FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

IF SIMPLE MEASURES DON'T CURE BAD BREATH, SEE DOCTOR

Question: What causes bad breath, and what can be done for it besides using mouthwash?

Answer: From time to time, each of us has experienced this problem. Bad breath, sometimes known by the fancy term halitosis, is not a disease itself but merely a symptom. It can be a symptom of a specific disease or more frequently of dietary "indiscretion," a lapse in oral hygiene, or just getting up in the morning. Regardless of its cause, it always has some associated social consequences.

Most "morning breath" odor, which makers of mouthwashes and breath mints make us all acutely aware of, originates from the growth and metabolism of bacteria that live in the mouth. And as the advertising suggests, brushing one's teeth or using a mouthwash will quickly improve this cause of halitosis. I suspect you know this and, therefore, are writing because of a more persistent problem.

More persistent halitosis can originates from severe dental decay (cavities) or chronic infection of the gums (gingivitis). In these conditions, the bacteria have established an infection that actually invades normal healthy tissue. A simple "swish" of mouthwash may temporarily perfume the breath without changing the underlying cause. In a short period of time, the bad breath returns.

Other infections of the sinuses, nose, throat and tonsils can cause halitosis. In fact, Strep throat and infectious mononucleosis each have distinctive aromas that a trained nose can detect across the room. The acute "whole-body" illness that accompanies these complaints makes identifying the underlying cause fairly easy. Once the underlying infection is treated, the halitosis disappears.

Most causes of persistent and objectionable breath odor originate from outside the mouth. Lung pathology, particularly chronic bronchitis, bronchiectasis, and lung cancer have associated halitosis. Chronic liver disease and liver cancer also cause a persistent fetid odor to the breath.

Fortunately, most people with bad breath have other less serious causes. Bacterial action upon the food we eat forms malodorous gasses in the intestines. These gasses are often acted upon by other bacteria and pass from the body as flatus. However, some portion of the gas is absorbed by the blood and carried to the lungs. There it is given off as part of normal respiration, thereby causing "bad breath."

In the same fashion, foods and drugs may have volatile components that are released in the digestive tract and then carried by the blood to the lungs, where they are exhaled. Garlic is a good example of this. One delightful Italian meal will take at least 24 hours to clear the garlic aroma from the breath. As one eats more garlic, the strength and, to some extent, the duration of the bad breath increases. Brushing the teeth, using a breath mint, or using a mouthwash only temporarily changes the odor in these situations.

So look at your diet and oral hygiene habits. You may discover the cause and cure for you bad breath. If you don't, see your family doctor.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.