Dear Dr. Reitz: My husband has bad breath, which I am sure is obvious to anyone he is close to when speaking. He tried mouthwash, but it only works for a few minutes. What other options exist to cure this problem? – Carol, Sinking Spring
Dear Carol: Bad breath, termed halitosis, is a problem that is thought to effect at least 50 percent of the population. If it lasts a day or two the foul odor is usually being caused by something in the diet such as onions or garlic. The most common form of chronic bad breath originates in the mouth, called intraoral halitosis. This problem is easy to treat because it is caused by gram negative bacteria that live on the tongue or the gum tissue surrounding the teeth.
The mouth is home to hundreds of different bacteria that feed on the food left behind on the teeth and tongue. When pathogenic gram-negative bacteria take over the area, they produce volatile sulfur compounds, which smell like rotten eggs. Fortunately, most oral bacteria live in one location, on the back of the tongue, which is why tongue brushing is effective at reducing 70 percent of the cases causing bad breath. Eliminating the gram-negative bacteria that populate the gums requires frequent professional dental cleanings, effective home care, and often a course of antibiotics.
Hopefully your husband is not part of the 0.5 to 3 percent of the population effected with extraoral halitosis, which we are only beginning to understand. Extraoral halitosis can originate in the nose, sinuses, tonsils, and esophagus, and in some individuals even the blood. New published research out of Radboud University in the Netherlands suggests some people inherit a defective gene that causes extraoral halitosis. People born with the defective gene cannot rid their body of sulfur containing byproducts produced by bacteria in the stomach. There is no treatment for this form of halitosis, but it may be possible to control the odor from inherited halitosis through dietary measures.
Identifying the smell may help in finding the cause. A vomit smell can indicate gastric reflux and stomach acid backup into the esophagus. An ammonia smell can result from a problem with the liver. Kidney problems often cause fishy odor breath plus a salty tasting saliva. Untreated diabetics often develop a sweet breath from the buildup of ketone bodies in the blood. In all these cases, it is important to seek a physician’s help in making the diagnosis.