Bad Breath Blues

According to the American Dental Association, bad breath can go hand in hand with medical problems such as a respiratory infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance and liver or kidney ailment. But just because the peppermints aren’t doing the trick doesn’t mean you should panic.

While breath odor can occasionally be a symptom of these serious illnesses, such conditions are rarely the cause of chronic bad breath in an otherwise seemingly healthy person, and this distinction is an important one.

According to Dr. Richard Price, a dentist and ADA consumer adviser, “Ninety percent of bad breath comes from bacteria in the mouth.” The other 10 percent could be from sinus problems, gastrointestinal issues, the Atkins diet (the high protein diet can lead to a metabolic imbalance called ketosis) and, in rare cases, serious disease such as those listed above. Dr. Price emphasizes, however, that it’s unlikely that the first sign of serious illness would be bad breath.

Dr. John W. Kirk, associate professor in family medicine at Dartmouth Medical School, concurs. “In 35 years practicing general internal medicine I don’t think I have ever discovered anyone whose bad breath emerged from anything other than an oral dental situation,” he says. “Occasionally severe chronic sinusitis is the one other situation. But that’s not mysterious.” A person knows if he or she has a sinus problem.

Diagnosing bad breath

The first (and last) stop for most people in good general health with bad breath is the dentist.

One of the things a dentist might do to define where the bad breath is coming from, notes Dr. Price, is a simple test. Take a deep breath, hold it for about 20 seconds. Pinch the nose, slowly exhale through mouth—and sniff the breath. If the stench is coming from the mouth, you’ll know it. Conversely, you can hold your breath and slowly breathe out through your nose to define sinus problems. (However, again, most people with sinus issues are keenly aware of it.)

Chances are your dentist will be able to tell that it’s a mouth bacteria problem and prescribe a regimen of brushing, flossing and tongue scraping.

This will solve most cases of halitosis. “Sometimes, even doing everything you can under the care of a dentist, people with chronic gingivitis and periodontal disease can still have trouble completely overcoming the problem,” says Dr. Kirk.

If your dentist finds nothing wrong with your oral health and hygiene and you still have bad breath, he or she may ask about your diet. What you eat can cause halitosis. Foods like garlic and onions are absorbed into the bloodstream and the odors are exhaled through the lungs. But unless you eat odor-causing foods with every meal, this is temporary. Price notes that high protein diets like the Atkins diet can lead to mild ketosis, which can cause bad breath. Adding carbs back into your life can eliminate this problem.

If there are no evident dietary causes either, your dentist may refer you to a doctor. Again, for otherwise healthy people, this is rare. Dr. Kirk emphasizes, “I’ve never had a dentist tell a patient to go back to their primary care doctor because it’s not an oral health issue.”

So, what's the deal with bad breath and illness?

Dr. Kirk notes that diabetes and liver or kidney problems can cause distinctive breath odors. But by the time this happens a person is acutely ill. As for gastrointestinal problems like GERD (gastroesophageal reflux disease), he says that odor from a burp can cause a burst of bad breath, but it doesn’t cause chronic stink. “We physicians think we can sometimes help identify strep throat by  a characteristic smell,” says Kirk, “but again we're talking about transient acute illness.”

When people are sick with colds or flu, they can become dehydrated, which can cause bad breath. But that is due to bacteria that accumulates in the mouth from dry mouth. Drinking more fluids can help. In these cases, the bad breath should clear up when the cold resolves.

Even if you are keeping people away with your bad breath, if you are up and about, chances are your bad breath is not a sign of a serious systemic medical condition.  So breathe easy.

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