October 5, 2022

Bad breath (halitosis in doctorspeak) is not a topic for polite conversation. In fact even your dentist or best friend may not bring up the subject of dragon breath. Many people are painfully aware of their breath problem. They chew gum, suck on mints, gargle regularly and ask health professionals for help. They frequently feel frustrated because no one can can come up with either the causes or the cures for bad breath.
Determining the cause behind bad breath can be challenging. There are so many contributing factors that it can take Sherlock Holmes-type sleuthing to discover what is really going on. That’s partly because there is no one medical specialty that is responsible for figuring out what is causing halitosis or coming up with the “best” solution.
Gastroenterologists, family dentists, periodontists and otolaryngologists (ear, nose and throat specialists, aka ENTs) can all diagnose and try to come up with cures for bad breath. How successful someone is depends a lot on experience and the capability of the individual practitioner.
Food is an obvious source of odor. It’s not just garlic and onions that can cause bad breath. Readers of this column have shared some fascinating stories about milk and dairy products:
“I have a problem with terrible bad breath after eating anything with dairy in it, and also anything with sugar. I have had this problem since my early twenties and am now in my sixties. My husband says it is so bad that he can sometimes smell it from his side of our king-size bed. This is right after brushing, flossing and rinsing with mouthwash before bedtime.
“If I stay away from sugar and dairy, the smell goes away completely after four or five days. It starts again within 30 to 45 minutes of eating the offending foods.”
“I suffer from severe lactose intolerance. Even after taking Lactaid enzyme pills I would have body odor when I ate dairy products. Once I eliminated dairy from my diet, the odor went away.”
We have heard from a great many people who report that dairy products contribute to their bad breath. To read how they came up with cures for bad breath check out this link.
“You have written about bad breath that might be caused by an infection with H. pylori. May I suggest an approach that helps my husband?
“When his breath turns bad, he takes acidophilus for a few days. That seems to settle his stomach as well as eliminate the bad breath. This probiotic pill does not require a prescription.
A. Thank you for the suggestion. Lactobacillus acidophilus is the name for beneficial bacteria that normally live in the mouth and digestive tract. Probiotics containing this bacterial strain are widely available over the counter.
We checked the medical literature for research on bad breath (halitosis) and probiotics. A recent meta-analysis found only four randomized controlled trials testing whether probiotics can reduce bad breath (Frontiers in Nutrition, Jan. 21, 2022).  The authors concluded:
“Despite the limitations of this meta-analysis, we believe that some probiotics have a beneficial effect on halitosis, although more clinical trials are needed to establish real evidence on this aspect.”
You are right that stomach infections with Helicobacter pylori bacteria are associated with bad breath. Sometimes bad breath originates in the stomach. Decades ago we spoke with Nobel Prize laureate Barry Marshall, MD. He discovered that the bacterium Helicobacter pylori could cause stomach ulcers. He told us that these germs are behind some cases of hard-to-treat bad breath.
Other symptoms include abdominal pain, nausea, bloating, loss of appetite and weight loss. Eliminating H. pylori can produce long-lasting relief from halitosis (Journal of Gastroenterology and Hepatology, March 24, 2022).
This is not a do-it-yourself process, however. It will require a physician who is up on the latest treatment approaches to get rid of this bad actor of a bacteria. Many gastroenterologists prescribe “triple therapy.” It includes a proton pump inhitor (PPI), and antibiotics such as amoxicillin and clarithromycin. There is even a product that contains all three called Prevpac.
But some infections have become resistant to clarithromycin, so it is critical to determine the best combination for any given patient. There is even quadruple therapy that involves bismuth, the same ingredient found in Pepto-Bismol. And once H. pylori is gone, it can come back. Follow-up is essential!
One radio listener told us that after years of suffering with heartburn and ulcers he was treated for Helicobacter pylori. After successful treatment with antibiotics, our listener was astonished to find that his long-standing bad breath had disappeared. His girlfriend used to complain bitterly and even his dog would retreat. He was thrilled about the unexpected bonus in curing his ulcers–his dog and his girlfriend no longer backed off.
Other causes of bad breath may include gum disease, tooth abscess, bacterial overgrowth on the tongue, tonsil troubles, sinusitis, bronchitis, diabetes or liver disease. A specialist should do a complete workup to discover the source of the odor.
Here is an example:
“My 11-year-old daughter had terrible breath. The dentist said that it wasn’t coming from her teeth and referred us to an ear, nose and throat specialist. The ENT said that he suspected that the small sinus cavities on each side of her nose had fungal infections in them. He prescribed a special nose spray to get rid of the infection. Within two days her bad breath was gone. Now whenever her breath starts to get bad we just have her start using the nose spray mixture and it disappears.”
Some people may imagine that they have bad breath. Doctors have a term for this condition. It is called halitophobia or delusional halitosis. No matter how much they are reassured that their breath smells fine, such people are convinced they could knock out a horse with each breath. There are no cures for bad breath that originates in the mind.
Diagnosing the cause of bad breath and coming up with cures for bad breath can be challenging. Once the origin is identified, however, halitosis can frequently be remedied. Please share your own story in the comment section below. We are especially interested in cures for bad breath if you have been successful.
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