Bad Breath in Children

Not infrequently we will receive inquiries from parents regarding their children having bad breath. Having children of my own I too have witnessed periodic episodes of halitosis from my kids, usually when they awaken in the morning. Probably the most common time for kids to experience halitosis is when they awaken in the morning or after a nap. With bad breath being so common with young children what could be the cause?

The overriding cause of most breath problems, whether in an adult or a young child, is bacterial in nature. It often is a side effect of bacterial imbalances taking place in the mouth. Bad breath can effect kids of all ages, even as early as toddler age. Parents are also often unaware of how frequently they should brush and floss their kids’ teeth so something as simple as plaque building up on the teeth can contribute to a breath problem.  For those children that are old enough to brush their own teeth a common problem is the child either not brushing frequently enough or not doing an adequate job. In these situations an electric toothbrush such as the Sonicare® can make all the difference in the world, and it can also motivate the child to brush their teeth more often. See our website for more information on the Sonicare® toothbrush.

A dry mouth condition can also be a contributor to halitosis both in adults and in children and can have numerous causes especially in adults. Typically both adults and children will have stagnant mouths during sleep and the natural flow of saliva will decrease dramatically during sleep. Children can also mouth breathers due to allergies, congestion from colds and flus, and this can restrict breathing through the nose and can result in mouth breathing which in turn will dry the mouth. Mucous and drying saliva along with gram (-) anaerobic bacteria can accumulate on the tongue and be a major source of malodor. Teaching your child to brush their tongue or even having them scrape their tongue can make a significant difference in their breath odor. Depending upon the child’s age mouth rinse may be ill advised because the child may swallow the rinse. Also many mouth rinses contain high levels of alcohol and this can further dry the mouth and worsen the halitosis condition.  The majority of children who experience halitosis experience it upon awakening but if the condition continues longer into the day this is often a sign of mouth breathing or an allergy condition that is impeding the child’s ability to breath adequately through their nose.

Methods to aid in the prevention bad breath in children:

• Make sure your child’s teeth are being brushed and flossed adequately twice a day.
• Have your child brush or scrape their tongue when they are brushing their teeth.
• Make sure your child is drinking plenty of fluids throughout the day and they are not becoming dehydrated.
•  Have your child see an allergists if you suspect they have allergies. If they are mouth  breathingand don’t have a cold there is a decent chance they have some form of allergies. 

About the author: Dr. Anthony Dailley is a practicing general dentist in Berkeley California. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley also holds a fellowship position with the International Congress of Oral Implantologist (ICOI). Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and was a member of their board of directors from 1997 -2014.

Most Common Mistakes Halitosis Sufferers Make

During the 18 years of helping patients resolve their chronic halitosis conditions we have successfully treated approximately 14,000 patients. Seeing this many patients over this period of time has allowed us to observe a lot of the common mistakes people have made during their attempts to resolve their problem. We have also been privy to a lot of the myths that have been commonly associated with halitosis. In this blog, however, we will focus on some common mistakes that we have seen people frequently make.

    •    Having one’s tonsils removed either because someone told them the tonsils were the cause of their breath problem, or because they believed the myths surrounding the so-called tonsil stones or tonsiloliths. During the 18 years of treating this condition we have seen probably 3,000 patients who have made the mistake of having their tonsils removed for the purpose of resolving a halitosis condition. Unfortunately for those patients the tonsillectomies did nothing to change their halitosis condition. It is an extremely painful procedure and one that nobody forgets.
    •    Seeking the help of a gastroenterologist is a common mistake we have seen people make. A visit to the gastroenterologist often involves an endoscopic examination of the upper and lower gastrointestinal tracks, a colonoscopy, and other similar unpleasant procedures. These procedures are expensive, unpleasant, and subject the patient to a certain degree of unnecessary risk. Over the many years of treating patients for chronic halitosis we have yet to see a gastrointestinal condition result in a halitosis conditions. Any good gastroenterologist will also confer with our conclusions.
    •    Brushing one’s teeth frequently is another mistake people tend to make. It is an understandable mistake to make but excessively frequent tooth brushing will tend produce a dry mouth condition, which will often exacerbate a breath condition. Excessively frequent brushing can cause gum recession and damage the tooth’s enamel. The majority of patients we see in our clinic tend to be aggressive tooth brushers and this often results in damage to the teeth and gums. It is for this reason we often recommend the Sonicare toothbrush. This toothbrush is not only much more gentle than manual or other electric tooth brushes, but it’s sonic cleaning technology will assist in removing bacteria from deep within the tongue’s taste buds and from under the gums.
    •    Using hydrogen peroxide as an oral rinse is another common practice we have seen over the years. Most people do not realize that the FDA considers hydrogen peroxide to be a cytotoxic product. The word cytotoxic means toxic to the cells.  Hydrogen peroxide is also known to be a proteolytic product which means it breaks down proteins. It is for this reason that the use of hydrogen peroxide is contraindicated for the treatment of wounds. The problem is the tissues in our body are made of protein. If used on an occasional basis in the mouth hydrogen peroxide will generally not have any negative effects to an individual. If, however, it is used on a regular basis, which many people have done, the oral tissues will become sensitive, and can become ulcerated and raw. In the end the hydrogen peroxide has never provided any benefit to resolving a halitosis problem.
    •    Out of desperation we often see patients trying to treat or resolve their breath problems without ever understanding what the actual causes of their problem are. This usually results in a failure to resolve the problem, frustration and despair, and a lot of wasted time and money. When trying to resolve a medical or dental condition, or even a problem with your car, it is imperative that one understands what the cause or causes of the problem are. Without this information one will not know what to treat or fix. As a result of this type of approach it is not uncommon for us to see a patient who has been unsuccessfully experimenting with different oral products and techniques over a 20 year period. Once we take the patient through the proper diagnostic process at the Center for Breath Treatment we can quickly obtain an understanding of the causes of their condition and successfully direct treatment towards those causes.
    •    Altering one’s diet in an attempt to resolve a chronic halitosis condition is another common mistake we see people making. Over the many years we have been treating chronic halitosis conditions we have never seen foods of any kind be a causative factor for anybody’s halitosis condition. It is not uncommon for patients to provide us with a list of foods they “know” are contributing to their halitosis condition. The only thing a food product can do is produce the odor of that food on one’s breath. To be clear, this is a food odor, not a halitosis odor. Certain foods do have the ability to produce an aftertaste that one may not care for and this may in turn confuse you into thinking the food is causing a bad breath condition. When it comes to the deciphering one’s own tastes and smells it can become quite confusing.

About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.

Bad Breath & The Battle of Bacteria

Bad Breath & The Battle of Bacteria
From HealthSouth News
By Gary Gately

Do you have bad breath, really bad breath? It might not be the garlic or onions, coffee or alcohol. Rather, a new study links it to the types of bacteria that dominate the back portion of the top of your tongue. Some bacteria protect against halitosis, the formal name for really bad breath, while others cause the pungent odor, says a team of researchers from The Forsyth Institute in Boston and the University of Michigan School of Dentistry. "I think there's a definite smoking gun here -- that it's a strong association," says lead researcher Bruce Paster, a senior staff member at Forsyth. "There are
the good bacteria and the bad ones. Normal bacteria keep out bacteria from the bad guys." The study, reported in the February issue of the Journal of Clinical Microbiology, relied on gene sequencing to compare bacteria found on the tongues of
those with halitosis and those with fresh breath. Researchers reported species of the same three bacteria were prevalent among five people with fresh breath. The most common of these germs found on these subjects' tongues, Streptococcus salivarius, appeared in only one of six people with halitosis -- and at extremely low levels. About 65 million Americans suffer from halitosis at some point in their lives, the National Institute of Dental Research has estimated. Halitosis differs from the temporary mouth odors caused by foods or drinks. Six species of bacteria were linked to halitosis, and several of those germs were not found in those with fresh breath. The study is part of an ongoing effort to determine genetic sequences for all species of bacteria in the oral cavity. Paster says that the results have been confirmed by still-unreported research involving a larger group of people and adds that forthcoming research will look into possible treatment for halitosis.

About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.

Are over–the-counter mouth rinses of any benefit to a halitosis condition?

The mouth rinse industry is a multi-billion dollar industry and it is thriving quite well these days. There are all types of mouth rinses of which some cater to resolving bad breath conditions, while others are for preventing tooth decay, and some are geared towards preventing gum disease. Some mouth rinses even claim to prevent or treat all of the above. It is a very loosely regulated area and as a consequence many of the claims made by these companies about their products are often quite exaggerated. For simplicity let’s separate these products into three categories.

Products that prevent tooth decay are generally of good benefit to the average consumer.  These contain a mild concentration of fluoride that is a known compound for preventing tooth decay. Fluoride rinses are typically recommended to people who have a history of getting frequent cavities or for some reason are very prone to tooth decay. Fluoride mouth rinses are also recommended frequently for people who suffer from dry mouth conditions. The concentration of the over-the-counter fluoride rinses is less than that of the prescription grade fluoride products a dentist might normally prescribe. The difference really comes down to the fluoride concentration levels, with the prescription grade products having much higher fluoride concentrations. Fluoride is also know to have some benefit in preventing gum disease because it prevents the growth of the oral bacteria (bacteristatic), but doesn’t kill bacteria (bactericidal).  Over the years we have found a lot of patients using fluoride rinses in their attempts to resolve a halitosis condition. These have clearly proven to be ineffective and a waste of money.

Mouth rinses for treating or preventing gum disease are often very similar to the ones being used to treat halitosis. In fact many mouth rinses that claim to treat halitosis also claim to be able to treat gum disease or gingivitis. The effects of these products on even the mildest forms of gum disease are very limited at best because of their fairly weak bactericidal properties. If a dentist wishes for a patient to use a mouth rinse to treat or prevent gingivitis they will usually prescribe a stronger prescription grade mouth rinse, not an over-the-counter mouth rinse. These same over-the-counter mouth rinses offer virtually no benefit when trying to resolve a halitosis condition.

The last category of mouth rinses are the products that claim to treat bad breath. Within this category there are two subcategories: Those that contain alcohol and those that don’t contain alcohol. You can always tell the alcohol rinses apart from the non-alcohol rinses because they cause a burning sensation in the mouth, and the non-alcohol rinses do not do this. Both are just as affective as each other but the problem with the alcohol based mouth rinses will actually dry the mouth. As a result most people’s bad breath conditions will worsen very significantly shortly after using an alcohol mouth rinse. Unfortunately the burning sensation that the alcohol based mouth rinses only provides the impression to the user that the product is really strong and therefore more effective. In reality the alcohol provides no additional benefit. The only benefit the non-alcohol based mouth rinses have is they won’t dry the mouth. In the arena of mouth rinses for the treatment of halitosis we have found that there are a lot of very bold marketing claims consistently being made about these products but there is little real scientific evidence to support the claims being made. We always recommend our patients steer clear of these types of products.



About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.

Xerostomia

A dry mouth condition, known as xerostomia, is one of the more common causes of halitosis. It also is a common reason why people suffering from xerostomia experience increased tooth decay and gum disease. Saliva plays many important roles in the oral environment. When there is a deficiency in salivary production the bacterial concentrations in the mouth increase, and the saliva’s ability to wash particulate matter and plaque away are decreased due to the lack of saliva or the higher viscosity of the saliva. The saliva’s buffering capacity is also hindered. The pH levels of the saliva also change and provide a more conducive environment for certain types of anaerobic bacteria to grow. For patients in our practice who experience chronic xerostomia we recommend more frequent examinations and teeth cleanings (prophylaxis), and also regular use of prescription grade fluoride gels or solutions in order to prevent tooth decay and periodontal disease.

Xerostomia also plays a big role as one of the most common contributing factors to chronic halitosis. Because of the pH changes there is an increase in the odor producing gram (-) anaerobic bacteria in the oral cavity.  In addition when the the saliva content decreases the volatile sulfur compounds (VSC) that are produced by these bacteria tend to volatilize or evaporate more readily. The VSCs are the molecules of odors that we smell when someone is suffering from halitosis. The VSCs tends to have a rotten egg or sulfur-like odor. A sewer-like odor is another common description of the VSCs.

Common Causes of xerostomia are:

1.     Age - As one ages the saliva glands tend to produce less saliva.
2.     Medications – There is a plethora of medications that can produce xerostomia as a side effect. The most common medications that are responsible for causing xerostomia are anti-hypertensive medications, various cardiac medications, anti-depressant medications and other drugs used for treating psychiatric conditions.
3.     Diet – A high salt diet can result in a dry mouth condition.
4.     Alcohol based mouth rinses – Frequent use of these types of mouth rinses can quickly and drastically dry the mouth.
5.     Excessively frequent tooth brushing
6.     Various medical conditions such as Sjögrens disease
7.     Smoking
8.     Radiation treatment to the head and neck region

The treatment of xerostomia is difficult, and unless there is an obvious cause from an external source such as alcohol mouth rinses or excessively frequent brushing we are usually dealing with a physiological condition. Physiological conditions are very difficult to change or eliminate. Changing a patient’s medication or dosage can sometimes help with a dry mouth problem. Drinking lots of water (at least 64 oz. of water per day) is another good place to start. Avoiding smoking is also of benefit. Although there are prescription medications available for treating xerostomia, none of these work perfectly, and they all have significant side effects. On our web site we have a number of different saliva stimulating products that are helpful in stimulating more saliva. Chewing sugarless gum is also helpful. Regardless of whether you use a gum or some kind of lozenge it is important to make sure that they are sugarless so that you don’t promote tooth decay. Overall it is important not to do things to exacerbate a condition of xerostomia.


About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.

Why Do People Have Difficulty Smelling Our Own Breath Odors?

In our clinic at the Center for Breath Treatment the subject of how one goes about assessing their breath comes up every day. We hear numerous methods being used by patients, and most of these are the same methods that you will read about on the Internet. People also tend to be very convinced that these methods are accurate, but what we find is that almost all of these methods are improper methods to use and often provide misinformation about what one’s breath odor is actually like. The bottom line is that an individual does not have the ability to accurately assess their own breath odors no matter how good their sense of smell is. Patients frequently asked us why they couldn’t smell their own breath accurately and there are a number of reasons for this.

The majority of patients who come to see us at the Center For Breath Treatment in the San Francisco Bay Area complain that they experience bad tastes in their mouth much or even all of the time. Sometimes the brain actually can be fooled or confused regarding whether a particular sensory input is an odor or a taste, especially if it is chronic in nature or a particularly strong in nature. Your nose and mouth are connected as are the senses of smell and taste, and because of this your sensory system must learn to ignore certain odors that are constantly there. Your breath odor is a good example of one of thee odors. Another issue is that our nasal passages and sinuses naturally harbor bacteria that have the ability to produce malodors. Under normal conditions this is not usually something that is perceived by an individual, but those individuals that have bouts of even mild congestion due to hay fever or allergies can start to sense odors in their nasal passages. This occurs because of the decreased ability of the sinuses or nasal passages to drain normally during bouts of even mild congestion. This in turn can result in higher concentrations of anaerobic bacteria within the sinuses that produce very minute odors. Because these bacteria are in close proximity to the nerve endings in the sinuses that detect odors one may become aware of a malodor that is not detectable by anybody else.

Sometimes these minute odors that emanate from the sinuses or nasal passages can be bothersome to an individual. In situations such as that we often recommend a sinus irrigating device to help flush the sinuses and the nasal passages. There are a couple of nasal irrigating devices that can be found in drug stores but we have not found them to be very effective and they tend to be unpleasant to use.

One overriding factor to consider is that as human beings we do not have the ability to sense our own bodily odors very accurately. This stems from an evolutionary adaptation that has occurred to humans. Certain odors just simply do not need to be detected all of the time, and if you could smell your own odors, particularly breath odors, it would be much more difficult to sense other odors around us. In primitive times this could lead to issues affecting our survival in the wild. The mind does have the ability to “filter out” the majority of odors that are around us on a daily basis. This is one of the reasons why we have difficulty accurately smelling our own breath.



About the author: Dr. Anthony Dailley is a practicing dentist that specializes in halitosis treatment. He has been practicing since 1981 and graduated from San Francisco State University with a degree in Cell & Molecular Biology, and obtained his dental degree from the Pacific School of Dentistry. Dr. Dailley founded the Center for Breath Treatment in the San Francisco Bay Area and conducts research on curing halitosis. Dr. Dailley has also been a founder in a biotech company called NovaBay Pharmaceuticals and on their board of directors from 1997 -2014.