Bad Breath and Bacteria

Bad breath and bacteria go hand in hand. Few people realize how many bacteria live in the human mouth. Scientists tell us that as many as seven hundred different species of bacteria can live in our mouths, with each individual playing host to perhaps one hundred species at any given time. This may not sound good, but in fact most of these bacteria are harmless, and some are even beneficial, protecting us from disease causing organisms that might move in if they had the opportunity. Only a handful of the species living in our mouths produce volatile sulfur compounds (VSC), the bad smelling gases in oral malodor.

The link between halitosis and VSC was worked out decades ago. Some anaerobic bacteria (anaerobic means living in the absence of oxygen) break down proteins in the mouth to obtain nutrients. In the process, they release sulfur compounds as a by-product. Studies show that in at least 85% of cases, bad breath and bacteria that obtain their food in this way are closely linked. Most cases involve one or more of four specific groups of bacteria.

Studies focused on bad breath and bacteria have revealed other things about a typical case of oral malodor. The bacteria can flourish anywhere in the mouth where they are not exposed to oxygen, but in the majority of cases, the culprits live in the grooves at the back of the tongue, shielded from oxygen by a tongue coating, or biofilm, and well supplied with a protein food source from food particles, dead oral cells, and sinus drainage. Other possible oral sources of halitosis and VSC include pockets in the gums, and the tonsillar crypts, both places where there is little air flow.

Once people understand the relationship between bad breath and bacteria, they are better able to deal with the problem. In the majority of cases, vigilance toward dental and oral hygiene, including regular scraping and cleaning of the tongue to remove tongue coating will make an immediate difference in the production of halitosis and VSC. Oral products that contain essential oils, zinc chloride, and cetylpyridium chloride have been studied and there is some evidence that they’re effective. Drinking plenty of water is also helpful as it not only rinses the mouth, but also encourages plentiful saliva production.

Source: Krespi, Yosef P., Mark G. Shrime, and Ashutosh Kacker. The relationship between oral malodor and volatile sulfur compound–producing bacteria. Otolaryngology–Head and Neck Surgery (2006) 135, 671-676.

Control Morning Breath

Traditional ways to control morning breath involve oral hygiene routines and the use of commercial products upon waking. You open your eyes, yawn, swallow, and run your tongue around the inside of your mouth. Then you head for the bathroom to brush, rinse, and gargle. All this is indeed helpful: you get the saliva running again, physically remove odor producing bacteria that have multiplied overnight, and inhibit the remainder with antibacterial compounds in the products that you use.

New halitosis research, however, suggests that we can adopt daily routines that will have us waking up with less of a problem. Some products are more effective than others as preventative measures and some approaches appear to control morning breath before it happens. Researchers in South America have studied the effects of mouthwash containing chlorine dioxide, and the effects of using a toothpaste with added flavor, to see if these products reduce the amount of volatile sulfur compounds present in the mouth after sleep.

Chlorine dioxide is believed to both break down volatile sulfur compounds by reacting with them chemically, and kill the bacteria that produce these compounds through oxidation. New halitosis research has supported the claims about sulfur compounds, and a number of studies are now looking at the antibacterial activity, as well as comparing the effectiveness of chlorine dioxide to control morning breath against that of other products. The Brazilian study found that mouthwash containing chlorine dioxide (used three times daily) is more effective than mouthwash without it.

The idea of added flavor in toothpaste being used to control morning breath relies on the belief that oral malodor after sleep results from a decrease in saliva production. Less saliva allows odor producing bacteria to proliferate through the night. Because enjoyable flavors induce salivation, adding flavors to a dental hygiene routine should keep saliva flowing at an increased rate and therefore cut down the numbers of bacteria being produced in the mouth. New halitosis research coming out of Brazil indicates that the use of flavored toothpaste (three times a day) resulted in lower levels of volatile sulfur compounds compared with non-flavored products.

Sources:
Peruzzo, Daiane Cristina, Sérgio Luis Salvador, Antonio Wilson Sallum et al. “Flavoring agents present in a dentifrice can modify volatile sulphur compounds (VSCs) formation in morning bad breath.” Brazilian Oral Research Vol.22 no.3 São Paulo. 2008.
Peruzzo, Daiane Cristina, Priscila Fontoura Castelo Branco Jandiroba, and Getulio da Rocha Nogueira Filho. “Use of 0.1% chlorine dioxide to inhibit the formation of morning volatile sulphur compounds (VSC).” Brazilian Oral Research Vol.21 no.1 São Paulo Jan./Mar. 2007.

Facts About Bad Breath

A search of the medical literature yields some interesting facts about bad breath. It is also called fetor ex ore, fetor oris, halitosis, and oral malodor. It is one of the most common medical problems in humans; however, a lack of epidemiological data make it impossible to accurately state how common it really is. It has both medical and social significance, since sufferers also experience social problems. It has a variety of underlying causes, including both serious organic disease, and mental delusion.

Explaining malodor then, is achieved on a case by case basis. Fortunately, though this condition wasn’t taken seriously by the medical profession until relatively recently, it is now getting careful and widespread attention, and sufferers can get help. One of the undisputed facts about bad breath is that in most cases, the underlying cause is located in the mouth, and this is the best place to start. Surprisingly, the first step is to confirm that a genuine case of halitosis exists.

Because halitosis carries a social stigma, and because scientifically valid facts about bad breath are not widely known, almost everyone fears that they have it, and a significant number are convinced that they have it when they actually do not. (We are not very good judges of our own breath odor.) Specialists have devised several tests to objectively measure the degree of odor present, and can help such people by explaining oral malodor and offering assurances that there isn’t actually a problem.

At the other end of the spectrum are those who have halitosis because they suffer from undiagnosed underlying disease. Because of these rare cases, it’s important that people familiarize themselves with the facts about bad breath and see a specialist if they think they have it, or when other people remark that their breath smells bad or even strange. Thus, though explaining oral malodor in most instances is a simple case of confirming that it originates in the mouth, in the most extreme cases, it could save a life.

Teeth and Bad Breath

Many people assume an association between teeth and bad breath (halitosis). In many instances they are right: some cases of bad breath are associated with poor dental hygiene, dental cavities, and gum disease (though many are not). Fortunately, when oral malodor is caused by these dental problems, the problem is relatively easy to correct. Like other causes of oral malodor, the unpleasant smell is the result of bacterial multiplication in the mouth.

The role of dental cavities in halitosis usually begins with poor dental hygiene and a lack of regular professional dental care. If you don’t brush and floss your teeth regularly, plaque forms on the outside surfaces due to the activities of oral bacteria. Plague that remains on the teeth causes a buildup of hard tartar, also teeming with oral bacteria. In additional, food particles caught between the teeth are broken down by bacteria. Many of these bacteria produce unpleasant smelling gases as byproducts of metabolism, and some break down tooth enamel. Thus they cause both decaying teeth and bad breath.

Tooth decay, of course, results in cavities—holes in the teeth in which more food particles become trapped, bacteria gain entrance and multiply, and healthy tissues break down. All of these things increase the amounts of unpleasant smelling gases being produced and exhaled from the mouth. Thus, decaying teeth and bad breath are directly linked. When inflammation spreads to the gums, or a decaying tooth develops an abscess, the role of dental cavities in halitosis is even more pronounced.

Gum disease provides an indirect link between teeth and bad breath. When gums become inflamed and/or infected, they may allow bacteria to multiply between the gum and the tooth, and sometimes even around the root of the tooth, creating a dental abscess. Inflamed tissues slough off dead cells as well, which are then consumed by bacteria, encouraging bacterial growth. The more odor-producing bacteria present, the more oral malodor produced.

The role of dental cavities in halitosis, combined with the effect of other dental problems, is so well understood, that anyone suffering from a breath problem is well advised to consult a dental professional and have their oral health assessed before pursuing other possible causes of this common condition.

Understand Bad Breath

Bad breath (also called oral malodor or halitosis) is a surprisingly common affliction in all parts of the world; nevertheless, relatively few people really understand bad breath. This is partly because it’s only in the last few decades that scientists have begun to take the problem seriously and try to figure out what is going on when breath turns foul. There are a number of causes for the condition including eating, drinking, and smoking habits; dental problems; sinus and throat problems; and a few diseases and disorders, but most cases stem from a single simple cause.

Information about halitosis usually stresses the use of antibacterial products without really explaining why that should be necessary. As the advice implies, most uncomplicated oral malodor is produced by bacteria that are living in the mouth. These bacteria are not abnormal or dangerous bacteria—they live in our mouths all the time, usually without causing any problem. To understand bad breath, we have to understand that, for some reason, certain types of bacteria sometimes take over and proliferate to abnormal numbers. This results in an imbalance in the normal oral bacteria.

Scientists understand bad breath is usually caused by anaerobic bacteria—bacteria that live in places where there is very little or no oxygen (like the back of the mouth and between the teeth). Most of us are familiar with the offensive smells given off by things rotting in very wet or airless conditions. These odors are reminiscent of the odors we think of when we think about halitosis. In fact the same gases are involved: airborne volatile sulfur compounds (VSC) that are byproducts of anaerobic decomposition.

Volatile sulfur compounds are actually waste products of the bacteria themselves. These bacteria break down protein in the environment or in the mouth (dead skin cells, food remnants, sinus drainage etc.), taking what they need to grow and reproduce, and releasing VSC among other waste. Thus, we now understand bad breath can be treated simply by reducing the numbers of anaerobic bacteria in the mouth. Today’s breath products typically only do this temporarily and have to be used daily. New research and discussion about halitosis focuses on how to cure the problem permanently and reestablish a healthy balance of oral bacteria in the mouth.

The Science Behind Breath Products

Once upon a time, there was no science behind breath products. Freshening the breath was a simple matter of what worked. This explains the wide variety of home remedies, such as mint, cloves, anise, parsley, dill etc. most of which rely on strong natural odors to mask a bad smell on the breath. Many of these remedies are still in use today, despite the considerable scientific research that has now been done. Not surprisingly, when scientists look at these old remedies, they find that some of them do have real value in treating bad breath.

We now know that relieving halitosis in a significant way depends on controlling the numbers of anaerobic odor-causing bacteria that live in the mouth. Thus, both old and new treatments that work are those that have some antibacterial activity. In home remedies, it is usually essential oils that act on bacteria and these may hold the key to new treatments in the future. Using the current science behind breath products, however, manufacturers of commercial preparations generally add antiseptics such as chlorhexamide, attempt to introduce oxygen to the anaerobic environment of the mouth, or try to physically remove the bacteria with oils (also tongue scrapers, and other mouth cleaning tools).

Unfortunately oral malodor is an obstinate problem that is still difficult to get rid of permanently, especially when no specific cause can be found. Relieving halitosis is typically a long term commitment that requires daily oral care and the purchase of commercial preparations. Fortunately, an increased interest in halitosis in the medical community means that the science behind breath products will continue to expand.

Relieving halitosis remains a challenge for both health care specialists and patients. Breath products are improving, however, and oral malodor sufferers today have more choices than ever before. Advancing science behind breath products will no doubt eventually lead to a better understanding of the causes of this common problem and to new drugs and oral treatments that cure it for good.

History of Bad Breath

Not surprisingly, the history of bad breath – or halitosis – goes back a long way. People have been suffering from this problem for thousands of years and trying, of course, to find a solution. Medical scrolls from 1500BC mention the condition and ancient cultures had traditional ways of treating it, many of which parallel the remedies we use today. People in the Far East devised an early tongue cleaner, and people all over the world turned to aromatic herbs and spices to freshen the breath and mask breath odor. Mint, anise, cloves, cinnamon, parsley, guava, and lots of others have been used.

Halitosis in the past was generally regarded as a personal hygiene problem rather than a health problem and sufferers were often stigmatized, ostracized, and blamed for their condition. In some cultures divorce was sanctioned when one of a couple had the problem. During the twentieth century, help came in the form of commercial mouthwashes and breath mints, but the history of bad breath did not take a significant turn until we figured out the source of the odor. That information gave us a recognizable target.

University of British Columbia researcher Dr. J. Tonzetich figures prominently in the history of bad breath. In 1964, he proved that the typical foul smell of oral malodor came from volatile sulfur compounds (VSC). These compounds proved to come from anaerobic bacteria that are a normal part of the bacterial life in human mouths – they aren’t a problem unless they multiply to numbers large enough to be detectable. Most cases of halitosis in the past, like today, were caused by an overgrowth of anaerobes.

Since 1964, we’ve learned that VSC-producing anaerobes live in large numbers on the surface of the back of the tongue, and also in pockets and folds in the gums, and between the teeth. A suspicion that halitosis in the past was caused by gum disease and tooth decay has been proven, but we also know that lots of people with healthy mouths suffer from the problem as well. The most recent developments in the history of bad breath have been products that specifically attack anaerobic bacteria in the mouth, and objective methods of measuring and diagnosing oral malodor. In all likelihood, the first really effective treatments for this problem are just around the corner.