causes gums to recede and increases the chance of losing the bone and fibers that hold your teeth in place and can cause oral cancer.

  5. Infomerical items......use items that have the ADA Seal of Approval. Unapproved items could do more harm than good.

  6. Alcohol........will cause dry mouth causing bad breath.

  7. Brushing with is poisonous and dangerous...don't laugh people do do this!

  8. Intestinal cleansing methods........bad breath does not originate from the stomach.  Anaerobic bacteria in your mouth produces bad breath.

  9. Using mouthrinses with alcohol........dries out gum tissue and only covers bad breath it does not deal with the cause.

  10. Tongue piercing...allow you to harbor more bacteria on your tongue where sulfur compounds that cause bad breath live.
    Dentistry Today pg 42 February 2003

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Bad Tastes

Bad taste can be caused by benzodiazopenes, new restorations, oxidation of the older metallic fillings (galvanism) and saliva acidity, you have also the "fork" syndrome when touching one of these fillings that can cause metallic taste.  Also these conditions can cause metallic taste in mouth:1.Gastritis 2. G.E.R.D. 3. Jaundice4. Lead poisoning
5. Post nasal drip 6. Scombrotoxic fish poisoning 7. Heartburn 8. Tooth abscess. Feverfew and chromium may cause this condition. Echinacea can cause tongue tingling.

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New bacteria associated with halitosis identified

Employing an advanced DNA sequencing technique, investigators from the State University of New York at Buffalo have identified several previously unknown bacteria related to chronic halitosis that may offer new avenues for treatment of the affliction.

For their study, the UB investigators employed a new identification method called universal polymerase chain reaction, or universal PCR, to identify more oral bacteria that may be implicated in halitosis.
The technique permits the analysis of any short sequence of DNA or
RNA by amplifying selected sections of it.

Tongue scrapings from six adults with persistent halitosis were analyzed using both bacterial cultures and universal PCR. While the cultures revealed significant proportions of six bacteria previously implicated in halitosis, they also contained bacteria whose species could not be identified, the UB investigators said.

In contrast, the universal PCR analysis identified the unknown species as well as four others not previously associated with halitosis atopobium, erysipelothrix, firmicutes and granulicatella. The technique also revealed the presence of Solobacterium mooreii, which has recently been implicated in bad breath. The investigators said that since halitosis therapies focus on reducing the concentrations of oral bacteria that cause bad breath,
identifying more of the bacteria can lead to more effective treatments.


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The British Dental Health Foundation (BDHF) says that sugarless yogurts could help people beat bad breath while also fighting tooth decay and gum disease.

The Foundation was talking after researchers in Japan revealed that eating traditional, sugarless yogurt reduces the malodorous compounds that cause bad breath.

Volunteers in the study were given strict instructions for oral hygiene, diet and medication intake. They then spent two weeks avoiding yogurts and similar foods such as cheese before moving on to consume 90 grams of yoghurt a day for six weeks.

The study found that after six weeks the hydrogen sulphide levels (a major cause of halitosis) decreased in 80 percent of volunteers who had bad breath. Bad breath affects one in four people on a regular basis, while 19
out of 20 people are affected by gum disease at some point in their lives.


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The study focused on the psychosocial and breath odor history. . Society uses odor as a means to define and interact with the world. The olfactory, smelling experience is intimate, emotionally charged and connects us with the world. It follows that the smell from mouth breath odor can connect or disconnect a person from their social environment and intimate relationships. How one experiences one's own body is very personal and private but also very public. Breath odour is public as it occurs within a social and cultural context and personal as it affects one's body image and self-confidence. Body image, self-image and social relations mesh, interact and impact upon each other. Breath odor is a dynamic and interactive aspect of the self-image. In addition, breath odor may be value-coded as 'bad'. In 75% of the cases reviewed, decreased self-confidence and insecurity in social and intimate relations led clients to seek treatment at the specialized breath odor clinic.  When a person perceives a constant bad breath problem, she/he uses defense techniques, and may avoid social situations and social relations. This affects a person's well-being.

International Journal of Dental Hygiene Volume 1 Issue 4 Page 213 - November 2003 Social relations and breath odor L McKeown 

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Tea Fights Bad Breath 

Compounds found in tea can stop the growth of bacteria that cause bad breath, . Polyphenols, chemical components of tea, prevent both the growth of bacteria responsible for bad breath and the bacteria's production of malodorous compounds.  It is caused by foul-smelling volatile sulphur compounds, like hydrogen sulphide, produced by anaerobic bacteria that thrive in environments lacking oxygen, such as the back of the tongue and deep gum pockets. The polyphenols found in tea include chemicals called catechins and theaflavins. Catechins are found in both green and black teas, while theaflavins are found predominantly in black tea. 

Key ingredients to look for in a product for bad breath treatment:

  1. Cl02 

  2. Zinc Acetate

These  are on top as controlling agents for volatile sulphur and volatile organic compounds (the actual "smelling stuff" of halitosis).#

Cranberry Breath

Wish you could sweeten your breath . . . and the breath of people around you? Serve cranberries.
Cranberries just may have the power to crush the offensive-smelling bacteria that can build up in your mouth and lead to bad breath. Apparently, the tart berries make the bacteria less sticky, so plaque is less likely to form. Plaque not only makes your breath less than aromatic, but also it can lead to cavities and gum disease.
RealAge Benefit: Flossing and brushing your teeth daily can make your RealAge as much as 6.4 years younger  9/00

Real Age

Watch Your Tongue! 

Do friends offer you mints when you get too close? Brushing your teeth twice a day may not be enough. Your tongue needs attention, too.
Malodorous, plaque-causing bacteria not only build up on your teeth, but they also can build up on your tongue. 
RealAge Benefit: Flossing and brushing your teeth daily can make your RealAge as much as 6.4 years younger.  10/00


~We have NO financial interest in this company.

Researchers Identify Bacteria Associated With Good and Bad Breath, RDH on line,3/03
Resource: Back to the Basics in Breath Treatment. by Dr. Melvin Babad,  Dental Equipment & Materials May 2001 pgs 54-57
#IDF, Mel Rosenberg, PhD., a professor of microbiology at the School of Dental Medicine at Tel Aviv University

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