Life in the Fast Lane

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It’s a taboo subject for which many people dare not breathe its name — bad breath or halitosis — when you can’t stomach the rancid smell of your own breath that reeks like something died in there.

Photo Hendricks NY

Some sufferers of halitosis are so ashamed that they have their sinuses flushed, undergo surgical explorations and even have their tonsils removed. They may even become depressed and get agoraphobia as a result. “We take the problem very seriously.” says Dr. Phil Stemmer of the Fresh Breath Centre in London.

Photo Er!ck

“Patients regularly tell me their bad breath affects their every waking moment.” says the dentist, who has seen up to 50,000 patients.

“I’d been a dentist for 20 years and have always had a special interest in trying to cure and prevent gum disease. Often, patients with gum problems also have bad breath and I wanted to find out why, so I spent more than 4,000 hours with a team researching bad breath before opening the centre.”

“Huge strides in diagnosis such as studying bacteria under a microscope, in the mouth, on the tongue, between the teeth have been made and happily, we now know how to treat what has become one of the last taboos.”

Dr. Stemmer expresses confidence that he can cure the problem in more than 95% of cases.

Clark Gable was a notorious halitosis sufferer, though it didn’t appear to put off all the ladies.

Kiss Me Quick: Clark Gable and Vivien Leigh in
Gone With The Wind. Photo Daily Mail

Bad breath is nearly always due to poor dental hygiene which causes a build-up of bacteria in the mouth. There are 2 types — one uses oxygen, the other can only grow without it.

Too much of the latter is generally believed to be responsible for smelly breath as it leads to a fierce combination of volatile sulphur compounds such as hydrogen sulphide, dimenthyl sulphide and methyl mercaptan with others including nitrogen containing gases such as cadaverine (smell of corpses) and putrescine (smell of decaying meat).

If you have bad breath these gases can overwhelm others when you speak or exhale.

Photo Goombay

Although the condition may be caused by poor oral hygiene, Dr. Stemmer has seen patients who clean their teeth as much as 20 times a day and still suffer, in which case their technique may be wrong.

“They may be cleaning their teeth incorrectly and missing the buildup of core bacteria that is causing problems.” he says.

“Those with gum disease will, for example, have 4 times more bacteria in the mouth than those with healthy gums. Excessive bacteria may also occur due to illness — such as colds, flu or diabetes, which can lower your immune system — or because of low fluid intake, stress and lack of salivary flow. Anything that dries the mouth will make it worse, particularly alcohol. Coffee does, too.”

Bad breath caused by dry mouth — xerostomia — occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth. If you suffer from dry mouth, your dentist may prescribe anartificial saliva, or suggest using sugarless candy and increasing your fluid intake.

“Very rarely is it a problem with the stomach, although many people think it must be.” he says.

And diet has precious little to do with the problem either, he adds. “If you eat garlic, onion or pizza, you’ll smell of garlic, onion or pizza, and if you stop eating it you won’t. But with bad breath, whatever you do you’ll smell of it.”

Once the food is absorbed into the bloodstream, it’s transferred to the lungs, where it’s expelled. Brushing, flossing and mouthwash will only mask the odor temporarily. But the odors only continue until the body eliminates the food. Dieters may also develop unpleasant breath from infrequent eating.

Photo Kaksisa

Dr. Stemmer’s first diagnostic tool is a halimeter — a white rectangular box that measures 2 of the smelliest sulphur gases contained in exhaled air. He attaches a red and white drinking straw to one end of a clear plastic tube and vacuums air from the mouth.

“Under 50 is nothing to worry about, anything over 150 would be noticed socially but we’ve had people in here registering as high as 2,000.”

But with 50 to 60 other ghastly oral gases to check for, he cannot take one test in isolation, so a trained odor judge is used to evaluate breath on a scale of 0 to 5. “This can range from ’slightly unpleasant’ at the lower end, to ‘dog’s breath’ in the middle, to ‘dragon’s breath,’ way off the scale.” Dr Stemmer says.

Dr Stemmer’s most remarkable revelation is that some people think they have a problem when they don’t. “Someone will register zero on the halimeter yet can’t accept it. It’s all in their minds, but a low reading does go some way to convincing them otherwise.”

Persistent or chronic bad breath affects some 25% of the population in varying degrees. It can negatively affect the individual’s personal, social and business relationships, leading to poor self-esteem and increased stress.

Origins of Bad Breath
Though the causes of breath odor are not entirely understood, most unpleasant odors are known to arise from proteins trapped in the mouth which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Several dozens of these can produce high levels of foul odors when incubated in the laboratory.

Photo Madirakshi

Tongue
The most common location for mouth-related halitosis is the tongue. Large quantities of naturally occurring bacteria are often found on the back of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells and postnasal drip.

When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the ‘rotten egg’ smell of volatile sulfur compounds such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide.

Gum disease
There is some controversy over the role of periodontal diseases in causing bad breath. Whereas bacteria growing below the gumline have a foul smell upon removal, several studies reported no statistical correlation between malodor and periodontal parameters.

Photo Sasa Cam247

Nose
The second major source of bad breath is the nose. In this instance, the odor exiting the nostrils has a pungent odor which differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.

Tonsils
Putrefaction from the tonsils is generally considered a minor cause of bad breath, contributing to some 3 to 5% of cases. Although approximately 5% of the population suffers from small bits of calcified matter in the tonsils, which smell extremely foul when released, they don’t necessarily cause bad breath.

If you believe you have a problem, Dr. Stemmer says your first inquiry should be the dentist and not the doctor.

Sources: Daily Mail, ADA and Wikipedia

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