Causes of Bad Breath: Gum Disease
In a healthy mouth, about 30% of all the germs in the mouth that can cause bad breath are in the sulci, the tiny gaps between the gums and the base of the teeth. Even if you fail to reach this 2 to 10 mm (1/10 to 1/3 of an inch) gap above or below the gum line, taking care of the other 70% of bad breath bacteria that live on the surfaces of your teeth or on your tongue can keep bad breath in good control.
If you have the kind of gum disease known as gingivitis, however, removing the bacteria, trapped food particles, and cellular debris that is trapped beneath your gums becomes critical for controlling bad breath. Even if you are punctilious about other aspects of oral hygiene, gingivitis can give you a hard to handle case of especially nasty bad breath.
What Is Gingivitis?
Gingivitis is a process of inflammation limited to the portion of the gums nearest the the teeth. Gingivitis can be caused by bacterial infection, but it can also occur as a side effect of medication, as the result of vitamin C deficiency, as a reaction to shifts in hormone production, and as a response to the accumulation of bacterial plaque on the surface of the tooth beneath the gum line.
The damage caused by gingivitis is generated by the immune system, not by the bacteria that accumulate underneath the gum line. The immune system sends neutrophils to release toxic chemicals to break up the accumulation of bacteria, and these chemicals also destroy the collagen that holds the gums together. Tiny pockets can develop in the gums and fill up with white blood cells and bacteria. As the white blood cells, they die and provide yet more nourishment for yet more bacteria, and the body sends still more neutrophils to generate more inflammation.
The process of gingivitis can occur very quickly, usually in just 4 or 5 days after plaque has reached a critical mass. The first sign of gingivitis may be bleeding when eating, noticing tiny amounts of blood after biting into a piece of fruit or a slice of bread. In acute necrotizing ulcerating gingivitis, even tiny amounts of trauma to the gums may result in significant bleeding, and the breath can be especially foul.
Who Gets Gingivitis?
In the United States, relatively few children get gingivitis. The American Dental Association estimates that only 9% to 17% of all American children have gingivitis.
In the rest of the English-speaking world, rates of gingivitis are much higher. Up to 45% of children in Australia and the UK have this kind of gum inflammation, and up to 90% of adolescents and adults. In the United States, where dental care is traditionally given greater emphasis, the rates are about 30% lower.
Since inflammation of the gums can release infection into the bloodstream, gingivitis is a risk factor for cardiovascular disease and even certain forms of cancer. Women are more likely to get gingivitis during pregnancy or if they develop vaginal yeast infections, and men are more likely to get gingivitis if they have type 2 diabetes.
What Can You Do About Gingivitis?
If you are noticing blood when you bite into an apple or a crust of bread, your primary concern needs to be saving your teeth rather than freshening your breath. When you receive successful treatment from your dentist, bad breath will go away on its own.
If you don’t have gingivitis yet, then you may be able to prevent it by:
- Regular dental checkups and cleaning, at least twice a year. If you have a history of gingivitis or if you have type 2 diabetes, you may need to go the dentist 4 times a year.
- Use of oral irrigation devices such as Hydrofloss or the Oxycare 3000. These machines direct a gentle jet of warm, slightly “magnetized” water into the gap between the teeth and the gums. It is essential to direct the flow of water into the sulci at the base of the gums. Using any kind of oral irrigation to squirt your teeth will not prevent either gingivitis or bad breath.
- Getting enough vitamin C. It only takes the equivalent of a piece of fruit every day to get enough vitamin C to prevent gingivitis, but many people do not get that much. If you live in Europe and you vacation in Florida or some other tropical location and drink lots of juice, be sure to take supplemental vitamin C when you go back home. Your body can become accustomed to excreting large amounts of vitamin C so that your normal diet can cause gum problems when you get back home.
- Dentists and doctors often recommend 0.2% chlorhexidine mouthwash to treat gingivitis. Mouthwash alone won’t work, because the chlorhexidine does not just kill bacteria. It also kills healthy tissue, and the dead cells can feed the bacteria that are not killed by the chlorhexidine. It is necessary to use oral irrigation along with chlorhexidine to realize any benefits in treating gingivitis. Brushing and flossing with the mouthwash are not enough.
- Lose weight. In both men and women, the greater your weight, the more severe your gingivitis. It is likely that keeping your weight in check will make managing gingivitis and bad breath easier. However, it is important to point out that research data to date also supports the idea that gingivitis somehow causes overweight, rather than the other way around. It is possible that inflammatory compounds from the gums get into the bloodstream and attract white blood cells, which literally get stuck in the tiny, crooked blood vessels in belly fat. Up to 1/3 of fat mass is actually white blood cells in many overweight people, so it may turn out that reducing inflammation in general and reducing weight will help resolve gingivitis and bad breath.
