Bad Breath and Proton Pump Inhibitors

Many people are confused about the relationship between bad breath and proton pump inhibitors: do these drugs for gastroesophageal reflux disease (GERD) cause halitosis? The confusion arises from the fact that GERD itself is thought to be a cause of halitosis.

GERD is often cited as a cause for halitosis and proton pump inhibitors are a standard treatment for GERD—the idea that these drugs may cause the bad breath, or make it worse is a relatively new development. Some medical professionals, in fact, will assume halitosis in a patient with acid reflux is caused by the condition and use GERD drugs to treat it. We need more research to investigate proton pump inhibitors and bad breath to clarify these issues.

In 2006, Brazilian researchers reported on a study that suggested a link between bad breath and proton pump inhibitors. They reported that a large percentage of patients taking these drugs have halitosis. Furthermore, their research showed a relationship between halitosis and proton pump inhibitors regardless of whether the breath odor originated in the mouth or from a non-oral source. They suggested that the underlying cause was an overgrowth of bacteria, in either the mouth or the intestine, caused by the drug.

Interestingly, many experts feel that relatively few cases of halitosis are caused by acid reflux and odors traveling up the throat from the stomach. This lends more support to the suggestion that halitosis and proton pump inhibitors may be linked: it is possible some cases of bad breath associated with GERD in the past were actually caused by the drugs instead. In addition, it suggests that treating halitosis in GERD patients with these drugs may actually make the problem worse. The answers remain far from clear: more research on bad breath and proton pump inhibitors is required.

For the present, when patients suffer from bad breath and proton pump inhibitors are necessary for the treatment of GERD, the best recourse is still a good breath product that targets the bacteria that produce bad odors in the mouth. At least for those whose halitosis originates in the mouth, this approach should offer some relief.

Patients suffering from either halitosis or GERD should consult a qualified medical professional to determine the best course of treatment.

Gums and Bad Breath

It’s been the standard wisdom that there is a relationship between diseased gums and bad breath; however, the results of some studies suggest that periodontal disease isn’t as likely to cause a problem as we once thought. This is not to say that people with gum disease won’t have bad breath: what it may mean is that their oral health problem is not the cause of their halitosis.

It makes sense that diseased gums and halitosis will be seen in the same patient: we know that people with periodontal disease have spaces and pockets in their gums where bacteria can grow, and indeed, when these spaces are cleaned by dental professionals, the material removed does smell bad. Many of the bacteria that grow there are anaerobic producers of compounds that smell awful, such as volatile sulfur compounds, the smell of rotten eggs. It may be, though, that bacteria and their byproducts remain secluded in the gums and halitosis generally originates in some other part of the mouth.

It’s important to look after your teeth and gums and bad breath should be a secondary concern if you have gum disease. See your dentist promptly and arrange treatment before the condition threatens your teeth – that way you’ll have your own teeth much longer. Those who genuinely suffer from diseased gums and halitosis will probably have to tackle the two problems separately: professional care for the gum disease and a good breath product for the halitosis.

If diseased gums and bad breath are not related, the chances are that the bad odor is originating at the back of the mouth, particularly on the surface of the back of the tongue. Research on halitosis indicates that cleaning this area regularly and gently with an inverted spoon or tongue cleaner can yield good results. Using a mouthwash that inhibits the multiplication of odor-causing bacteria will help as well. Avoid those that contain alcohol, as this tends to dry out the tissues and has an adverse effect on both gums and halitosis.