All About that Bad Breath Smell

Ordinary bad breath is probably the single most common health complaint. Sometimes, however, extraordinary bad breath can signal a treatable health condition or even a medical emergency. Here is what you need to know about the kinds of odors that you can encounter as bad breath.

Bad Breath You Can Correct with Good Oral Hygiene

The kinds of odors you smell when you have the kind of bad breath that you can correct with good oral hygiene are the sulfurous odors associated with hydrogen sulfide, better known as rotten egg odor, or methyl mercaptan, better known as sewer gas odor. Bad breath literally causes your breath to smell like a sewer, although the odor originates in your mouth, not in your lower digestive tract.

The bacteria that cause bad breath release these odoriferous chemicals in the process of digesting food particles and dead tissues in your mouth. The chemicals themselves can form an enzyme called collagenase, which breaks down the collagen that keeps cells “glued” together in the lining of your mouth. Cells break away from surrounding tissues and no longer receive oxygen or nutrients. They die and provide still more food for bad breath bacteria.

Rotten egg odor and sewer gas odor emanating from the mouth are extremely unpleasant, but they are seldom signs of a health emergency. Other kinds of bad breath odor, however, are.

Bad Breath Caused by Diabetic Ketoacidosis

Sometimes diabetics develop high blood sugar levels. The amount of glucose in the bloodstream can run so high that insulin essentially stops working at all, and the body starts burning fat by creating ketone bodies. Many of the tissues in the body can operate on these byproducts of burning fat, but the brain cannot. The brain needs to get at least some of its energy from sugar, so it can absorb the amino acids it needs to make neurotransmitters. Ketoacidosis can lead to dehydration, coma, and death, but it is usually preceded by very obvious dehydration and very obvious mental disturbance. Caught in time, however, it is relatively to treat with intravenous fluids and insulin.

Ketoacidosis is more common in type 2 diabetics than in type 1 (insulin-dependent) diabetics. Sometimes the way type 2 diabetics learn they have diabetes is by coming down with condition. One of the earliest signs of ketoacidosis is an odor of acetone (nail polish remover) on the breath. This odor is often described as “fruity” in online health guides, but if you have ever actually smelled it, you would notice overtones like nail polish remover or formaldehyde.

When a type 2 diabetic in your life develops this kind of bad breath, it is imperative that you persuade them to do a quick test for ketones (it’s done by placing test strip in the urine stream and only takes a few seconds) and getting them to an ER if the test is positive, or seeking emergency medical care if ketone test strips are not available.

Bad breath that is caused by diabetic ketoacidosis is likely also to be accompanied by frequent urination, dry skin, dry mouth, difficulty breathing, and wild mood swings.

Bad Breath Caused By Kidney Disease

Chronic kidney failure also can cause a distinctive kind of bad breath. When bad breath is caused by kidney failure, the breath usually has a “fishy” smell, due to the accumulation of ammonia in the bloodstream that spills over into the lungs. The odor caused by chronic kidney failure is more like the odor of decaying fish than the odor (if any) of fresh fish.

Chronic kidney failure requires medical treatment. Depending on the stage of the disease, it may be accompanied either by urination of large volumes of clear urine or small volumes of dark urine, swollen ankles, swollen wrists, and extreme fatigue. Eating too much meat will sometimes trigger the fishy odor in the breath.

Bad Breath Caused By Ischemic Colitis

Ischemic colitis is the potentially deadly disease you never hear about—unless you have it. It is a disease that tends to strike either young athletes or the elderly, although in different settings.

The upper left quadrant of your colon receives oxygenated blood through the inferior mesenteric artery. Sometimes when people get dehydrated when they work out, the tissue surrounding this artery can shrink and shut off blood flow. The upper left quadrant of the intestines begins to die from the outer lining of the colon inward, and stops conducting feces to the rectum.

The result can be a condition that is indelicately but accurately described as “shit breath.” This isn’t something you should try to cover up with mouthwash or candies. If it is caused by ischemic colitis, you may have just a few hours to prevent a potentially fatal complication. Go to an emergency room at a hospital with excellent surgical facilities if you notice this kind of bad breath. It may not be ischemic colitis, but if it is, your doctor may have to act swiftly to save your life.

Bad Breath Caused by Liver Failure

Bad breath caused by liver failure is so common that there is even a term for it, fetor hepaticus, also known as “breath of the dead.” This kind of bad breath is a combination of sweet and fecal smells. It’s caused by the accumulation of a specific chemical that the sick liver cannot remove from the bloodstream, methyl disulfide. Once you have smelled this odor, you’ll never forget it.

Liver failure also causes altered mental status, severe fatigue, and dark red urine. It’s usually not a condition that comes on quickly unless poisoning of some kind is involved. If you observe this combination of symptoms, don’t try to treat the condition on your own. Seek urgent medical care. Some kinds of liver toxicity can be treated.


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