Bad breath or halitosis, may have many causes but may be due to poor dental health or oral hygiene. It may arise from respiratory tract infections (both lower and upper), post-nasal drip, diabetes, chronic acid reflux and other digestive disorders such as constipation, liver or kidney problems or salivary gland problems. Breath odor may also be influenced by diet and other lifestyle habits, such as smoking or other tobacco-based products. However, bad breath and an unpleasant taste in the mouth (known as dysgeusia) may indicate gum disease or periodontitis, and very often it is due to poor oral hygiene and irregular dental check-ups.
Why does oral hygiene affect your breath?
Brushing teeth and flossing daily removes food particles from your mouth and prevents bacterial growth on and around the teeth and other oral structures. It is the growth of bacteria that leads to odor. Badly fitted dental prosthetics, candidiasis (thrush) of the mouth and dental caries (cavities) can also be to blame.
Medical salivary conditions can also lead to bad breath. Insufficient saliva production or flow (known as dry mouth or Xerostomia) is also associated with gum disease or periodontitis. Saliva has an important role as it keeps the mouth moist, neutralizes acids arising from plaque, and assists with the removal of dead cells that may accumulate in the mouth. If they remain, these cells will decompose and lead to mouth odor. Dry mouth or Xerostomia may be a side effect of various medications, due to salivary gland problems, or result from continuous mouth-breathing.
How are halitosis (bad breath) and dysgeusia (bad taste) connected to gum disease (periodontitis)?
Gum disease appears in different forms of severity from mild (gingivitis) to severe (periodontits) but all may result in bad breath. Let’s look at these stages.
In early stages, in mild gum disease or with bleeding gums, plaque builds-up and tartar occurs. This eventually results in enlarged spaces between your teeth and gums, known as pockets. Food can become trapped in these pockets and attract bacteria, which leads to the bad odor. Foods containing dense proteins (meat, dairy or fish) break down and produce sulfurous compounds, reminiscent of rotten eggs or cabbage.
As gum disease progresses, more harmful bacteria is seen but the primary cause of odor is blood. One particular type, called anaerobes, thrive in an environment deficient in oxygen and so their presence indicates that the gum disease is quite severe; they lead to pH and oral microbiome change and can cause either a metallic smell and taste or putrid/rotten odor.
What helps periodontitis-caused bad breath and taste?
Good oral hygiene is the key to addressing halitosis
Twice-daily brushing (teeth and tongue) with fluoride toothpaste is recommended. On occasion, brushing after eating may also be advised. Flossing or using an interdental cleaner is believed to be beneficial, alongside antibacterial mouthwash. Dentures must always be cleaned and removed at night prior to reinsertion in the morning.
Regular dental check-ups are considered vital in the fight against gum disease
Dentists may utilize scaling and or root planning techniques to address gum disease. In healthy gums, the gum is attached to the tooth one to three millimeters (mm) below the gumline but in gum disease, this will increase and the pockets that form can fill with plaque leading to discomfort and problems like halitosis. Dental scaling tends to be carried out where pockets are more than 4mm and the plaque below the gumline requires removal. Sometimes metal hand instruments (known as a dental scaler and curette) are used to scrape plaque from parts of the tooth inaccessible to your toothbrush. On occasion, they may use an ultrasonic instrument to scale your teeth which uses a vibrating metal tip to chip away at tartar while water flushes out the pocket.
Dental scaling would typically be followed by root planing which removes abrasive spots on the root of the tooth (a place that bacteria can collect) to enable gums to reattach correctly.
Typically these procedures are not uncomfortable. If discomfort is felt during treatments, topical or local anesthetics can be applied to reduce sensation. Gums may feel sensitive or sore after scaling and root planing but this should be mild and manageable and responsive to over-the-counter medications. Gentle brushing and use of mouthwash will also assist with recovery.
Additional measures to assist with periodontal-related halitosis include not smoking, which includes chewing tobacco-based products as well.
Keeping your mouth moist through adequate hydration and use of gum or mints/candy (sugarless and preferably containing xylitol) will maintain your mouth moist.
Keep a log of the foods you eat and be cautious about medications you take
Sometimes foods and medications you take may play a role in creating mouth odors. In this case, review the foods you eat, but most of all medications you take to see if they may play a role in creating oral odors.