Or maybe controlling bad breath really boils down to diet and lifestyle issues. All you have to do is never to eat garlic and onions or stinky cheese. Asian “rotted fish” and “rotted oyster” sauces probably should be on the list, too. Stinky foods are what causes odors in your mouth.

Or maybe it’s really all about oral hygiene, but you need to do more to stay on top of bad breath. Make sure you see your dentist at least twice a year to remove the plaque on your teeth beneath the gum line. Make sure fillings and crowns don’t come lose. See your dentist at the first sign of bleeding gums. Stop smoking tobacco in any form and especially don’t let cigarette tar accumulate on your tongue and teeth, avoid tongue piercing and keep sinus infections under control.

But sometimes the real cause of overwhelming mouth odor isn’t any of these things. It can be a medical condition for which medications don’t really provide a good solution. There isn’t a nutritional supplement that works very well, either.

Sometimes the cause of bad breath is not periodontal disease or particles of food you don’t wash away. Really difficult halitosis is often caused by tonsil stones, also known as tonsoliths. And most of the world might not know this except for the extended efforts of a blogger and lay expert named Meghan Swann.

Meghan Swann’s Tonsil Stones

All through her childhood Meghan Swann suffered recurrent colds and influenza. She had sore throat so many times she lost count.

But one time when she was a teenager her there was something about her umpteenth case of sore throat that felt very different. The back of mouth was sore, but the pain seemed to be coming from inside the deep tissue of her throat rather than the lining of her throat. The pain was more akin to a muscle ache than to strep throat or the kind of sore throat you get with a cold. She had a feeling that something was stuck in her throat, not at the Adam’s apple where you get a lump in the throat, but higher up, almost in the mouth. Mouthwash and gargling and coughing didn’t bring relief.

Finally Meghan decided to take her treatment literally into her own hands. She pressed hard on the back of her throat. In a few seconds a sulfurous, smelly mass passed out. It was about the size of a small pebble or a piece of gravel. it smelled terrible.

And it was not alone. Ms. Swann developed a personal ritual that anytime she felt a “sore throat” coming on, she’d take a cotton swab and press out the debris. But her condition continued for years and years.

About ten years ago, when Meghan had reached age twenty-five, Meghan’s mother commented that she had heard of a something like Meghan’s condition called tonsillolithiasis, which is a technical term for the formation of tonsoliths, also known as tonsil stones. These are collections of dead cells and mucus that accumulate in crevices in the back of the mouth.

What Causes Tonsil Stones?

Bacteria feed on cells killed by throat and sinus infections. The process of digestion gives rise to a quite noticeable bad smell that mouthwash and breath mints cannot completely disguise. The odors emitted by the putrefaction of human tissues in the throat are chemically identical to the odors associated with sewer gas and rotten eggs. They are so potent that they kill still more cells that feed more bad breath bacteria and release more odor-causing gases.

Tonsil stones accumulate pockets of debris and digestive waste products that start smaller than the size of a pin and that can grow from the size of a pencil eraser to about 1 inch (25 mm) or in some cases 1.5  inches (38 mm) across. The decay process can be aggravated by eating lots of sugary foods and by diabetes, and also by anything that dries out the mouth, such as alcohol-based mouthwashes or drinking extremely hot coffee or tea. But before Meghan started searching on the Internet, she did not know that she was not the only person who had the condition, or that she didn’t even have the worst case on record.

A typical posting on a site for rare conditions like wrongdiagnosis.com might read, “Whew. So I’m actually not the only person on earth who gets rocks falling out of the back of her throat. I’m not such a weirdo after all. Finally I know what caused and continues causing my fearsome halitosis.” Another poster might write, “I thought I had cancer, but I really had bad breath!” The fact is, tonsil stones are getting more and more common.

An Epidemic of Tonsil Stones?

Until about 1980, it was common for children who got recurrent sore throats to have operations to have their tonsils removed. Now, under the pressure of insurance rules and risk of malpractice liability, plus the reluctance of insurance companies to approve hospital stays, it’s increasingly rare for a child to undergo the operation.

Doctors prefer to handle sore throats with antibiotic treatment, even when breathing and swallowing are impaired—and even when antibiotics won’t work, when the infection is viral! Make matters even more complicated, antibiotic drugs are a “whole body” remedy, with various potential side effects in lungs, liver, and kidneys. In children, antibiotics frequently cause skin reactions. In women, how well antibiotics work may be influenced by hormone levels the connective tissue holding the stone in place thickening when progesterone levels are higher, during the second half of the menstrual period. But the most significant predisposing factor for tonsil stones is antibiotic therapy.

Antibiotics, as we all know, kill bacteria. What do you suppose happens to bacteria when they die? Other bacteria have to break them down, of course.

The release of gases from the decay of bacteria itself can cause creation of tiny crevices in which dead cells can accumulate and from which infection can spread to living tissue. And even otolaryngologists often fail to realize that the stinky smell in the bad of the mouth isn’t the due to the decay of particles of yesterday’s cold pizza left behind by poor oral hygiene, it’s often a tonsil stone. That’s despite the growing number of reports about tonsil stones in the medical literature, including a study reported in 2008 from the Brazilian state of Minas that found that 75 per cent of children and teens who have tonsillitis that has not been treated by surgery have bad breath caused by tonsil stones.

Getting Rid of Bad Breath from Tonsil Stones

There’s one sure way to get rid of bad breath caused by tonsil stones. It’s tonsillectomy. You don’t get tonsil stones if you don’t have tonsils.

The reality is, of course, nobody likes to have surgery, especially parents of children who would receive surgery. And insurance companies won’t pay for it, anyway. For patients who wish to avoid (or cannot have) surgery, Dr. Lee A. Zimmer of the University of Cincinnati recommends this simple tonsil care regimen anyone can do at home:

1. Rinse twice a day with a mouthwash that does not contain alcohol. This means no regular Listerine. That stinging you feel when you use alcohol-based mouthwash isn’t bacteria dying. It’s the lining of your tongue and mouth dying!

2. Rinse the back of your mouth at least once a day with a cleaning jet of high-pressure water from oral irrigation products such as Hydrofloss or the Oxycare 3000. You still need to use the device on your gums (and it does not help if you point the stream of water at your teeth).

3. Chew gum. The saliva released by chewing gum, especially gum sweetened with xylitol, flushes bacteria away.

Oxygenating sinus sprays and mouthwashes may also prevent problems, since the bacteria that cause the odor are killed by exposure to oxygen. All oxygenating remedies will probably help.
It’s always possible that surgery would be the best way to handle this problem. As of the date of this article, however, Meghan Swann is still getting good results from her tried-and-true oral health maintenance routine: When you feel the stones, push them out. It will get rid of bad breath for several weeks or maybe even several months.

Click here to learn how to cure bad breath in 3 days

After all, bad breath is hard to ignore. We have all smelled bad breath from other people. We know how it makes us feel. But we usually can’t smell our own bad breath, so we play it safe and use products to knock out bad breath just in case we have it.

Just visit your local supermarket and take a look at the oral care aisle.  You will see row after row of mouthwashes, toothpastes, and oral rinses.  All of them guarantee fresh breath.  Yet, how many deliver?  How can you find remedies for bad breath that actually work?  This article reveals some ideas about what you should look for and what to watch out for.

Do You Really Have Bad Breath?

Most of the time bad breath is caused by two sulfur-bearing gases, hydrogen sulfide and methyl mercaptan. Hydrogen sulfide is also known as bad breath odor. Methyl mercaptan used to be identified as the “breath of death,” but it’s now more closely associated with sewer gas.

Bacteria on the teeth, gums, and tongue decay dead tissue (and other bacteria) and release these gases as a byproduct of making their own proteins from the amino acids in their food. Their food can be your food, particles of which remain in your mouth after eating, or you yourself!

The more bad breath bacteria you have in your mouth, the more bad breath you have. When brushing is enough to stop bad breath, you didn’t have many bad breath bacteria in your mouth. When brushing isn’t enough to stop bad breath, the problem was bad breath bacteria lurking on your gums or your tongue or your tonsils. But how can you tell whether brushing is enough?

Many of us don’t have a person in our lives we feel comfortable asking whether we have bad breath. It’s possible to buy bad breath meters that work a little like breathalyzers for measuring alcohol—if the bad breath meter registers off the charts, then don’t drive to your date—but the meters that work cost several hundred dollars.

There’s also the old lick-your-arm-and-sniff test, but that won’t pick up bad breath emanating from the back of your throat or your tonsils. Some sites advise you to ask a little kid you don’t know whether you have bad breath, but some of find that suggestion to be just a little creepy. (So will most little kids.) So we use bad breath remedies even when we are not entirely sure we need them. They don’t have to complicated.

Water as a Treatment for Bad Breath

One of the most effective tools for fighting bad breath is water. Sipping water removes food particles as you eat your meal. Rinsing your mouth out with water can make onion or garlic breath a lot more bearable. A gentle jet of water aimed at the sulcus, the gap between your teeth and gums, can remove bad breath bacteria from your gums and plaque off your teeth, leaving your breath feeling as fresh as it is just after you get your teeth cleaned (something that you should do twice a year or more) at the dentist’s office.
And while an oral irrigation device such as Hydrofloss or Oxyfresh might cost your $150 or more, once you have made the initial investment in the tools of oral hygiene, water treatment of bad breath is totally free.

Who is most likely to benefit from water as a treatment for bad breath?

• People who take medications that dry out the mouth.
• People who snore (forcing the mouth open all night and drying out the tongue and tonsils).
• People who have autoimmune diseases that cause dry mouth.
• People receiving radiation or chemotherapy.
• People who live or work in high-heat or low-humidity conditions.

Water is not a miracle cure for bad breath, but it always helps. But it’s not the only nearly-free remedy that works.

Green Tea (The Kind You Drink)

Sipping green tea is an age-old remedy for bad breath. Tests in Japan and Canada have found that green tea reduces concentrations of both of the gases that cause bad breath, both hydrogen sulfide and methyl mercaptan, for up to two hours after drinking the beverage. (Warm green tea is more effective than hot green tea.)

There is a catch. The benefits of green tea on bad breath only last about two hours. If you can’t drink green tea all day long, or even if you can, you still need to pay attention to other aspects of oral hygiene to keep your breath fresh. But green tea is very helpful when you just can’t brush first thing in the morning, especially when you are on a trip.

Oral Hygiene for Bad Breath

It’s conceptually simple to understand what you need to do in your oral health care to keep bad breath at a minimum. Bad breath bacteria can live on the surfaces of your teeth, in the gap between your gums and your teeth, on your tongue, in the back of your throat, and in your sinuses. If you have lots of bad breath bacteria in your mouth, nose, and throat, your breath will smell bad. If you get rid of the bad breath at enough locations in your mouth, then your bad breath may not be noticeable.

Most of us brush our teeth and forget about cleaning other bad breath havens. Oral irrigation of the gums, gentle scraping of the slimy film off the tongue (you don’t want to scrape your tongue raw, ever), removing tonsil stones at the back of your mouth, gargling (warm salt water works), and using a neti pot all may be necessary in the very worst cases of bad breath. But all of these methods are natural and cost-free ways that really work for curing bad breath.

Click here to learn how you can cure bad breath in 3 days

Sometimes, however, bad breath is more serious. Medical problems that cause bad breath, such as uncontrolled diabetes, liver failure, kidney failure, or a blockage in the colon are very serious but account for less than 1% of all cases of bad breath. Dental problems related to fillings, braces, or crowns are more common, but they are not the major cause of chronic bad breath, either.

The most common cause of halitosis is inadequate oral hygiene. This doesn’t mean that people who have bad breath are too lazy to brush their teeth (although some seniors have to have help with their daily oral care). It’s really just a matter of not knowing when brushing is not enough. This article will help you know what to do. But first, how can you tell whether you have bad breath?

Do You Really Have Bad Breath?

Depending on which oral health expert who is doing the counting, from 50 to 100 million Americans have halitosis. A lot more worry that they do.

Dr. Walter Loesche is an expert on bad breath and cavities who teaches dentistry and microbiology at the University of Michigan. Dr. Loesche says that many more people think they have bad breath odor than actually do. A few of the people he treats are actually at risk of suicide.

The rest of are more accurately described as self-conscious worriers. The best way to find out if you have bad breath, Dr. Loesche says, is to ask a child. Children are less likely to be concerned about the social implications of honesty on this issue. Another way to determine whether you have bad breath is to lick your wrist and sniff.

If you don’t want to ask others whether you have bad breath, you can buy a breath meter. The devices that cost $20 or so don’t work all that well. The devices that cost $200, $300, or more work quite well. But if you don’t want to invest in a bad breath gas detector, you can also consider the seven symptoms of bad breath.

Spending a Fortune to Get Rid of Bad Breath

Bad breath has Americans spending up to $4 billion a year on breath mints, breath sprays, toothpaste, mouthwashes, and other remedies that they hope will keep treat the conditions causing halitosis and breath fresh. But dentists and other bad breath experts say that most of these purchases are a waste at best. Some supposedly healthy treatments for bad breath can even make the problem worse. Even the semiannual trek to the dentist the scrape away plaque and treat gingivitis-affected gums will not necessarily prevent or stop stinky breath.

According to Dr. Lawrence Meskin, who was editor of the Journal of the American Dental Association for many years, people going to these clinics spend hundreds or thousands of dollars, sometimes  ore than 10,000 dollars, for what a dentist “can do” and “should do for less.” If you just make some simple changes in the way you brush your teeth and keep your mouth clean, and in what you eat and drink you may find the perfect—and effective—home remedy for the factors that really cause bad breath. Here are 10 tips providing the vital hygiene info you need to know to stop bad breath from coming back and live your life bad breath free.

1. Onion and garlic breath, and stinky breath after eating stinky cheese or pickled fish, last only as long as food particles remain in your mouth. The easiest way to get rid of them is to rinse your mouth with plain water. Since most of us can’t gargle at the dinner table, a better solution is to brush and floss and rinse the mouth after eating. (Be sure to rinse your toothbrush, too, to keep from putting the offending food particles back in your mouth the next time you brush.) Over 95% of the volatile oils that cause bad breath will be eliminated by digestion once you clean your teeth, tongue, and gums, although a few may be detectable for up to six hours if you burp.

2. Allergies can cause bad breath, and antihistamines you take for allergies can make the problem worse. Runny-nose allergies generate a lot of mucus. Mucus contains proteins on which bad breath bacteria can feed. It’s best to get rid of dried mucus with the help of a neti pot. Antihistamines that make you sleepy also stun the cilia that help move mucus out of your sinuses and nose. They stop runny nose, but the provide bacteria with a feast of proteins from which they digest sulfur-bearing compounds.

3. Always make sure your toothbrush is clean and dry before you use it to brush your teeth. A wet toothbrush caked white with toothpaste is a bad breath germ factory. And remember to rinse your toothbrush every time you brush.

4. Chewing sugarless gum keeps saliva flowing. This carries food particles and bacteria to the stomach where they will be digested. It’s probably an overstatement to claim that sugarless gum can cure bad breath, but it can be very helpful when the underlying problem is dry mouth caused by medications of various sorts, especially medications for irritable bladder and uncontrollable bladder. Sugarless gum flavored with xylitol can also prevent ear infections in both children and adults.

5. Chronic bad breath can be a symptom of an illness centered elsewhere in the body, such as diabetes, chronic bronchitis, liver disease, kidney failure, or autoimmune disease. Breath odor alone is never a symptom of any of these problems. It is always one of several symptoms of a serious disease. Breath that smells like a combination of fruit juice and nail polish remover, for instance, along with dry skin, confusion, and blurred vision, may be signs of a diabetic emergency known as ketoacidosis. Breath that smells “fecal” along with pain on the left side of the abdomen can indicate an intestinal blockage. We have written about bad breath as a medical symptom elsewhere on this site.

6. Alcohol-based mouthwashes like regular Listerine usually don’t work for more than an hour or so. Worse the alcohol they contain can dry out the mouth and create new homes for bacterial infection. Ironically, using a mouthwash that has enough alcohol to kill bad breath bacteria would be a little like gargling with aguardiente or scotch (something we don’t recommend). It would sting your mouth but not sting the germs.

7. Red lips, red gums, or a red tongue (unless it’s red due to piercing) that don’t change color when you put ice on them are a sign of serious infection that requires medical or dental attention right away. Really bad breath may follow, but that’s not the main problem.  Bacteria escaping into the bloodstream can cause serious infections of the arteries, heart, and kidneys.

8. Water softeners replace calcium ions (which can cause deposits that clog pipes and hot water heaters) with sodium ions, but extra salt used to soften water can dry out your mouth. If you use a water softener in your home, drink bottled water.

9. When even careful attention to brushing and flossing does not get rid of halitosis, sometimes tongue cleaning can make all the different. Dr. Erika Boever, also of the University of Michigan School of Dentistry, explains that the tongues of some people are coated with bacteria the feed on and ferment proteins. The process of fermenting food particles in the mouth produces fatty acids, ammonia, methylmercaptan (a chemical also found in feces), and hydrogen sulfide, the chemical that causes rotten egg odor. Gently scraping the tongue with a plastic instrument at least three times a week sometimes eliminates bad breath odor when nothing else works. It may take as long as three weeks to remove enough bacteria on your tongue to make a difference. Don’t forget to rinse the scraper (or your toothbrush) after you use it on your tongue.

10. The chemical chlorhexidine can kill bad breath bacteria. It’s also good for removing the sulfurous odor left by onions and garlic. But because it can also kill your taste buds, you should not use it on a continuous basis, for more than a week at a time with a week “off.”

Click here to learn how to cure bad breath in 3 days

The dentist-researchers recruited volunteers who would agree not to eat any food, drink, floss, clean their gums or tongue, or brush their teeth from midnight of the night before their appointment until they came in to the lab. This was to make sure that the test was measuring the ability of the tested products to control “garden variety” bad breath, the bad breath caused by bacteria that are in the mouth every day.

The volunteers blew into a collecting device for a gas chromatograph calibrated to measure hydrogen sulfide and methyl mercaptan, two especially stinky chemicals that are associated with bad breath odor, rotten egg odor, and fecal odor. This chemical identification tool measured a baseline level and how much the concentration of the chemicals decreased—or not—at one hour intervals after using various breath fresheners.

The scientists made some interesting discoveries. For instance:

• Breath mints never reduced the concentration of the two stinky chemicals in the air in the mouth at any time.
• “A very popular parsley oil product” (Clorets) did not absorb any of the stinky chemicals at any time. After about 2 hours, mouth bacteria apparently started making hydrogen sulfide and methyl mercaptan out of the gum itself.
• Chewing gum did not reduce the concentration of these two chemicals at any time.
• Toothpaste absorbed a little of the hydrogen sulfide and methyl mercaptan for up to 2 hours.
• Drinking green tea was a significant deodorant (it caused removal of half of these bad breath chemicals) for up to 2 hours, but not for longer than that.

What the science seems to show is that most of the things we take for bad breath don’t really get rid of bad breath. They only cover it up with other odors. However, everything about breath mints, chlorophyll chewing gum (Clorets, made with parsley oil), and toothpaste obviously isn’t bad! Here’s how these products help you get rid of bad breath over the long run.

Breath mints don’t have a big effect on the odors in your mouth, although if you use a breath mint, other people probably won’t smell those other odors at least for a while. What breath mints do for you that reduces halitosis is they reduce the likelihood you will burp up obnoxious gases released from the digestion of garlic, onions, smoked fish, and cheese. Breath mints can also “trick” the nose so other body odors are not noticeable.

Chlorophyll chewing gum and other sugarless chewing gums don’t deodorize, but they do stimulate salivation. If you can keep your mouth and tongue from getting dry, there will be fewer tiny cracks to provide halitosis bacteria with a home. These products don’t get rid of bad breath right away, but they do keep it from developing later. And chewing gum flavored with xylitol can also prevent ear and sinus infections.

Toothpaste isn’t a deodorant, either. But a daily brush with peroxide toothpaste really can help prevent gingivitis and other forms of gum and tooth decay capable of causing overwhelming odors. Be sure to rinse your toothbrush after you use it.

And what the research reports don’t make clear is that all forms of green tea are not equal when it comes to halitosis care. Green tea you make the Asian way, by putting finely ground green tea directly in the cup and covering with hot water, is an excellent breath freshener and an important aid to oral hygiene. Green tea you make from tea bags, not so much. White tea has similar properties, but the bagged form is not best.

There are times, of course, that additional effort is necessary for controlling bad breath. Certain medications, like the drugs used to treat irritable bladder disease, depression, or Parkinson’s disease, are especially drying to the mouth. Any infection that causes bleeding or that makes the gums or tongue red is likely to cause bad breath, and getting a dentist to look at it should be a top priority. Person-to-person transmission of cold and flu germs will also result in halitosis about a week later, even if other symptoms are not all that rough.

Just be careful about the mouthwash you choose. Any product that contains alcohol, Listerine, for instance, can dry out the mouth and over the long run cause a bad breath problem as bad as the one it cures. At the top of your list of mouthwash selections should be alcohol-free herbal mouthwashes such as Sarakan and Astring-O-Sol.

Click here to learn how to cure bad breath in 3 days

Only about 1% of all cases of chronic bad breath are caused by a serious medical condition, but if yours is one of those cases in the 1%, your breath can be an important diagnostic sign that you can use to get timely, in many cases emergency, medical care. It’s highly unlikely you will ever need to know about any of the following unique bad breath odors associated with medical emergencies, but it’s vital that you pay attention and get care if these combinations of symptoms arise.

A Fruity, Chemical Odor

Sometimes type 2 diabetics develop an oddly chemical yet fruity bad breath odor that some describe as a cross between grape jelly and nail polish remover. This type of bad breath is most often caused by diabetic ketoacidosis, a potentially fatal condition that requires hospital care.

The underlying health issue in diabetic ketoacidosis is blood sugars spiraling out of control. In type 2 diabetes, insulin resistance, which is something like cells shutting off the switch that allows insulin to transport glucose inside, protects the energy-making machinery in cells of most of the tissues of the body from absorbing so much sugar that they are overcome by free radicals of oxygen. When the muscles and the liver and certain other tissues become insulin resistant, glucose is left in the bloodstream. The pancreas attempts to reduce blood sugar levels by producing still more insulin, and tissues respond by becoming still more insulin resistant.

Sometimes blood sugars can rise to levels that make the blood literally syrupy. Blood flow slows throughout the body. Urination may stop. Eyesight may become cloudy. The brain probably will receive enough energy, but nerves misfire and mood swings and poor judgment follow.

The tissues that aren’t using sugar as fuel use fat, with the creation of ketone bodies. Some of these ketone bodies are exhaled with the breath and smell like nail polish remover, which is mostly acetone. The excess sugar in the bloodstream is noticeable on the breath with a fruity smell. The combination of acetone odor and fruity odor is a key diagnostic sign of diabetic ketoacidosis—which can easily result in death if not treated—but the change in breath odor does not occur by itself.

Fecal Breath Odor

Another distinctive breath odor that indicates a medical emergency is an odor on the breath that one would ordinarily associate with bowel movement. This is not the odor of methyl mercaptan, the volatile sulfur compound produced by bad breath bacteria that smells like sewer gas. This odor smells like feces because it actually is feces, regurgitated into the lower throat because the colon is blocked.

A surprising number of people in two very different groups have this condition. Blockages of the colon, or ischemic colitis, occur in about 20% of people over the age of 85 whose inferior mesenteric arteries (the blood vessel providing oxygen and nutrients to the left side of the colon) no longer function. They also occur in athletes (especially Iron Man triathletes on the island of Hawaii) and people who become severely dehydrated during intense physical activity. Both groups are likely to suffer intense upper left abdominal pain—preceded by intensely odorous breath. If you believe you may have become dehydrated, your breath smells like bowel movement (this is one kind of bad breath odor the person who has it will notice in a big way), and you have abdominal pain or cramping, seek medical attention immediately. Do NOT take any food or fluid by mouth until you see a doctor for evaluation.

Fish Breath Odor

Another distinctive diagnostic symptom is bad breath that smells like rotting fish. It’s not that hard to identify the odor of rotting fish. Fish sauce served in certain Asian dishes is literally made by letting fish lie out in the sun and collecting the fluid that they ooze as they decay. It’s an easily recognizable odor.

In people who have chronic kidney disease, the kidneys lose their ability to clear amino acids from the bloodstream. One of the first chemicals to build up in the bloodstream is creatinine, which forms compounds that cause fishy breath. It’s also possible to develop fish breath odor after ingesting too much selenium (typically by taking too many selenium supplements).

Chronic kidney disease will cause weight loss, severe fatigue, skin problems, swollen joints, and other symptoms. It’s easy to test for, requiring just a simple blood test, but hard to treat. Acute kidney failure may also produce fishy breath—it’s most common after an injury or poisoning. And selenium poisoning will cause changes in the skin and nails as well as the breath. It’s most common after overdosing nutritional supplements but it can also occur after eating too many (more than 20) Brazil nuts.

“The Kiss of Death”

There is also a kind of bad breath that was once known as the “kiss of death.” It occurs during liver failure, which may be chronic, caused by ongoing alcohol or drug abuse or ongoing liver disease, or acute, caused by certain kinds of poisoning.

The kind of bad breath caused by liver failure has an especially putrid odor. It is not “fecal,” but it may include concentrated methyl mercaptan, which is also the odor component in sewer gas. Yellow or orange tinting of the skin and eyes usually accompanies liver failure. Bad breath alone is never the only diagnostic sign. Simple blood tests can detect liver failure very quickly—and treatment is sometimes possible.

These four kinds of chronic bad breath are warning signs of serious health issues—but they never occur as a solo symptom, and they affect fewer than 1 in 100 persons who has bad breath.

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Bad Breath Caused by Tonsillitis

When elementary school children have really awful breath, the problem is usually tonsillitis. This all too common condition results from chronic inflammation of the tonsils, tissues at the back of the tongue and the roof of the mouth that release white blood cells to fight infection. Especially in children aged 6 to 10, the tonsils can become so swollen, relative to the size of the face, that breathing through the nose becomes impossible. Tissues in the mouth and throat dry out and die, providing substrate for bad breath as they decay.

Surgery usually provides and immediate and permanent cure for the bad breath caused by tonsillitis. The surgeon most often cuts out the tonsils with steel surgical instruments, or burns out the tonsils, cauterizing blood vessels as the operation proceeds in order to prevent bleeding. The “burn it out” method usually causes significantly less pain and bleeding. Even after tonsils are removed, however, the infection may remain.

Bad Breath Caused by Sinusitis

The sinuses are cavities in the skull filled with air. The four paranasal sinuses capture about 15 ml (1/2 of a fluid ounce) of air at a time, warming it and moisturizing it as it passes down to the throat and to the lungs. The sinuses have very tiny openings which give the stream air greater velocity as it goes into the throat.

Sinusitis is a condition of inflammation in the lining of the sinuses that can cause pain and stuffiness. The sinuses respond to infection and irritation by releasing mucus that can trap noxious materials and germs. Tiny hairs known as cilia propel mucus out of the sinus through its small opening into the nostrils and throat, but some toxic agents paralyze them. They also can be trapped in harden mucus if the sinuses are exposed to dry air for extended periods of time. The trapped mucus can decay and cause an awful stink, and dry air can desiccate the throat and lead to tissue decay there.

In the twentieth century, surgeons sometimes cut through the skin and muscle, drilling into bone, releasing mucus and accumulated bacteria. The procedure had a high risk of spreading infection and was abandoned in the first years of the twenty-first century in favor of up-the-nose endoscopic surgery to place tiny stents containing steroid drugs to help the sinuses slowly shrink over a period of 3 to 6 weeks.

Because the drugs put in the stents take several weeks to work, there is no immediate improvement in bad breath. Moreover, infection can return as soon as the medications wear off—and the second round of sinusitis can be even more severe.

Going to the Bad Breath Clinic

So far, medical options for treating bad breath don’t sound all that promising. There is an innovative clinic in San Francisco, California, however that specializes in medical solutions for bad breath. The Center for Breath Treatment was founded in 1996 by otolaryngologist Dr. Anthony Dailley. Since its founding the Center has been studying scientific methods of diagnosing and the most treating severe bad breath. As of late 2011, when this article was written, Dr. Dailley’s treatment the Center for Breath Treatment has treated more than 13,000 cases of halitosis and claims an astonishing 99% success rate.

The secret of success, Dr. Dailley says, is finding the causes of halitosis before beginning treatment. And the most common methods of treating bad breath, Dailley tells his patients, such as mints, mouthwash, chewing gum, mouth sprays, and, at least in California, colon cleansings do little or nothing to get rid of bad breath permanently.

At the Center for Breath Treatment, almost none of the worst cases of chronic halitosis are found to have a medical cause. The doctors almost always discover a combination of uniquely potent strains of bad breath bacteria and unusual features of patient anatomy that make changes in personal hygiene a must.

Each patient at the Center for Breath Treatment is given a unique prescription for fresher breath, but certain products are recommended over and over again, such as the:

• Hydrofloss Oral Irrigator,
• Dioxirinse mouthwash,
• Dioxibrite toothpaste, and the
• Hydropulse Sinus Irrigator.

When bad breath is especially hard to manage, these products, the clinic claims, often make the critical difference in successful treatment.

If you don’t have health insurance, and sometimes even if you do, medical treatment for halitosis in the United States can be extremely expensive, well into the thousands or tens of thousands of dollars. These four products, however, are worth a second look if you are seeking ways to treat halitosis on your own.

Doctors at the Center also look for those relatively rare cases in which halitosis is caused nasal polyps, autoimmune conditions that can cause dry mouth, deviated septum, misalignments of the teeth, problems with the jaw bone, allergies, and sleep apnea. Treating these problems sometimes resolves bad breath, along with giving overall health an enormous boost. If you think you might have one of these conditions, treatment really is not optional. You simply must have a doctor take care of these conditions for your health and longevity. When you, however, bad breath may quickly become a thing of your past.

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The ancient Chinese masters of herbal medicine theorized that bad breath during winter was caused by “wind devils.” These evil spirits lodged in the throat and caused bad breath. Drinking hot tea with cinnamon would cause them to flee, as would drinking what we would call miso soup with scallions.

The ancient Greeks treated bad breath with ouzo, the alcoholic drink made flavored with aniseseed. If it didn’t kill your bad breath, it at least masked it.

The ancient Romans taught that red wine causes bad breath and white wine sweetens it. Of course, if you drank enough wine, you stopped being worried about your bad breath.

And the twentieth century Americans were by and large convinced that the one best way to treat bad breath was with a kind of chewing gum known as Clorets. Laced with artificial green dyes and chlorophyll from parsley, tens of millions of Americans convinced themselves on tens of billions of occasions that chewing Clorets took care of bad breath. But as someone who lived in the USA in the 1950′s and 1960′s, I can attest that it didn’t.

There have always been bad remedies. Some of the work. Some of them don’t work. A few of them actually make your breath worse (usually so you will keep buying more). Here are the highlights of the good, the bad, and the just plain stinky of common bad breath remedies.

Brushing Your Teeth

The good news about brushing your teeth is that will in fact reduce bad breath odor. The bad news about brushing your teeth is that it will only reduce bad breath for about an hour.

Only about 30% of the bacteria that cause bad breath are actually on the surfaces of your teeth. Another 30% are in the crevices or sulci between your gums and your teeth that your brush can’t reach, and the remaining 40% are mostly in the cracks on your tongue. As soon as you get bad breath bacteria off your teeth, they migrate from your gums and tongue and form new colonies. But brushing your teeth is a great short-term fix.

Flossing Your Teeth

If you brush your teeth regularly, flossing won’t do anything to prevent morning breath. If may be helpful after you have eaten a meal including chopped onions or garlic, and it’s a good thing to floss once a day for general oral hygiene. Flossing the wrong way, digging into your gums by flossing up and down between your teeth instead of with a loop around each tooth, however, can make your breath worse.

Oral Irrigation

Oral irrigation devices shoot a jet of water into the sulcus, the tiny gap between the base of the tooth and the gums. These machines, such as the WaterPik and Hydrofloss, shoot a stream of water into the 2 to 10 mm (1/10 to 1/3 of an inch) gap between the gums and the tooth that is strong enough to dislodge bacteria and debris but not so strong as to loosen the tooth. Some brands “magnetize” water so that it removes even more of the smelly gunk beneath the gum line, about 44% of tartar over three months of use compared to 20% of tartar removed by untreated water.

For oral irrigation to work, however, the stream of water has to go below the gum line. Water you squirt against your teeth won’t do any good beyond the benefits of brushing your teeth or sipping water throughout the day.

So What Doesn’t Work?

Brushing, flossing, tongue scraping, and oral irrigation are slow but sure ways to get bad breath under control. There are some other common methods that don’t work as well.

• Breath mints for bad breath are a little like sledgehammers for an itchy nose. If you take a breath mint, you will still have bad breath but you won’t notice it. If you hit your toe with a sledgehammer, your nose will still itch but you won’t notice it. Breath mints only mask bad breath, and only temporarily. Breath sprays are not any better.
• Mouthwash usually freshens breath for several hours, but leaves you needing more and more. That’s because most brands of mouthwash contain ingredients like alcohol, chlorhexidine, and sanguinarine that can dry out your tongue and gums and create places for germs to hide that the mouthwash can’t reach. The process of drying out your tongue and mouth kills tissue that in turn becomes food for bad breath bacteria. A few brands, such as Dr. Katz’s and Oxyfresh kill germs without killing tissues to feed them.
• Megadoses of nutritional supplements don’t provide additional protection against bad breath. That is not to say that smaller doses of nutrients are not useful. Up to 5,000 IU of vitamin A every day may help prevent a condition called “hairy tongue” (although medication may be needed to treat it). Up to 100 mg of vitamin C a day may help strengthen your gums so that gingivitis is less of a problem. It can be useful to take CoQ10 (at 30 mg and up to 200 mg a day) and methylsulfonylmethane (MSM, up to 5,000 mg a day). Taking larger doses of these useful supplements, however, won’t do anything for your oral health and can cause unpleasant or even dangerous side effects.

You will get better results for controlling bad breath from things you rather than from things you take. Personal attention to your oral hygiene every single day is the single most important thing you can do to control and prevent bad breath.

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Of course, there is no shortage of information on the Internet, and there are excellent sources of information in printed natural health guides. You can consult your physician or even a bad breath specialist at bad breath clinic. But where is the best place to get bad breath information fast?

Bad Breath Information on the Internet

If you Google the term “bad breath,” you’ll get about 27,500,000 links to pages just in English. If you look on PubMed for peer-reviewed medical studies on bad breath, you will find no fewer than 1230 studies in medical journals and academic journals. And you can even find 52 books about bad breath you can download to your Kindle.

All Internet information about bad breath, however, is not of equal quality. What can you do to maximize your success in locating the appropriate solution to bad breath?

The types of sites providing information on treating bad breath vary greatly in quality.  Anyone can find anything from official oral health sites to blogs offering a free bad breath cure e-book for immediate download. Google translate can even help you read the information you need in your language choice, from  Afrikaans to Yiddish.

Dentists’ office and bad breath clinics generally offer some information on their site, usually a collection of articles and an explanation of their products and an FAQ. Of course, they don’t put up that information so you will feel confident about treating bad breath on your own. The variety of choices for bad breath information can be overwhelming. How do you decide which one?

Choosing Bad Breath Sites

We won’t be coy. We don’t think it’s hard to find the best bad breath site. We think you are visiting it right now. Even with the information this site provides, however, we recognize that sometimes you’ll want a second opinion about Internet information the same way you may want a second opinion about a doctor’s diagnosis.

It’s not that tough to determine which site is better than another. The best site is the site that gives you information you can use right now. You could spend a lot of time visiting sites and comparing  content. You could ask yourself if reading a few articles will be sufficient or if you might benefit more from resources such as FAQs or email Q and A with a dentist or oral health professional.

You might learn something relevant to your situation by reading a post by a blogger who has taken the time the research the topic of bad breath himself. The web offers you ready access to a dozen different ways to cure bad breath.

But you don’t really need them. You need actionable information. Whether it’s the right way to brush your teeth or to floss or scrape your tongue, or what to do if you can’t afford prescription mouthwash, or how to treat sinusitis or sore throat or post-nasal drip to get rid of bad breath, you don’t need verbiage. You need methods you can use right away. If you get information you can use, the next time you need information, come back to the same site for more.

What If You Don’t Feel You Are Particularly Internet-Savvy?

Of course you’re Internet-savvy! You’re hear. But sometimes you want to get information from pages that appear on paper instead of on the computer screen.

Maybe will find something that does the trick in a book at the local library. Maybe talking with a friend of loved one could yield a new method that you hadn’t tried before—one that might be more effective than what you’ve tried already.

If none of the information you get from the Internet or books works out, or if your bad breath comes with the other symptoms of diseases that require urgent treatment, that might be time you have to seek a trained professional’s help with your bad breath issues. What are some examples of bad breath that requires a doctor’s care?

• You have breath that smells a little like a mixture of fruit juice and nail polish removers plus emotional mood swings and signs of dehydration. This can be a sign of diabetic ketoacidosis.
• You have breath that has not just a “sewer gas” odor but also a “fecal” odor. This can be a sign of a blockage of the colon, especially when there is severe pain on the left side of the abdomen.
• You have particularly putrid breath, severe fatigue, and dark urine. This can be a sign of poisoning or liver failure.
• You have breath that smells like rotting fish (or fish sauce without eating fish sauce). Particularly  if this kind of bad breath odor occurs with swelling of the lower limbs and severely limited urination, it may be a sign you need to see a doctor to be tested for kidney failure.

These four combinations of symptoms require a doctor’s care. But so can bad breath that absolutely you do seems to treat. Tonsillitis, deviated septum, chronic sinusitis, and severe acid reflux disease (GERD) are causes of bad breath you probably can’t tackle on your own no matter how good the information you have from a book or the Internet. But working with your doctor to resolve these health problems can cure both your bad breath and bring you to a far better state of health.

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How Bacteria Cause Bad Breath

In addition to cadaverine, putrescine, and skatole, many of the bacteria that live on your gums and tongue produce hydrogen sulfide, which is the odor associated with rotten eggs, dimethyl sulfide, which is the odor belched out of the ocean floor when oil rigs dig down, and methyl mercaptan, which is better known as sewer gas. This sulfur-laden compounds almost smell like sewage, and in a way they are. They are formed as byproducts of bacterial digestion of proteins inside your mouth. The stinky odor generated by bacteria in your mouth is the odor of their own excreted waste.

Not every kind of bacteria in the human mouth generates odor. The offending species of bacteria are mostly Gram-negative, that is, they can be identified under the microscope by their failure to absorb a dye. Gram-negative bacteria either don’t need or can’t tolerate oxygen, so they flourish in the tiny nooks and crannies and crevices that form in the lining of your mouth when your mouth dries out. Harsh detergent toothpastes made with sodium lauryl sulfate (SLS), mouthwashes that contain high amounts of alcohol (usually enough to dry out your mouth but not enough to kill bacteria), and breathing through your mouth can create the dryness that creates the cracks that gives bad breath bacteria a home.

There are many different kinds of Gram-negative bacteria that can cause bad breath. The list includes but is not limited to Bacterioides loescheii, Centipeda periodontii, Eikenella corrodens, Enterobacteriaceaea, Fusobacterium nucleatum, Prophyromonas gingivalis, Prevotella intermedia, Tanerella forsythensis, and Treponema denticola. These bacteria like your mouth but they don’t like each other, so you may have large numbers of one strain but small numbers of other strains in your mouth at any one time. All of these strains, however, can give you bad breath.

Even if you have bad breath bacteria in your mouth, they don’t necessarily cause bad breath. Odors usually result when bacteria digest so much more protein that they have an excess of the amino acids cysteine, cystine, and methionine. These amino acids are converted by enzymes already in your mouth and enzymes released by bacteria into the sulfur compounds that cause bad breath odor. Bacteria fed excesses of certain fatty acids can produce butyric acid, which has a rotten butter smell—but which also protects your digestive tract against certain forms of cancer.

You don’t need to avoid feeding yourself to try to starve out your bacteria. They would just feed on your own tissues. And the good news about bad breath bacteria is usually there are not enough bacteria in your mouth for you  to know they are there. And there are things you can do to get rid of bad breath bacteria are so obvious that they are often overlooked.

Getting Rid of Bad Breath Bacteria the Easy Way

It does not have to be hard to get rid of bad breath bacteria. After all, they are teeny tiny organisms with teeny tiny anchors in your oral tissues. It’s not like you need a jackhammer to pry them loose from your tongue and gums.

Just rinsing your mouth with water gets rid of some bad breath bacteria. Scientific studies have found that rinsing your mouth with water is as beneficial for reducing bad breath as brushing your teeth. (You still need to brush your teeth to prevent cavities, but you can sip water many more times a day than you brush your teeth.) You can get rid of still more bad breath bacteria by sipping whole milk, but not everyone can drink milk, and it’s not a low-calorie or low-fat food.

Getting Rid of Bad Breath Bacteria the Not-So-Easy Way

An even better way to get rid of bad breath bacteria is to scrape your tongue. You absolutely do not want to scrape your tongue raw so that it bleeds. This will increase bad breath. You just want to remove the brown, yellow, or gray film on your tongue that “glues” bacteria in place on your tongue.

Research studies have shown that you remove about 33% of bad breath bacteria if you scrape your tongue with your toothbrush and you remove about 42% of bad breath bacteria if you scrape your tongue with a plastic tongue scraper. Either way, it takes more than one scraping to give you lasting fresh breath. Usually bad breath is not brought under control until the tongue has been scraped, or brushed, every day for two weeks.

Brushing your teeth reduces bad breath for about an hour. Flossing your teeth is useful for the kind of halitosis you have 24 hours a day, but it does not have an effect on morning breath. About 30% of bad breath bacteria lie on the surfaces of your teeth, another 30% are in the sulcus or crevice between your gums and your teeth, and about 40% live on your tongue. It’s necessary to treat all three areas to get rid of bad breath bacteria for good.

What About Mouthwash?

The most successful chemical mouthwash is 0.2% solution of chlorhexidine. It kills bad breath bacteria on contact, and it continues to sweeten the breath for about 3 hours after you use it. It doesn’t kill all your bad breath bacteria, however, and it’s necessary to use it once or a twice a day to keep halitosis bacteria partially under control.

Chlorhexidine is not without its drawbacks. It can cause a change in the way food tastes, or a burning sensation in the tip of the tongue. In about 4% of people who use it, this mouthwash ingredient can kill gum tissue and cause it to slough off—creating new homes and new food supplies for bad breath bacteria. There are similar problems with alcohol and essential oils used in mouthwash—only they are worse.

So what is the solution for bad breath? Getting rid of bacteria is not the whole job. You also have to take care of your teeth and gums.

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Scientists estimate that about a quarter of the population has bad breath at any given time. It’s hard to tell if you have bad breath without someone else to give you feedback. That’s because we inhale and exhale vertically, while bad breath odors spread horizontally.

Certain stinky foods cause bad breath, but their effects are short-lived. About half the chemicals that cause garlic breath, for instance, can be removed from the mouth just by taking a few sips of water. The other half will dissipate in about six hours. There is no food that causes lingering bad breath, although if you are ill with certain digestive complaints (for example, the water-born parasitic disease giardiasis, which causes a particularly unpleasant symptom called “purple burps”) can cause release of unpleasant odors through the mouth.

Lasting bad breath is caused by bacteria that live on the back of the tongue, between the teeth, and in cracks and crevices caused by drying out the mouth or treating the mouth with harsh, alcohol-based mouthwashes, such as Listerine. If you have healthy gums and teeth, the place where the bacteria that cause bacteria are most likely to reside in your mouth on your tongue. If you see your dentist on a regular basis, simple dental hygiene will remove the plaque that forms a home for bad breath bacteria between your teeth.

Bacteria break down mucus and dead cells from your mouth and tongue, as well as tiny food particles left in your mouth after eating. As these bacteria digest protein, they produce two waste products, hydrogen sulfide (the chemical associated with rotten egg odor) and methyl mercaptan (the chemical associated with fecal odor). They can literally make your mouth smell like a sewer.

You can take products that cover up the sewer smell, or you can get rid of the bacteria and get rid of bad breath for good. If you take the second option, you need to be sure the product you take doesn’t also get rid of your taste buds (as prescription mouthwashes with chlorhexidine sometimes do) or cause tiny cracks in your mouth and tongue to create new homes for bacteria so have to keep using the product (as is the case with Scope and Listerine).

Here is the essential information for dealing with bad breath effectively.

1. Wash the odor away.

If the problem is garlic or onion breath, your best tip is that simply taking a few sips of water at the end of your meal will relieve a lot of the bad odor. Bad breath of any origin is relieved by drinking water regularly to keep food particles and bacteria from building up in the mouth. Green tea deodorizes the mouth for up to 2 hours. The kind of green tea you make with powdered tea over which you pour hot water is more effective than green tea made with tea bags. There is no top brand for this kind of tea, but powdered green tea is available in Asian markets everywhere.

2. Cover up the odor.

Mints and chewing gum don’t really get rid of bad breath odor. They just cover it up. Peppermint, however, can reduce the risk of burps (and flatulence) that also cause disagreeable odor emissions.

3. Let your saliva do the work.

Chewing gum stimulates the flow of saliva, which reduces the accumulation of bacteria and food particles in your mouth. You want to be sure to chew sugarless gum, of course, because sugar also feeds bacteria.

4. Kill the bacteria. Kill them all.

Alcohol-based mouthwashes like Listerine are designed to eliminate the bacteria that cause bad breath. Originally designed as an antiseptic for the walls of operating rooms and surgical theaters, Listerine contains over three times the concentration of alcohol needed to kill the bacteria in your mouth. (It’s about 54-proof.)

The problem with alcohol-based mouthwashes like Listerine and Scope is that they not only kill bacteria, they also kill tissue on the lining of your tongue and mouth. This creates new homes for bacteria that quickly find their way to your mouth. The more you use mouthwash, the more you need it. It’s no wonder people buy nearly a billion dollars worth of these products every year. Alcohol-based mouthwashes are no cure for halitosis.

If you have any questions about whether the product contains alcohol or not, just don’t use it. Your dentist can recommend an alcohol-free alternative.

5. Don’t kill the bacteria, just deprive them of a home in your mouth.

Another way to deal with bad breath bacteria is to prevent them from colonizing in your mouth. This is what mouthwash and toothpaste made with sanguinarine (bloodroot, in same dosages) does. The bacteria stay in your mouth, but they never attach themselves to your tongue so they can digest food particles (and dead tongue cells), so they never emit stinky sulfur compounds.

Some natural products, including the green, red, black, or white tea your drink, and the oral care products Sarakan and Astring-O-Sol, prevent the formation of bacterial colonies in a different way. These natural products provide tannins that literally “tan” the inside of you mouth and your tongue. Tiny cracks and crevices never form, so the bacteria that cause bad breath never form colonies and are easily rinsed away as you drink water and eat food.

Of course, brushing your teeth after every meal is important, but you don’t need to brush all day long. Too much brushing, especially with a harsh toothpaste, can wind up causing some of the same problems as using an alcohol-based mouthwash. Over-brushing doesn’t help halitosis. Dry mouth caused by drying toothpastes creates the same conditions that enable bacteria to thrive.

It’s also important to floss the right way. Floss side to side, not up and down. Loop dental floss around each tooth and loosen food particles. Pushing them up and down can trap them between your teeth, and the floss can injure your gums. Take good care of your oral health and hygiene, but let the right products do the work for you.

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