Bad Breath (Halitosis): Bacterial Origins and Scents

Bad breath, or halitosis, is a very common oral health problem. People of any age may have halitosis, including:

• Those who practice poor dental hygiene.
• The elderly, disabled people and young children, who find dental hygiene difficult.
• People who use mouth appliances, including dental braces and dentures.
• Smokers are more prone to halitosis and periodontal disease (another contributor to bad breath).
• People with certain medical conditions, including tooth decay, impacted teeth, abscessed teeth, periodontal disease, alcoholism, uncontrolled diabetes, kidney disease, sinusitis, throat and lung infections (such as bronchitis), post-nasal drip, allergies and dry mouth. Dry mouth may result from a high-protein diet, non-fibrous diet or medical condition.
• People on certain medications, including certain vitamin supplements, antihistamines, calcium blockers, cardiac medications, blood pressure pharmaceuticals and psychiatric drugs. These substances can inhibit saliva flow or produce dry mouth, which may lead to halitosis. Dry mouth may also lead to excessive thirst and tooth decay – a good foundation for halitosis once again.
• Poor dieters who are dehydrated because of certain foods they eat may have bad breath. Foods that contribute to halitosis include diet soda, onions, spices, garlic, curry, cabbage and coffee. High-protein food debris lodged between the teeth can produce halitosis as well.

Bacterial Origins of Bad Breath

Researchers have determined that bad breath typically begins when the waste produced by bacteria in the mouth, nose or stomach comes into contact with the air.

There are numerous nasal triggers for bad breath. Nasal dysfunction, including a genetic abnormality in the nasal passage, may inhibit proper mucus flow. The bacteria found in sinusitis, post-nasal drip and allergies may pass from the nose to the back of the tongue where it can lie dormant due to improper saliva flow or poor dental hygiene.

When bacterial plaque is not removed from the teeth, the gums or between the teeth, it continues to grow and ultimately may lead to halitosis, tooth decay and gum disease.

Bad Breath Bacterial Scents

Biologists have found that numerous types of bacteria contribute to halitosis. All of these bacteria are found in other types of unpleasant odors, including corpse scent (a combination of oxygen and sulfur compounds and/or nitrogen-containing gases such as cadaverine), decayed meat (putrescine), rotten egg stench (hydrogen sulfide), smelly feet (isovaleric acid), as well as feces aroma (methyl mercaptan and skatole).

To think that such scents could be emanating from your mouth is unpleasant indeed, illustrating the importance of proper dental hygiene and regular dental check-ups

Bad Breath Solutions: Hygiene, Diet and Breath Aids

What can you do for bad breath? If you have halitosis, try these strategies:

Use Good Dental Hygiene

Simply put, good dental hygiene prevents halitosis that originates in the mouth. Food debris between your teeth and around your gums creates an ideal environment for the bacteria that cause bad breath, so you need to remove it often.

Brush your teeth at least twice a day, and floss between each tooth daily, if not more often. Your dentist will tell you that brushing and flossing are particularly important after high-protein meals or other meals that trigger foul breath and dehydration.

Use antiseptic mouthwash in the morning, before bedtime and after eating, to reduce halitosis-causing bacteria growth. Antiseptic mouthwash ingredients vary from one product to another and may include chlorhexidine, chlorine dioxide, zinc chloride and oils (such as eucalyptus oil).

Tongue scrapers are also useful in managing bad breath. Scrape the mucus off the back of the tongue, where bacteria may be present; do it gently, to avoid damage to the tongue.

If you have dental braces, dentures or other dental appliances, follow your dental professional's specific instructions for cleaning these appliances in order to avoid bad breath. This is especially true when it comes to appliances that you remove at night.

Maintain a Proper Diet

Diet plays a significant role in dental hygiene. Certain foods can promote saliva flow to limit the possibility of halitosis; one example is fibrous foods such as raw vegetables. And eating a healthy breakfast every morning starts saliva flow after a night's sleep when bacteria and odor tend to build up in your mouth.

Staying hydrated through sufficient water intake is also important for bad breath prevention. Sodas, juices and other drinks that are high in sugar and acid, however, will encourage growth of bacteria that cause bad breath.

Use Bad Breath Aids

Mouthwashes, mints and gum can freshen breath in the short term, but they can't prevent bad breath altogether. You may want to try these bad breath aids as well:

• Straws can send sugary or sticky liquids past the teeth and tongue, so they can't stay in the mouth and house bacteria. Straws are especially useful for the elderly, small children and disabled people, for whom proper dental hygiene may be difficult.


• For dry mouth sufferers, over-the-counter and prescription medications can help. Certain toothpastes, toothbrushes, mouth rinses and breath sprays are also made to relieve dry mouth. Ask your dentist which ones would be best for you.

If you have bad breath, discolored mucus, colored blotches or bumps on your tongue, it may be a sign of a serious medical condition such as oral thrush, oral herpes or oral cancer. See your doctor and dentist for a diagnosis.

Burning Mouth Syndrome

Burning mouth syndrome (BMS) is a chronic, painful condition characterized by burning sensations in the tongue, lips, palate (roof of the mouth), gums, inside of the cheeks and the back of the mouth or throat. The discomfort cannot be easily attributed to any physical abnormalities in the mouth or any underlying medical disorders.

A complicated and poorly understood condition, burning mouth syndrome appears to affect women seven times more often than men. Most people suffering from burning mouth syndrome are middle aged, but younger individuals also have been affected by the condition.

Burning mouth syndrome may also be called burning tongue syndrome, burning lips syndrome, glossodynia, stomatodynia and scalded mouth syndrome.

Symptoms of Burning Mouth Syndrome

There are a number of symptoms associated with burning mouth syndrome, most notably the sensation of pain or burning. The pain or burning sensation is typically mild in the mornings, becoming progressively more intense throughout the day, peaking in the evening and subsiding at night. Some burning mouth sufferers feel continuous pain while others experience intermittent burning sensations. The pain associated with burning mouth syndrome can last for several months or years.

Other symptoms often reported with burning mouth syndrome include dry lips, a sore or dry mouth, tingling or numbness on the tip of the tongue or in the mouth and bitter or metallic changes in taste.

Causes of Burning Mouth

The exact cause of the condition is still not clearly understood. A burning sensation or symptom in the mouth can result from, or be a symptom of, a number of oral and systemic conditions. These problems must be ruled out before a diagnosis of “burning mouth syndrome” can be made.

Some of the factors contributing to oral burning include:

Nutritional deficiencies: Deficiencies of iron, folate and vitamin B complex have been associated with a burning sensation in the mouth. As a result, some treatment approaches have included supplements of B vitamins and minerals like zinc and iron. (Read more about diet and dentistry)

Dry Mouth (xerostomia): Medications, Sjogren's syndrome and any number of other causes can lead to dry mouth and its related burning sensation. Sipping liquids throughout the day, using artificial saliva and/or eliminating the cause of the dry mouth may reduce or eliminate the burning sensation.

Oral Candidiasis (Oral Thrush): A symptom of this oral fungal infection is a burning sensation in the mouth, particularly when consuming acidic or spicy foods, or when the cottage-cheese like lesions are scraped from the inside of the mouth. The plan that your dentist recommends to treat oral thrush can help end the burning sensations associated with this oral yeast infection.

Diabetes: Diabetics are more susceptible to oral infections (including oral thrush) that produce burning mouth sensations. Additionally, diabetics are prone to vascular changes that affect the small blood vessels in the mouth, creating a lower threshold for pain. A better control of blood sugar levels in diabetic patients may prevent onset or help improve symptoms of burning mouth.

Protein Causing Migraine Pain May Also Cause Orofacial and Burning Mouth Pain

The protein that triggers migraine pain by causing the blood vessels in the brainstem to dilate and release inflammatory substances is being examined in order to relieve the pain associated with orofacial disorders.

These include trigeminal neuropathies associated with burning mouth syndrome and incidences of electric shock-like pain in the lips, tongue and jaw.

A professor at New York University College of Dentistry will investigate whether the molecule that blocks the protein calcitonin gene-related peptide (CGRP) – which has shown promise for treating migraine pain – can help prevent orofacial inflammation and pain.

Menopause: Hormonal changes have been associated with a burning sensation in the mouth in middle-aged women. Burning mouth is among the most common oral manifestations of menopause. However, hormone replacement therapy has only been effective in relieving burning mouth symptoms in certain patients.

Anxiety/Depression: Psychological problems do not directly cause burning mouth but could aggravate these symptoms or even result from the frustration patients experience dealing with their chronic pain. Anxiety or depression may have a role in initiation of destructive oral habits such as tooth grinding (bruxism) or tongue thrusting which can further irritate burning lips and mouth. Stress may also lead to alteration of the flow or composition of the saliva, exacerbating the oral burning.

Other: Additional causes of burning mouth symptoms could be physical irritation from dentures, contact allergy to denture components (contact stomatitis) or oral hygiene products (Sodium Lauryl sulfate in toothpastes), gastroesophageal reflux disease, low levels of thyroid hormones, certain antihypertensive medications, changes in salivary composition, tongue thrusting and cancer therapy.

If you are experiencing burning sensations in your mouth, it is important that you visit your dentist as soon as possible to discuss your symptoms and undergo an examination. Your dentist will likely review your complete medical history and perform a thorough oral examination in order to help identify the local cause of the burning sensations in your mouth. If oral thrush (oral fungal infection), dry mouth, oral sores or other oral/dental issues are ruled out as the cause, you may be referred to a physician or an oral medicine practitioner for further evaluation and treatment.

Blood work and other diagnostic tests may be necessary to look for infection, nutritional deficiencies, diabetes or thyroid problems, Sjogren's syndrome and allergy. Once identified, treatment is directed against the cause of burning mouth symptoms.

In the absence of local or systemic causes for oral burning sensations, the condition is diagnosed as burning mouth syndrome thought to be caused by neuropathy or dysfunction of the nerves involved in the perception of pain and taste sensations from the oral cavity.

Treatment for Burning Mouth Syndrome

The treatment for burning mouth syndrome aims to alleviate symptoms. Burning mouth syndrome treatments include different medications traditionally used to relieve the underlying causes of other conditions, such as depression and chronic pain. Tricyclic antidepressants (amitriptyline/Elavil), antipsychotics (chlordiazepoxide/Librium), anticonvulsants (gabapentin/Neurontin), analgesics, benzodiazepines (clonazepam/Klonopin) and mucosal protectors have provided effective relief for some patients.

In addition, topical capsaicin (the natural chemical in cayenne pepper) has been used to desensitize patients suffering from burning mouth syndrome.

However, despite the success of these approaches in certain situations, there is no universal treatment for burning mouth syndrome that is effective in all cases. Treatment is planned to meet the specific needs of each patient. The cost of treatment varies depending upon the medications prescribed (if any), how long they will be needed and whether or not medical and/or dental insurance will cover all or some of the costs.

Additional relief from the symptoms of burning mouth syndrome may be achieved by making some simple changes:

• Stop using mouthwash that contains alcohol.
• Stop using toothpaste that contains sodium lauryl sulfate.
• Chew sugarless gum, preferably sweetened with xylitol.
• Avoid alcoholic beverages.
• Use baking soda and water when brushing your teeth.
• Refrain from drinking beverages with high acidity (fruit juices, coffee, soft drinks).
• Abstain from tobacco use.
• Sip water or suck on ice chips.

Canker Sores

Canker sores (known by dentists and medical professionals as aphthous ulcers) are one of the most common oral conditions affecting people everywhere. Up to 25 percent of the population has these small, painful, persistent sores, with recurrence rates of up to 50 percent.

Canker sores appear on the tongue, soft palate, insides of the cheeks or lips and base of the gums. While they have the benefit of not usually being visible, they are likely to make eating, swallowing and speaking painful.

Cause of Canker Sores

Canker sores are not viral or infectious. They may be hereditary since 30 to 40 percent of those with recurrent canker sores have a family history of the condition. According to research reported by the National Institute of Dental and Craniofacial Research, “Canker sores may be caused by a faulty immune system that uses the body's defenses against disease to attack and destroy the normal cells of the mouth or tongue.”

Simply stated, their cause is unknown; however, common canker sore triggers may include:

• Stress
• Immune deficiencies
• Illness or infection
• Gastrointestinal disease
• Tissue manipulation – including prophylactic dental and gum cleanings and overzealous tooth-brushing
• Tissue injury – for example, biting the inside of the mouth
• Eating abrasive foods (such as potato chips, dry cereals and dried fruits), acidic foods (such as vinegar) and spicy foods (curries, chilis and hot sauces)
• Food or contact allergies
• Although not yet proven, nutritional deficiencies – particularly a lack of vitamin B-12, folic acid or iron – may also play a role.

Canker Sore Diagnosis

If you suspect you have canker sores, you may wish to consult with your dentist first to rule out a more serious type of mouth sore. Dentists specializing in oral health conditions are in a better position than physicians when it comes to diagnosing and managing these sores – and particularly at distinguishing them from intraoral herpes, a contagious viral condition which may lead to serious problems in people with an impaired immune system.

Your dentist can also assess whether sharp tooth surfaces or wearing an appliance may be triggering canker sores.

Canker Sores or Intraoral Herpes?

Intraoral herpes are frequently confused with canker sores. Not only do they have a similar appearance, last approximately 14 days and tend to recur, but they also have similar triggers, including stress, mechanical irritation and fever or illness. But the two conditions have different causes, and therefore require different treatments. Specifically:

• Canker sores aren't contagious. Intraoral herpes are.
• Canker sores appear on soft, movable tissue – on the insides of the cheeks, inside the lips and the back of the throat. Typically, intraoral herpes are seen on the mucocutaneous junctions, such as the lips. Herpes sores start off with tingling, followed by the appearance of little bumps or blisters that burst, leaving tiny ulcers.
• Canker sores can take anywhere from seven days to a month to heal, depending on the type of canker sore. Intraoral herpes tend to heal in about 7 to 10 days.
• Canker sores occur in different areas within the mouth. Herpes sores tend to reappear in the same place.

Canker Sore Development: What to Expect

Canker sores generally start as one or two tender, inflamed red spots, round or oval in shape, measuring an eighth of an inch wide (mild cases) to more than an inch wide (severe cases). These tender spots soon expand to form sores with a thin, yellowish center and a brisk red edge or halo. The presence of canker sores makes it hard to eat, talk or perform oral hygiene. As the sores heal, the pain also diminishes.

Small canker sores or minor aphthous ulcerations run their course in 1–3 weeks and leave no scar. In contrast, larger sores or major aphthous ulcerations typically take longer to heal and may scar. Finally, a herpetiform aphthous ulcer, the most severe type of ulceration, is characterized by multiple lesions occurring simultaneously and may require palliative treatment from your dentist.

Canker Sore Treatment

Canker sores typically heal without treatment. If the sores are especially large or painful, your dentist or doctor may prescribe a topical anesthetic, a prescription tetracycline mouthwash or a corticosteroid salve.

There are a number of home remedies that may alleviate pain or shorten the duration of canker sores:

• Apply ice over the sores.
• Rinse with pediatric diphenhydramine (Benadryl). But don't swallow the Benadryl; it can make you sleepy.
• Dab milk of magnesia on sores a few times a day, both to ease the pain and help healing.
• Take acetaminophen (Tylenol), aspirin or ibuprofen (Advil, Motrin, etc.).

Dry Mouth Syndrome: Signs, Symptoms, Causes and Treatments for Xerostomia

Dry mouth syndrome, also known as xerostomia, is a dry, uncomfortable feeling in your mouth that results from a decrease in the amount of your saliva. Dry mouth syndrome can be temporary or a chronic problem.

One or more factors can cause your salivary glands to function improperly and produce a less saliva than normal:

• Medications (prescription and over-the-counter).
• Medical conditions (Sjögren's Syndrome, diabetes, stroke or others).
• Emotional stress and anxiety.

The exact number of people suffering from dry mouth syndrome is unknown; however, everyone experiences it to some extent at one time or another. Dry mouth syndrome is more likely to occur among older adults, but it can affect a person of any age.

Signs and Symptoms of Dry Mouth Syndrome

A number of symptoms are commonly attributed to dry mouth syndrome, each of which can be classified as mild, moderate or severe. If you experience any of the following symptoms on an ongoing basis, you should talk to your dentist about xerostomia.

Signs and symptoms of dry mouth syndrome include, but are not limited to:

• A dry, sticky feeling in the mouth or throat.
• Insufficient saliva.
• Saliva that feels thick or is stringy.
• A rough, dry tongue.
• Sore throat.
• Bad breath.
• Difficulty swallowing, chewing or talking.
• Signs of dryness, such as cracked lips, sores or split skin at corners of mouth.
• A burning sensation in the mouth.
• Altered sense of taste.
• An infection in the mouth.

Causes of Dry Mouth Syndrome

Medications are a common contributor to dry mouth syndrome. For example, dry mouth syndrome is a side effect of more than 400 prescription and over-the-counter medications, such as antihistamines and decongestants that are used to treat allergies and colds, antidepressants used to treat depression, and pain killers and diuretics.

Even high blood pressure medications, muscle relaxants and medications for Parkinson's disease may cause dry mouth.

Certain cancer therapies – including chemotherapy and especially radiation treatments near the salivary glands in the head and neck region – can cause dry mouth syndrome by reducing the amount of saliva production.

For these reasons it is important that you tell your dentist about all the medications you are taking, as well as any other treatments you receive, because they could contribute to dry mouth or affect your oral health in other ways. It is ironic to think that something designed to help you could be causing or contributing to your dry mouth syndrome, but it has proven to be a common problem.

Various medical conditions may contribute to or cause dry mouth syndrome, so it is important that your dentist knows your complete medical history. This includes Sjögren's Syndrome (a chronic autoimmune disease affecting the moisture-producing glands, leading to dry eyes and dry mouth ), diabetes, Alzheimer's disease, stroke and other conditions.

If you are under stress or feeling anxious, you may experience dry mouth syndrome. Dry mouth symptoms can also occur as a result of hormone changes from pregnancy or menopause, as well as snoring or breathing with an open mouth.

Consequences of Dry Mouth Syndrome: Why Saliva Is Important

Saliva is approximately 99 percent water, with its remaining components consisting of lubricants that help fight infection, as well as enzymes and proteins that help you digest food. Healthy adults produce an estimated three pints of saliva a day.

Not surprisingly, dry mouth syndrome does more than leave your mouth feeling dry and uncomfortable. Insufficient saliva causes the soft tissues of the mouth to become irritated, making them inflamed and more susceptible to infection. Your tongue may feel sensitive (burning tongue syndrome).

Also, without saliva to wash away food debris and neutralize the acids produced by plaque, your teeth are more susceptible to dental cavities and tooth decay.

What's more, without the lubricating effect of saliva, you may find it difficult to swallow, talk and chew your food. You may be less able to taste foods, as well. Your throat may be sore and hoarse, and your nasal passages may become dry.

If you have any symptoms of dry mouth syndrome, talk to your dentist.

Wetting Your Whistle Again: Dry Mouth Syndrome Treatments

Once you have told your dentist about your dry mouth symptoms, he or she will examine your mouth for possible complications from dry mouth (cavities, irritation, infection), as well as ask you questions about the symptoms and any medications you are taking. Depending on the severity, he or she may refer you to a specialist, such as a periodontist.

There are a number of simple dry mouth syndrome treatments that are designed to restore moisture to your mouth. Your dentist may recommend:

• Sugar-free candy, sugar-free gum or gum specially made to stimulate saliva flow.
• Specially formulated oral rinses.
• Artificial saliva (saliva substitute).
• More fluid intake (frequent sips of water, sucking ice chips).
• Oral moisturizers (sprays or gels).
• Oral prescription medications to induce saliva production.

The American Dental Association (ADA) also suggests that people with dry mouth avoid tobacco and limit their consumption of carbonated beverages or those containing caffeine or alcohol. Also, because dry mouth increases the likelihood of tooth decay, the ADA recommends twice-daily tooth brushing, using floss or interdental cleaners once a day, and seeing your dentist for regular checkups.

Alternative approaches to treating dry mouth symptoms that scientists are currently investigating include acupuncture, nerve stimulation, guided tissue regeneration and gene transfer/DNA technology. These treatment options might be useful in the future for very severe cases of xerostomia.

Oral Cancer

According to the American Cancer Society, more than 28,000 cases of oral cancer are diagnosed annually, with more than 7,000 of these cases resulting in death. Oral cancer may occur on the mouth, lips, tongue, gums, salivary glands, and throat (oropharyngeal).

Possible Signs of Oral Cancer

Since oral cancer often begins with an asymptomatic stage during which symptoms may not be obvious, it is often painless initially and therefore difficult to detect.

Although the following signs do not necessarily signify cancer, are not all-inclusive, and may signify other dental conditions, they may be associated with early signs of cancer. Since oral cancer treatment is usually successful when performed in the early stages, any abnormal change in the mouth, gums, tongue, or surrounding area should be evaluated by a dental professional immediately.

The signs of oral cancer may include:

• Continuous pain in the mouth
• Sores and bumps inside the mouth, including ragged, ulcerous lesions
• Difficulty moving the mouth and jaw
• Difficulty swallowing and chewing
• Soreness in the throat
• Bump in the neck
• Pronounced pain in one ear
• Undiagnosed bleeding from the tongue, gums, or cheeks
• Numbness in a specific area of the mouth or jaw

Oral Cancer Check-up, Diagnosis and Treatment

For a definitive oral cancer diagnosis, you must see a dentist and a doctor (your dentist may refer you to an oncologist if cancer is expected). Your doctor and dentist will examine your mouth and evaluate your medical history to formulate an initial diagnostic impression and treatment plan. If the resulting treatment plan does not effectively resolve the dental condition within two weeks, a biopsy of the affected area will be performed to test for cancer.

Oral cancer is diagnosed through a confirmed malignant biopsy and a clinical evaluation to identify the stage and grade of the cancer. Cancer is present when the basement membrane of the epithelium is broken. The cancer may eventually spread to other areas of the mouth and body, resulting in secondary cancers that may yield even more serious consequences.

In order to determine the “path” of the cancer, the doctor may perform additional tests, including an X-ray, CT scan (computerized tomography) or MRI Scan (magnetic resonance imaging).

Ultrasounds may be used to establish the contour, consistency and composition of the cancerous mass or masses. In the end, your doctor and dentist will develop a treatment plan based on supporting diagnostic tests.

Oral Cancer Treatment and Prevention

To treat oral cancer, doctors may administer one or more of three primary treatment modalities: surgery, radiation therapy or chemotherapy.

If surgery is the chosen treatment, the extent of the surgery depends upon the stage and grade of the cancer. In some progressive cases, surgery may involve removal of tumors in the jaw or roof of the mouth bone tissue. If the cancer has spread to other parts of the body (such as the lymph nodes) then the tumors in those areas may be removed as well. The doctor may remove tumors in the neck area by performing neck dissection.

If surgery is not an option or is not otherwise necessary, doctors may opt to use radiation therapy (a form of X-ray) or chemotherapy (intravenous or oral drugs). Multimodal treatments may incorporate one or more of the aforementioned modalities. For example, radiation therapy or chemotherapy may be used to destroy any remaining cancer that surgery was unable to remove.

Following extensive cancer treatment, patients may need to undergo plastic reconstructive surgery and speech therapy to improve the appearance and functionality of the affected area. Some patients require the use of devices to speak properly.

If you have cancer, it is important to learn as much about your disease as possible. Whether you suffer from a common cancer like nonmelanoma skin cancer or an extremely rare cancer like mesothelioma, you can access a great deal of helpful information online or by contacting The National Cancer Institute at (800) 4-CANCER or (800) 422-6237 or contacting the American Cancer Society at (800) ACS-2345 or (800) 227-2345.

Oral Cancer Prevention

Any irritation of the mouth, gums or tongue may increase the risk of oral cancer. You are advised to perform periodic self-examinations of your mouth, gums, tongue and cheeks to check for the presence of any abnormalities.

Self-examination recommendations begin with an oral examination of the mouth, including checking the:

• Teeth
• Gums
• Cheeks
• Tongue (above and below)
• Throat
• Roof of the mouth
• Turning the lips up and down to view the inner tissue surfaces

However, since symptoms associated with oral cancer may be confused with other medical conditions, self examinations should not replace seeing a dentist and dental hygienist for oral care maintenance at least twice a year. When used in conjunction, periodic self-examination and regular dental hygiene visits can help promote early-stage detection of oral cancer. And remember, it is always best to see both a doctor and dentist to properly evaluate symptoms