Nobody likes or wants bad breath, also called halitosis. Many times I encounter patients who would otherwise not elect to go to a dentist but due to their concern about bad breath they present themselves to my office. Bad breath affects communication and relationships, making it a primary concern for many sufferers.
In an article titled “Oral-Systemic Links” presented in Dental Economics, August 2013, Dr. Richard H. Nagelberg, DDS presents helpful information that can be used by everyone, even those not suffering from bad breath.
In his article, Dr. Nagelberg briefly addresses periodontal disease as context for his article, and then continues:
Some of the same elements that are risk factors for periodontal disease also cause other issues such as bad breath. Anaerobic bacteria are operating when periodontitis develops and progresses; however the gingival sulcus (gums) and periodontal pockets (gums, ligaments, and bone) are not the only locations in which they cause trouble. Anaerobes (bacteria) are also the culprit in the most common source of halitosis, the posterior dorsum of the tongue (back of the tongue).
We need to be aware that there are other sources of bad breath other than the back of the tongue and the bacteria that reside there. Other causes of bad breath can include stomach, liver, and gall bladder problems; cancer, nutrition/diet, smoking, alcohol consumption, high stress levels and acid reflux, to name a few. Sinusitis and xerostomia (dry mouth) also cause bad breath, but directly involve bacteria or fungal infections that contribute to the bad breath.
Regarding the back of the tongue, Dr. Nagelberg states “The bacteria get trapped under layers of food debris, dead epithelial cells, postnasal drip, and assorted other crud. The anaerobic bacteria release volatile sulfur compounds that impart the rotten egg odor to the breath.”
So what options are available to reduce bad breath? “Frequent, effective biofilm control habits, including tongue cleaning” will help. I have been recommending the Oolit tongue scraper since I first learned of this instrument from Dr. Gordon Christensen. The Oolit tongue scraper is inexpensive, but very effective at cleaning the back of the tongue. The scraper can easily be cleaned and reused over an extended period of time. Many of my patients will try using their toothbrush to clean the back of their tongue, but after trying the Oolit tongue scraper they report it working much better for them.
In cases of dry mouth Nagelberg recommends prescription and over-the-counter products that help dry mouth, including “antioxidant rinses and gels and mouthrinses that operate by varying mechanisms of action. Essential oil mouthrinses stimulate salivary flow due to the strong taste of the oils, despite the alcohol that solubilizes the oils. Other mouthrinses that contain enzymes and ingredients to moisturize the mouth address xerostomia directly”.
Dr. Nagelberg introduces another reason to clean the back of the tongue:
Elevated biofilm levels, including those on the dorsum of the tongue, elevate the risk for pneumonia. Many studies have demonstrated the role of spirated oral bacteria in the development of pneumonia (yaledailynews.com/…/link-found-between-pneumonia-and-oral-hygiene)…Aspiration of these pathogens into the lower airway can incrase the risk for lung infections. Futhermore, aspiration of inflammatory products from periodontally diseased tissues can further insult the lungs.
So, perhaps after all, we should view bad breath as more than an unpleasant condition. Perhaps it should serve as a warning that biofilm levels may be dangerously high, especially in certain patient populations and that emphasizing the critical important of biofilm control is one of our primary responsibilities.
If you are concerned about your own bad breath, or that of a friend or family member, we would be happy to help address this topic with you. Feel free to call our office and schedule an appointment.
