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Active Living
Full Listing with story descriptions
A Healthy Balance
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Active Kids, Healthy Kids
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Prehistoric Workout
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Childbirth
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Advice from the Maternity Clinic
Advice from the Maternity Clinic (Part 2)
Alcohol in Pregnancy
Building a Better Baby
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Bleeding in Pregnancy
Breastfeeding Benefits
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Blue after Baby or Postpartum Depression
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Getting a latch on breastfeeding
Group B Streptococcus
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Postpartum Repetitive Strain Injuries
RH Disease
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Sex During Pregnancy
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Smoking and Pregnancy
Support During Labour
Travelling While Pregnant
Ultrasound for Fun & Photos
Natural Remedies in Pregnancy
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When Baby Comes Home
Childhood
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Not Just Baby Fat
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Whooping Cough
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Chronic Pain
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Introduction
Managing Your Pain
Movement Matters
Moving Forward
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Pain Medications
Prevention
Returning to Work
Understanding and Goal Setting
When Pain Doesn't End
Dental Health
Full Listing with story descriptions
Antibiotics and Dental Surgery
Baby Bottle Tooth Decay
Baby Teeth
Bad Breath (Halitosis)
Children's Dental Injuries
Choosing a Dentist
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Headaches
A Healthy Mouth
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Keeping it Clean
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Painless Dentistry
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Root Canal
Seniors Oral Care
Sensitive Teeth
The Smile You Want
Sore Mouth, Aching Jaw
Snoring and Sleep Apnea
Smiling through the Senior Years
Teeth for Life
Temporomandibular Disorders (TMD)
Tobacco Risks to Oral Health
Tongue Piercing
Tooth Whitening
Travel Dentistry
Water Fluoridation
Wisdom Teeth
Your Healthy Smile
DIABETES
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10,000 Steps
A1C Test
Accurate Blood Glucose Testing
Alchohol and Diabetes
A Diabetes Success Story
ABCs of Diabetes Management
Alternate Site Testing
Artery Health
ASA Therapy
Benefits of Insulin
Benefits of Breakfast
Blood Glucose Medications
Blood Glucose Myths
Blood Glucose Testing
Blood Glucose Testing Tips
Blood Sugar Lows
Blood Glucose Monitors
C-Peptide Testing
Canada Food Guide Revisited
Carbohydrate Counting
Catastrophic Drug Plan
CDA Guidelines for Diabetes
Celiac Disease and Diabetes
Celebrating Health
Childhood Diagnosis of Diabetes
Children and Type 2 Diabetes
Cholesterol-lowering Medications
Colds and Diabetes
Constipation
Continuous Blood Glucose Monitoring
Cutting Edge
Dangers of Uncontrolled High Blood Pressure
Debunking Diabetes Myths
Driving and Diabetes
Diabetes and Menopause
Diabetes and OTC Medications
Diabetes Care Team
Diabetes and Celiac
Diabetes and Depression
Diabetes Diet
Diabetes Distress
Diabetes Eating on a Shoestring Budget
Diabetes Etiquette
Diabetes and Oral Health
Diabetes and Thyroid Disease
Diabetes and Your Mouth
Diabetes and Your Eyes
Diabetes in Cats
Diabetes in Dogs
Diabetes Management ABCs
Diabetes Meter Technicians
Diabetes Myths
Diabetic Ketoacidosis
Diabetic Retinopathy
Diet Tips for South Asians
Dining Out
Drinking and Diabetes
The Discovery of Insulin
Eating Disorders
Easing the Strain of Stress
Eating to Protect Your Kidneys
Eating Well During Shift Work
Eggs in a Diabetic Diet
Emotional Eating
Emotions of Diabetes Diagnosis
Erectile Dysfunction
Exercise Excuses
Why Fad Diets Fail
Fats
Fibre
Fill Your Day with Energy
Financial Support for Diabetes
Food Temptation
Foot Care
Footwear and Foot Health
Fruits and Veggies
Gastroparesis
Gestational Diabetes
Get Active
Get Physical
Gift Ideas
Glucose Meters
Glycemic Index and Glycemic Loads
The Glycemic Index
Going Green in the Kitchen
Grocery Shopping Tips
Guidelines for Diabetes Management
Holiday Party Survival Guide
Health Information on the 'Net
Healthy Happy Holidays
Healthy Beverage Choices
Health Benefits of Soy
Healthy Restaurant Meals
High Blood Pressure and Diabetes
High Blood Pressure
HbA1c Test
Healthy Eating for Active People
High Blood Lipids
Home from the Hospital
Home Alone and Sick
Hypoglycemic Unawareness
Impaired Glucose Tolerance
Immunization & Diabetes
Incretins-a Hormone Treatment
Injecting Insulin
Insulin Discovery-The Story
Insulin
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Insulin - the Key to Energy Management
Insulin Pumps
Insulin Pen Needles
Insulin Pump Infusion Sets
Insulin Pump Therapy
Immunization and Diabetes
Internet Health Sites
Islet Cell Transplantation
Insurance
Ketones
Kidney Disease - Reducing the Risk
Living with Diagnosis of Diabetes
Living Powerfully with Diabetes
Low Blood Glucose
Managing Diabetes
Managing Blood Glucose
Metformin
Nutrition Food Labels
Meal Planning
Your Medication Expert
Medication Research Studies
Metabolic Syndrome
Microalbuminuria
New Diabetes Technologies
Natural Medicines and Diabetes
No Need for Insulin?
Not Snoozing
Over-the-Counter Medications
Oral Health and Diabetes
Osteoporosis and Diabetes
Diabetes and OTC Medications
Pedicure Precautions
Peripheral Arterial Disease
Pet Diabetes
Planning for Pregnancy
Prebiotics and Probiotics
Preparing for Activity
Putting off Insulin
Reducing Stress of Surgery
Safe and Successful Travel
Schizophrenia and Diabetes
Sensible Snacking
Setting Health Goals
Setting Goals for Physical Activity
Sharps Disposal
Shorter Insulin Needles
Sleep - a Missing Link
Smart Snacking
Smart Summer Nutrition
Snack Bars
Snacking with Diabetes
Sodium
Social Media & Diabetes
Solving the Insurance Puzzle
Stress and Diabetes
Success in School
Supplements
Supporting Spouse with Diabetes
Sweeteners
Sugar, Carbs and Blood Glucose Control
Think Positive with Diabetes
Tiny Bites Equal Big Calories
Travelling with Diabetes
Tips for a Better You
Tobacco Use and Diabetes
Top 10 Reasons to Exercise
Treating Low Blood Glucose
Treating Hypoglycemia - Role of Glucagon
Tune up Your Diet
Type 1.5 Diabetes
Type 2 Diabetes
Understanding Diabetes
Understanding Diabetes Medications
Understanding Ketones
Used Sharps
Urinary Incontinence
Vacationing with Diabetes
Vegetarian Eating for Diabetes
Vitamin D
Walking
Wise Choices About Natural Medicines
Wonderful Water
Natural Medicines & Diabetes
World Diabetes Day
Your Medicine Cupboard
Zimbabwe Hand Jive
Family Medicine
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ADHD in Children
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Antibiotic Use
Arthritis
Aspirin Every Day?
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Back Pain Myths
Back Pain - Lower
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Doctor Visit
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Stroke
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Win by Losing
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First Aid Travel Kit
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Canada's New Blood System
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Patient Safety in the Hospital
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Planning for End of LIfe
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Schizophrenia
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Soy
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5 Tips to Manage Weight
10 Ways to Cut Down on Fat
Battle the Bulge
Boost Your Bone Strength
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Breakfast is Important
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Building Your Bones
Celiac Disease
Challenging the Milk Myth
Diet Reality Check
Drink Up!
Eating Smarter & Cheaper
Energy Drinks
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Healthy Diet, Healthy Smile
Healthy Eating for Boomers and Zoomers
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Healthy Eating on Business Travel
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Fruits & Veggies - 5-10 a Day
Fats
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Feeding Your Kids
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Food Chemistry 101
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Getting Kids to MOVE
Healthy Eating for Teens
Healthy Habits
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New Ingredients for Your Shopping Cart
Iron
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Mercury Levels in Fish
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Changing Role of the Pharmacist
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H1N1 Virus - Plan Ahead
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15 Great Reasons to Breastfeed
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xx
Sexually Transmitted Infections
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Family Health Online / Pharmacy at Safeway
Family Health Magazine - DENTAL HEALTH

Bad Breath
Biology in action

Bad breath is quite common. It is not a disease – everybody has bad breath at some time. Certain diseases are accompanied by bad breath. For that reason, persistent bad breath should be followed up in medical and dental checkups. However, in most people bad breath can be dealt with in fairly simple ways.

Most bad breath is produced by bacteria growing on the back of the tongue and upper throat. It can also be caused by medical conditions. Infections of the nasal passages and disturbances of metabolism such as diabetes, kidney and liver disease can all affect breath. The cause and treatment of bad breath overlaps both dentistry and medicine.

Most people who have bad breath, or think they have, try to treat it themselves. Self-help in the form of mouth rinses, breath fresheners, or a tongue scraper, along with regular dental visits for teeth cleaning often works. A few people have chronic bad breath no matter what they try. Others only think they have bad breath.

Ancient people in the Middle East, China and Europe left behind various forms of toothpicks. Sometimes, these were part of a set of personal cleaning items made from precious materials. From these artifacts, we learned that people have always worried about bad breath. The toothpicks were probably intended to remove bits of food stuck between teeth. Bits of food do start to smell if left in the teeth – and most likely the toothpicks solved the problem. We can still use this strategy today.

The famous Greek doctor Hippocrates described toothpowders and mouth rinses 2500 years ago. His own mouth rinse formula came from India. The medieval herbalist Hildegaard von Bingen described using fennel as a breath sweetener. Other natural remedies for bad breath include peppermint, parsley leaves and cardamon seeds. Still, focusing too much on bad breath can lead to unnecessary social isolation. Everyone has a bit of bad breath sometimes.

Causes of bad breath

Causes of Bad Breath

in children and youth in adults in the elderly
  • Metabolic diseases, such as diabetes or other changes in metabolism
  • Hiatus hernia
  • Something stuck in the nose or sinuses
  • Untreated decayed teeth in the mouth
  • Oral infection
  • Smoking

To avoid too much anxiety, be gentle in approaching the subject with children.

  • Periodontitis – gum disease
  • Poor oral health including lots of broken down or infected teeth
  • Hiatus hernia
  • Smoking, alcohol and dehydration
  • Coffee
  • Infection of the gums
  • Metabolic diseases and other medical conditions
  • Dry mouth (xerostomia), including a dry mouth caused by medication
  • Poor denture hygiene can involve amines
  • Dry mouth, which can be caused by medication
  • Metabolic diseases and other medical conditions
  • Hiatus hernia

One of the main causes of bad breath is the production of volatile sulphur compounds (VSCs) by bacteria that grow naturally in the mouth. The bad odour of rotten eggs comes from VSCs bacteria produce when digesting proteins in the egg. The same bacterial process happening on the tongue causes bad breath in our mouths. For some reason, human noses are sensitive to VSC at such low concentrations that they are measured as parts per billion. Our noses can clearly detect breath containing no more than 200 to 300 parts per billion of VSC. Natural amines produced by bacteria breaking down amino acids in the mouth also cause breath odours. The names of these amines – cadaverine and putrescine – indicate their foul smell. However, the nose cannot detect these amines with nearly the same sensitivity as VSC.

So-called ‘morning breath’ consists largely of VSCs on the tongue. Bacteria grow well overnight, as saliva flows very slowly during sleep. This dries out the back of the tongue, encouraging VSC production. Since the area is not flushed out by saliva, the odour becomes more noticeable. Control the smell by staying hydrated and cleaning your teeth and mouth well first thing in the morning. Remember to brush or scrape the back of your tongue as far back as you can manage, but do not overdo this.

A few people have breath odour most of the time. A minority are healthy and have healthy mouths. In people with persistent bad breath, there seems to be an imbalance in growth of oral bacteria. More bacteria associated with VSC production appear. We do not know how or why this imbalance occurs. Research has tried to identify molecules in saliva that might be different in these people. Part of treatment encourages the growth of normal bacteria in the mouth. Such treatment does not involve simply overcoming or ‘knocking out’ oral bacteria, because sometimes that approach causes bad breath.

In fact, in New Zealand, normal oral bacteria in the form of a strain of Streptoccus salivarius were developed as a probiotic treatment for bad breath. Other such probiotic treatments are underway, but all are still in the clinical trial stage. Simple remedies can involve gentle suppression of anaerobic bacteria in the mouth – the ones most closely associated with bad breath. Other remedies involve trying to bind VSCs in the saliva, so they do not come out of the mouth in air. All breath remedies on the market use either or both approaches to managing bad breath. Using a remedy like peppermint can also cover bad breath for a while.

Thanks to all the research in this area, we know more about why people get bad breath. One group of people likely to have bad breath are those with active or extensive gum disease (periodontitis). Bacteria associated with poor gum health produce VSCs. These bacteria also grow on the back of the tongue. One form of gum disease produces an odour generally described as ‘metallic.’ This condition is called acute ulcerative gingivitis and is usually associated with painful gums. People with inflamed tonsils may also have breath odour that contains lots of VSCs.

The condition of the esophagus, the tube from the throat to the stomach, can affect breath. In people who have a hiatus hernia, the esophagus stays slightly open. Stomach odour may scent the breath, especially if the person is hungry. Drinking coffee or smoking can make breath worse, since coffee stimulates stomach secretions and smoking dries the mouth. Some people taking antibiotics find stomach odour increases and then eventually goes away. Others have bad breath because of a sinus infection or even a chronic chest infection.

A range of metabolic diseases can produce breath odour. Poor diabetes control creates a smell like nail polish remover. Liver diseases and kidney disease are also associated with breath odour. In a few people, choline (found in eggs) transforms into a chemical that can contribute to a fishy odour of the breath and urine. There is a whole range of reasons why somebody can have bad breath. Many fall outside of dentistry and in the area of medicine.

What can you do?

What to do about bad breath

  • Practice good oral hygiene. Brush after meals and before bed. Floss once a day and scrape your tongue once or twice a day. Rinse your mouth with water if you are unable to brush.
  • Chew sugarless gum or try a mouth rinse.
  • Drink plenty of water.
  • Cut down on alcohol and coffee.
  • Eat a small cracker when hungry.
  • Have a dental check-up and cleaning. Discuss your concerns with your dentist, who may have products for you to try.
  • At your medical check-up, tell your doctor that you are worried about your breath.
  • Recruit a close friend to help find out what works to control your bad breath.
  • If you are concerned about bad breath, get help from a sympathetic person. Not everyone who thinks they have bad breath actually does. Halimetry can help set your thoughts at ease.
  • If you continue to have problems, a specialist in oral medicine at a dental school or clinic may be able to help.

Worrying about breath odour can be very socially isolating. It is almost impossible to detect and monitor your own breath. There is a remedy – find somebody to advise you. The human nose is still the most sensitive instrument we have to measure bad breath. Using the sense of smell in bad breath research is disguised under the term ‘neuroleptic assessment.’ If you are concerned about your breath, recruit a trusted friend who can tell you what works in controlling bad breath and what does not. The right person to work is often the person who tells you that your breath is bad. This person can also give support if you are unnecessarily afraid of having bad breath. If someone you know has breath odour, you might gently offer your help.

A number of instruments for measuring bad breath are used in the clinic. All can give clear proof to a patient and their caregiver of the presence or absence of levels of VSCs associated with bad breath. Appropriate treatment can then be recommended. The gas chromatograph is an example. One type, the OralChroma™, specializes in measuring oral VSCs. Many people working in this area use a portable monitor to measure VSC growth in a process called halimetry. The Halimeter™ is a souped-up adaptation of an industrial safety monitor. Instead of detecting ‘sour gas,’ it measures VSCs in mouth air. Like all aspects of scientific measurement, using an instrument to detect and measure VSCs in mouth air requires training for correct interpretation of results.

Such instruments have both benefits and limitations. They can be influenced or even deceived by other molecules, such as alcohol (frequently found in mouth rinses) and flavouring agents in products like toothpaste. The instruments used in clinics cannot detect amines which are associated with bad breath in some people, especially the elderly. Most important, the only thing this equipment can do is confirm bad breath at the time of measurement.

If you are worried about your breath, the best solution is to find an advisor you trust. If the problem persists, your doctor or dentist may be able to help find a solution.

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FAMILY HEALTH is written with the assistance of
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2015, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6   [GO_FHc11]
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