HOBBLED BY HALITOSIS?

Bacteria, not garlic, most likely the cause

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Here's to your health!

Bacteria on the tongue is the true culprit, say those who've studied halitosis, the proper name for seriously bad breath.

"Everyone has some of this bacteria, but in some people it really takes over," says Cleveland dentist Dr. Louis Malcmacher, who's treated more than 1,500 people for chronic bad breath.

Just why it affects some people more than others, though, remains unclear, he says.

About 65 million Americans suffer from halitosis at some point in their lives, according to the National Institute of Dental Research.

The problem bacteria, which cannot survive in oxygenated areas, hide in the thick surface in the back of the tongue and emit a sulfur compound that causes the offending smell, Malcmacher says. It's different from the smelly breath that comes from eating certain foods, he says.

That's a more temporary version, says Dr. Jon L. Richter, founder of the Pennsylvania Center for the Treatment of Breath Disorders, located in Philadelphia.

Onions, garlic and alcohol are absorbed rapidly in the bloodstream, Richter says, and then the blood is carried back to the lungs, where the food smells are released by the lungs and evaporate into the air, causing the food odors from the mouth.

"You let it run its course, and through evaporation, [the breath] eventually returns to normal," Richter says.

"The type of foul and pungent odor [that makes people worry] is almost invariably caused by bacteria in the back of the tongue," he says.

Bad breath's social toll

Bacteria-caused bad breath is chronic, the experts say, and can cause real problems for its sufferers.

"These people avoid social contacts, cover their mouths, are very aware of getting too close to people," Malcmacher says. One of his patients, a man in his early 30s, hadn't gone on a date for four or five years because of his bad breath, he says.

Richter says he's had people fly to his clinic from as far away as Singapore and Cyprus.

"There is a strong social taboo in Eastern cultures, which are particularly sensitive to bad breath," he says. And in Israel, "people have actually sued and won divorce decrees for bad breath," Richter says.

But Americans suffer and worry, too.

"We are a communication-driven culture, and the organ of communication is the mouth," Richter says. "The best way to make a bad impression is through that organ, and that includes having bad breath."

Getting rid of halitosis, however, can be fairly simple, the dental experts say. It all starts with brushing your tongue along with your teeth at least once a day.

"If you brush your teeth, it's about 10 to 20 percent effective in removing the odor," says Dr. Israel Kleinberg, an oral biologist and dental school professor at the State University of New York at Stony Brook. "But brushing the back of the tongue is about 70 percent effective."

A regular toothbrush works just fine, although it makes some people gag a little bit, he says, or you can buy a special tongue scraper or a tongue brush, which is thinner and easier to use.

"Everybody should be doing something to clean their tongue," Malcmacher says. "Nearly every dental professional brushes his or her tongue, but only 10 percent tell their patients to do so."

Taming the sulfur compounds

Combined with the daily brushing, Kleinberg recommends gargling with one of several products that affect the bacteria in your mouth. These range from anti-bacterial mouthwashes that kill bacteria -- although he says they're least effective because the bacteria grow right back -- to chemicals like chlorine dioxide that oxygenate the mouth, inhibiting bacteria growth. Zinc also is helpful, he says, affecting the enzymes of the sulfur compounds and making it harder for them to grow.

Many newer products on the market contain combinations of these elements, and their use should eliminate most of the mouth odor, Kleinberg says. But, he notes, the government considers these mouthwashes cosmetic products, so they have not gone through Food and Drug Administration testing to back up their manufacturers' claims.

Malcmacher says he offers his patients another remedy: a custom molded tray for the teeth similar to the mold used in bleaching teeth. In it, the patient puts an oxygen-releasing gel that inhibits the growth of bacteria. Worn for an hour a day for about two weeks and combined with regular tooth and tongue brushing, the procedure cures bad breath in about two weeks in about 75 percent of the people who wear it, he says.

But as important as curing halitosis, the dentists say, is making sure you have it in the first place.

"A significant proportion of people have imaginary halitosis," Richter says. "They think they have it, but they don't."

Many people who think they have bad breath actually suffer from dry mouth, Kleinberg says.

"Dry mouth is very common because of all the medications. More than half that are on the market dry out the mouth," he says.

Most dentists today have instruments to measure both the sulfide level and the amount of moisture in a person's mouth, to get a definite diagnosis, Kleinberg says.

"Find a dentist who knows how to take the measurements and can then take care of your problem," he says.

What To Do

Finding out if you have bad breath requires the help of someone you can trust to tell you. If that's difficult, Malcmacher suggests you floss your teeth with unscented floss and then smell the floss to see if there's an odor. But the surest way to confirm a diagnosis of halitosis, he says, is to go to the dentist.

To learn more about halitosis, visit the American Dental Association. And for facts and figures about the status of oral health in the United States, check out the Centers for Disease Control and Prevention.

Or, you might want to read previous HealthScout articles on dental health.

SOURCES: Interviews with Louis Malcmacher, D.M.D., dentist and researcher, Cleveland; Jon. L. Richter, D.M.D., Ph.D., periodontist and founder, Pennsylvania Center for the Treatment of Breath Disorders, Philadelphia; and Israel Kleinberg, D.M.D., Ph.D., professor and chairman, Department of Oral Biology and Pathology, School of Dental Medicine, State University of New York at Stony Brook, Stony Brook, N.Y.