I have very bad breath even after I brush my teeth! What can I do?

The diagnosis and treatment of bad breath (i.e. halitosis) is a popular area in dentistry today. Some research has been completed but we still have much to learn about the causes and treatments of halitosis.

There are actually several different sources of oral malodor. These include mouth and tongue sources, nasal and sinus sources, lower respiratory tract and lung sources, gastrointestinal diseases and disorders, systemic diseases, and ingestion of certain foods, fluids, and medications. The first challenge is to determine if a patient has chronic or acute bad breath. Chronic halitosis occurs all the time. Then the source(s) can be investigated.

If the source of halitosis is orally-related, tooth decay and/or periodontal disease is probably involved. Other oral problems, such as xerostomia (dry mouth), oral candiasis (fungal infection), and oral cancer, can also contribute to oral malodor. If all these conditions are eliminated and halitosis remains, I would next suspect bacteria as the cause. There are some bactieria that live on the tongue and emit volatile sulfur compounds (VSCs). The VSCs can cause bad breath.

I advise all my patients to gently brush their teeth, tongue and palate. Several companies market tongue scrapers. At first, I thought these devices were just a sales gimmick. However, after personally using them I realize that they do help reduce problems associated with halitosis! If scrupulous oral hygiene does not help alleviate the problem, other products can be tried. Salivary stimulants may help if the problem is related to dry mouth. Some newly formulated mouthwashes, which include various ingredients such as zinc and chlorine dioxide, are being developed to combat bad breath. While there seems to be some value in these new agents, further research still needs to be conducted.

First, get a complete examination by your dentist. The exam should include radiographs and an oral cancer screening. If no dental-related source of halitosis is discovered, see your physician to rule out a systemic cause. In the meantime, your best defense against bad breath is to practice excellent oral hygiene. This includes regular brushing, flossing, and tongue-scraping.