THERE are some patients who boldly admit that the only reason they visit my clinic is because they have bad breath. But I rather suspect that there are many others who come see me for the same reason, but are too ashamed to admit it. So, let me examine some of the conditions and circumstances which can cause or aggravate this totally preventable situation.

Regular readers of this column should know that the most common and fundamental source of bad breath is related to the presence of oral bacteria. The mouth is practically the ideal breeding place for germs: Warmth, moisture and food. There are, however, other factors which also influence the odour of one’s breath. In fact, the quality of a person’s breath is multi-factorial.
Let us look at some details of specific issues and conditions related to the presence of bad breath. But before dealing with the specifics of why bacteria cause odours, and specifically how to clean these bacteria away, at this point in our discussion, just realize that anything which promotes oral bacterial growth will most likely promote bad breath too.
Everyone knows that certain foods have a reputation for causing bad breath; possibly the two most notorious ones are garlic and onions. Incidentally, alcohol is included here. When foods are digested, their component molecules are absorbed by our bodies, and subsequently carried off in our bloodstream. Some of these molecules, which can have very unique and unpleasant odours, 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 I consider to be clinically critical. 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.
You are probably familiar with people who have ‘smoker’s breath’. While the odour associated with smoking is multi-factorial, a great part of it is related to the tar, nicotine, and other foul-smelling substances derived from tobacco smoke, which accumulate on a person’s teeth and the soft tissues of the mouth (tongue, cheeks, gums).
Once again, this is not the precise type of bad breath we will address here. Short of quitting smoking, there is no effective way to totally eliminate smoker’s breath, although immaculate oral hygiene can help reduce it. As a contributing factor, the act of smoking does have a drying effect on oral tissues. Decreased moisture in the mouth limits the washing and buffering effect of saliva on oral bacteria and their waste products.
It is a known fact that persons who smoke have a tendency to have problems with periodontal disease (gum disease) than those who do not. The causative agent of periodontal disease is bacteria. Gum disease is always related to bad breath.
Even if you don’t have significant problems with bad breath, you probably have noticed that your breath is least pleasant when you first wake from a night’s sleep. This is because while we rest, our mouth dries out, due our body’s natural tendency to reduce saliva flow when we sleep. The result of this mouth dryness is ‘morning breath’, due to the exacerbation of bacterial growth.
This same souring effect is often noticed in teachers and lawyers whose mouths have become dry after speaking for prolonged periods of time. Along these lines, persons with chronically dry mouth, a condition called xerostomia, tend to have more difficulty keep their breath pleasant.
Moisture in our mouth helps to cleanse it; the presence of moisture encourages us to swallow. Each swallow we take washes away millions of 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 which live in our mouths.
Saliva is a special form of mouth moisture; it is the body’s natural mouth-rinse. Beyond the washing and diluting effect, saliva also contains special compounds which kill oral and other bacteria which 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 mouth. This can be the side effect of the medication a person is taking.
Antihistamines (allergy and cold medications), antidepressants, blood pressure agents, diuretics, or anti-anxiety medications are each known to produce dry mouth syndrome. As a person ages, they may find mouth dryness becoming more of a problem. It seems that with age, our salivary glands tend to work less effectively, and the composition of our saliva changes also. Both of these factors result in less effective salivary cleansing and buffering. That is why there is artificial saliva on the market.
Compounding the problems associated with mouth dryness, long-term sufferers of xerostomia are known to have an increased susceptibility to tooth decay and peridontal disease.