Bad Breath

WHEN TO SEE YOUR DOCTOR

* Regular and thorough brushing of the teeth and tongue and flossing fail to eliminate the odor.

* A foul breath odor is accompanied by bleeding, swelling or pain in your mouth or throat.

What Your Symptom Is Telling You

You have to wonder why bad breath isn't discussed more often on the talk shows. After all, if you believe TV ads, the main reason why young love is victorious and old love renewed is because the breath of the lovers was sweet as...well, as mint or cherry flavoring.

Yes, as breath sours, so sours love. But what really gets those violins playing is a toothbrush and floss. That's because bad breath more often than not indicates gum inflammation called gingivitis or the more damaging gum disease periodontitis.

For any number of reasons—but most often because you haven't brushed and flossed as well as you should have—bacteria accumulate in your mouth, on your teeth and on your gums like mildew in a wet corner of the shower. If you don't keep teeth and gums free of the bacterial buildup, they'll start to cause odor as the bacteria rot leftover food particles in your mouth. This bacterial buildup can also lead to gum disease, according to Timothy Durham, D.D.S., director of adult general dentistry at the University of Nebraska Medical Center in Omaha. You also may even notice some bleeding or swelling of your gums along with the bad breath, he says.

If gingivitis and plaque aren't giving you breath that could fell a flower, dry mouth could also be the culprit. While some people have chronically arid oral cavities, most of us notice this dryness when we awaken. "Overnight, saliva flow is significantly reduced," Dr. Durham says, "and saliva contains protective enzymes that help keep bacteria in the mouth low." Without saliva, it doesn't take long for bacteria counts to build up. When you awaken, you have morning breath, and the only thing you want to kiss or be kissed by is a bottle of mouthwash.

Medications can also sour your breath. "Antihistamines and many over-the-counter drugs for sinus problems can cause bad breath because they dry out the mouth along with the nose," Dr. Durham says. Certain antidepressant drugs have a similar saliva-depressing side effect.

Other producers of bad breath, dentists say, include sinus or airway tract infections, inflamed tonsils or adenoids, mouth breathing, mouth ulcers, tooth decay, tooth abscesses and diseases of the liver or lungs. People with diabetes can have a sweetly acidic scent to their breath that may be somewhat objectionable. Digestive problems in which food finds its way back up the esophagus can also create an unpleasant odor.

Symptom Relief

Even if you have advancing gingivitis or periodontal disease, "the best thing you can do to eliminate bad breath is brush and floss and see a dentist for consultation and treatment of the gum problem," Dr. Durham says. See the chapter on gum problems (page 261) for how to brush properly, and check out these extra air fresheners.

Get cheeky. Don't forget to brush the insides of your cheeks, Dr. Durham says. "You should remove any debris and buildup there, too. You don't have to scrub," he says. "A few passes of the brush will do."

Brush your tongue. You often can eliminate bad breath simply by brushing your tongue, which holds the same plaque and bacteria found around your gums, Dr. Durham says. Try to brush your tongue as far back as possible, he suggests.

Dump mouthwash down the drain. All of those mouthwashes you see on TV and lining drugstore shelves are little better than useless in countering the true source of bad breath. "Brushing your teeth is a better solution than washing your mouth," says Michael Weisenfeld, D.D.S., spokesperson for the Academy of General Dentistry and a dental consultant with a private practice in Livonia, Michigan. "All mouthwashes do is mask the real problem, and they're not even a good way to cover it up at that. They're mostly just flavored water." The rare exceptions are available only by prescription, he says.

Dr. Durham agrees. "Using a mouthwash is like someone who doesn't take a bath for several days and then puts on lots of perfume to cover the odor," he says.

Take the pledge. If you suffer from dry mouth and choose to use mouthwash, look for a preparation that does not contain a high alcohol content, Dr. Durham says. Alcohol will dry out your mouth and enhance noxious emissions.

Wet your whistle. Keeping your mouth moist will help prevent the buildup of bacteria and plaque, dentists say. (For tips on dealing with a dry mouth, see page 415.)

Breathe on your dentist. If after scrupulous scrubbing you still have breath that would stop a steer stampede, it's time to visit the dentist because, most likely, plaque has hardened into tartar and your gingivitis is getting worse. "If you don't keep the plaque off, you have to come to one of us," Dr. Weisenfeld says, "and we have to scrape it off." If that doesn't do it, the dentist will have to look for other causes.