A reputation killer

Foul-smelling body odor and bad breath are social taboos that tarnish the reputation of the person, who, once “discovered,” are unfortunately “branded and condemned” for life. As members of society, all of us have the obligation to make sure our personal hygiene, appearance, and demeanor are proper, pleasing, and respectable, and not offensive to others. Osmidrosis or bromhidrosis are the medical terms for foul body odor. Halitosis (bad breath) is our topic in today’s column.

Dental reports in the United States state there are about 40 million Americans who have bad breath. In the Philippines, as in other regions in Asia, the incidence, conservatively speaking, may be 50%-60% or higher. The figure varies in different subgroups in the community. Halitosis, as a general rule, is less among those who live in the city (compared to rural areas), those who are more affluent, higher in socio-economic status, those who are more educated or professional, and those in the younger generation. Obviously, the financially handicapped could ill afford the luxury of toothpaste, dental floss, mouthwash, regular dental check-up and proper dental care. They may also be not as well-nourished, and as healthy, as those who can afford. But even professionals or the rich and famous could also have bad breath.

What causes bad breath?

Eating food that causes foul breath (like garlic, onion, fish sauce, durian, etc), poor dental hygiene, decayed tooth or infection of the gums or oral cavity, diseases like diabetes, esophageal diverticulum, esophageal reflux, sinusitis, emphysema, etc. But the commonest underlying cause is poor dental hygiene where care of the teeth and mouth is neglected. There are people who do not brush their teeth at all and go to bed at night with food particles stuck in between their teeth. They may gargle and rinse their mouth with water (or water and salt) after each meal, or even use mouthwash, but the food caught in between their teeth (especially meat and fish) rot and stink like dead animals on the street. This is putrefaction and the foul smelling odor is from the volatile sulfur compounds (VSCs) produced by the decaying meat, which usually results in bacterial infection (and more bad odor), and this makes the cycle a vicious one.

What are the types of halitosis?

Transitory halitosis is caused by food like onions and garlic and generally lasts from one day to day and a half, and chronic halitosis, which does not diminish or improve with time. It is permanently present until the cause is abolished. The bad odor comes from the bacteria in the mouth (between the teeth and on the tongue) which produce the foul-smelling volatile sulfur compounds (VSC) in the form of hydrogen sulfides. The tongue is a great source of bad breath.

Does tooth infection cause heart disease?

Yes, tooth infection can cause the bacteria in the mouth to circulate in the blood stream to infect the heart valve, causing bacterial endocarditis. Oral/dental infections also induce inflammation all over the body, especially in the cardiovascular system, increasing the risk for cardiovascular diseases.

How is intractable bad breath managed?

If there is no tooth decay or any infection in the mouth or throat, the bad breath may be coming from sinusitis, emphysema or from the stomach (as in esophageal reflux, where the controlling valve between the stomach and the food pipe is not closing properly, air-tight). A dental, or even medical, evaluation may be needed to ascertain the specific cause of this persistent halitosis.

Can mouthwash eliminate bad breath?

No, mouthwash alone cannot do the trick. First, the food particles caught between the teeth that will rot must be removed immediately after each meal by dental flossing. Tooth pick alone will not do the job and may even injure the gums. The next step is tongue-scraping from all the way back to the base of the tongue to the front and then rinsing (gurgling) with water. The tongue harbors a load of bacteria that cause bad breath, more than people realize. Then, brushing the teeth properly with a soft brush and gently brushing the roof of the mouth. Mouth-rinsing is the final step in this routine as an added regimen, tilting the head back as your gurgle to rinse the back of the tongue also. These are the four essential steps in the fight against bad breath, complimented by a dental check-up every six months. A study made on 15 mouthwashes showed that most masked the bad breath for a few minutes, only a few were still effective after a few hours. Ninety-nine percent of the products sold over-the-counter do not effectively eliminate halitosis. The best agent is stabilized chlorine dioxide, the ingredient found in Thera-Breath, CloSYS, ProFresh, DioxiRinse, and OroCare (Philippines), which kills the bacteria causing bad breath and neutralizing VSCs. Used as the final step in oral care (after dental flossing, tongue scrapping, tooth brushing), stabilized chlorine dioxide-containing oral rinse at least 2 times a day, is a magical way to eliminate bad breath.

What are the dental problems caused by bacteria?

Besides bad breath, the other problems caused by germs in our mouth include cavities, gum problems, plaques and tartar formation. Therefore, the routine regimen of dental flossing (to eliminate food particles that will rot and harbor bacteria), tongue-scraping, toothbrushing (to scrub food elements, juices and stains from the teeth, and protecting the teeth and gums with those ingredients in the toothpaste), and gurgling (with mouthwash that contain bacteria killing, and plaque-and-tartar preventing ingredients), and visiting your dentist at least every 6 months will not only eliminate bad breath but lead to a healthier dental and oral state.

Can mouth containing alcohol cause cancer?

Yes, according to a 1991 study in the Journal of the American Dental Association, which stated that mouthwashes “containing more than 25% alcohol could increase the risk of oral and pharyngeal (throat) cancer by 50%”. Fortunately, most, if not all, mouthwashes in the market today contain less than 15% alcohol.

How effective are breath-fresheners?

If taken as directed, and as a part of (not a substitute for) the comprehensive regimen we have discussed above, these breath-freshener capsules could be of help, especially for those with gastrointestinal reflux. And so with chewing gum, which induces saliva formation to prevent dryness. If added to the daily oral hygiene regimen recommended, chewing (sugar-free) gum can also be of help achieving a fresher and kissable breath.

Why do people not know they have bad breath?

It is odd but most people with chronic halitosis do not know they have it. Their own sense of smell is so conditioned to the bad breath in their mouth to the point that they do not even perceive or know they have halitosis. One test one can do is to lick the top of their hand or their wrist and smell it.  Unfortunately, their friends and relatives (including most spouse) will not even tell them they have bad breath, “to spare” them from the embarrassment (which actually leads to more future embarrassment because of the persistence of this very offensive problem.) So, the next time you see your lover or friend, or relative, beg him or her to be candid with you and to tell you if you have bad breath. This honesty could change your reputation and love life, and your life as a whole.

Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: FUN8888.com, philipSchua.com   Email: [email protected]