- The Washington Times - Monday, September 15, 2003

We’ve all probably suffered from it at one point or another, but even our closest friends and family might not tell us so. Halitosis — or, as it’s commonly referred to, bad breath — isn’t something we like to discuss.

It’s fairly natural, though, for a person’s breath to not always carry a clean or odorless scent. We eat too much garlic, cook with too much onion and brush improperly too often, allowing bacteria to gain a foothold in our mouths.

Bad breath is primarily caused by that bacteria, aided and abetted by food particles, collecting in a person’s mouth. The food collects between teeth, around the gums and on the tongue, helping the growth of naturally occurring bacteria.

Sub-par oral hygiene isn’t the only way bad breath happens. An early symptom of periodontal disease — in which a person’s gums begin to recede — is bad breath. Bad dentures or fillings also can spark nasty breath.

If a person has bad breath and isn’t suffering any periodontal disease or other mouth ailments, “it’s just a matter of not pursuing good oral hygiene,” says Dr. George Obeid, chairman of the oral surgery department at the Washington Hospital Center.

“A lot of the time people are unable to tell if they have bad breath or not,” he says. “Many people have bad breath, but they’re unaware of it.”

A simple tongue scraper can go a long way toward combating pungent breath. Using one before bed makes sure the bacteria won’t have time to fester and regroup during the night. The process should be repeated come morning.

“It’s becoming more evident that the collection of plaque on the back of the tongue is a significant contributor to bad breath,” he says.

A good, soft toothbrush can do the trick just as well as a tongue scraper.

People typically gulp down a few breath mints as a key line of defense, but these are only temporary measures, he says.

“They’re not addressing the problem. You want to get rid of the plaque and bacteria,” Dr. Obeid says.

A diet filled with garlic and onion might be another cause of breath distress. Those foods can cause bad breath once eaten and for a spell afterward.

“The odorous particles,” he says, “circulate in the blood and eventually it gets released in the lungs. That way the smell is going to linger.”

Dr. Richard H. Price, spokesman for the American Dental Association near Boston, says bad breath is not just a medical condition, but a social problem.

“It can be socially paralyzing,” Dr. Price says. Some patients are so cognizant of their breath they speak with their hands covering their mouths.

Dentists, too, may be reticent to discuss the matter. Numerous area dentists contacted for this article either didn’t return phone calls or let it be known they didn’t want to comment.

A bad breath sufferer might fear others believe his or her foul breath is a sign of dental neglect. Often, that isn’t the case. Someone can suffer from bacteria-borne bad breath even if they follow a regular regimen of brushing.

“Even in the healthiest of mouths you can have a problem,” Dr. Price says.

Those who want to test their breath for a nasty smell can pinch their nose closed, take a deep breath and hold it for a few seconds. Slowly breathe out and have someone inhale near your nostrils.

The bacteria that causes the smells are anaerobic, meaning they thrive without oxygen. They camp around the back of the tongue, a perfect spot away from the casual tooth brusher, and create volatile sulfur compounds. It’s also an advantageous location for bacteria in those with postnasal drip. In those sufferers, a thin mucus layer can protect the bacteria from oxygen and let it take root.

Dentist H. Charles Jelinek Jr. of Fairfax says he finds periodontal disease is the main culprit whenever his patients complain of bad breath. Another concern is his senior patients, who aren’t as adept at reaching the food debris between their teeth as others.

“It’s more of a subjective thing,” Dr. Jelinek says. “I’m in tune with it. For the average person it has to be fairly pronounced for them to pick it up.”

He estimates anywhere from 10 percent to 25 percent of his patients will exhibit symptoms of bad breath at some point. Part of that could be due to temporary causes like a garlic-rich diet.

A steady diet of garlic and onions can taint one’s breath, but so can adherence to a strict diet, such as the Atkins program.

Some Atkins proponents, whose diet favors meats and protein-rich food over carbohydrates, complain of poor breath when they initially switch to the diet. On the Web site www.atkinsdietbulletinboard.com, several Internet users swap tips on how to avoid the diet’s bad breath, such as drinking plenty of water.

Dr. Price says Atkins dieters have an increase of ketones — acids left behind when your body burns fat for fuel — in their system, which affects their lungs in a way similar to garlic and onion can.

“The body was meant to take a rounded diet and the Atkins isn’t a rounded diet,” he says.

District-based dentist Dr. Linda Check says while her patients haven’t had any concerns regarding the Atkins diet and poor breath, she says a stubborn cause of bad breath can be rotting food caught in the involutions of the tonsils.

“When you’ve got that, the breath is bad,” Dr. Check says. “Some tonsils have pockets in them. The food gets down to the bottom of the pockets … and forms a hard, white ball.”

Dentists have instruments that can get at these hard-to-reach spots, she says. A more drastic measure would be to have the tonsils removed, she says.

Those looking to stave off bad breath should keep their mouths as moist as possible. Dry mouths are more of a concern in the winter as man-made heating units rob the air of moisture. Dr. Price recommends those with a propensity for dry mouth run a humidifier during the day.

“The drier the mouth is, the more the bacteria can be active,” Dr. Price says.

A good, proactive approach to fighting bad breath is to eat a balanced diet, drink plenty of fluids and regularly scrape the back of one’s tongue.

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