Halitosis is More Than Bad Breath
This article begins a series exploring the health
of your intestinal tract. Consider the strongest contact with
the world around you is through your food, processed and absorbed by your
Halitosis, also known as oral malodor and bad breath, is a common and
distressing condition in which objectionable odors are present in mouth
air. Between 50% and 60% of the people in Western countries suffer from
this chronic condition. It is usually due to bacteria decomposing
proteins in the mouth and the large intestine, a process called microbial
putrefaction, generating malodorous gaseous sulfur compounds, which
contain dihydrogen sulphide (H2S) and methyl
mercaptan (CH3SH). These sulfur compounds are major members
of a family of gases known to be offensive in very low concentrations.1
Although most patients perceive this condition as primarily a cosmetic
problem, an increasing amount of evidence shows that extremely low
concentrations of many of these compounds are highly toxic to tissues.
These sulfur gases, especially methyl mercaptan, play a role in causing
inflammatory conditions such as periodontitis (inflammation of the tissues
surrounding and supporting the teeth).2 Periodontal
disease has been associated with other serious illness, including heart
disease.3 These sulfur gases are also involved in inflammation
of other cells lining the intestional tract causing colitis, and
occasionally, a life-threatening condition, known as ulcerative colitis.
The Source of Stinking Sulfur
So what is the primary source of all of these gaseous sulfur compounds
generated from decomposing proteins? They come from our food -- and
primarily foods of animal origin. Of the 20 amino acids that make up all
the proteins in nature, only two contain sulfur: methionine and
cysteine. Proteins with the highest content of sulfur-containing
amino acids are found in red meats, poultry, cheeses and all other
animal-derived foods. For example, based on calories, beef provides
4 times more methionine than pinto beans, eggs have 4 times more than
corn, cheddar cheese has 5 times more than white potatoes, and chicken
provides 7 times more than rice.5 If you want to
drastically cut down on your sulfur intake and improve your breath odor,
then the most basic step for you to take is to change your diet to one
based on starches, vegetables and fruits (without garlic and onions) – and
minimize your intake of animal proteins.
Classification and Causes of Halitosis
Bodily origins of breath odor are classified as being from either the
mouth and nose, or other parts of the body, referred to as a systemic
Further classifications of halitosis include: genuine halitosis,
sub-classified as physiologic halitosis (found in healthy people)
or pathologic halitosis (the result of a disease). Physiologic
halitosis may be due to food and beverage consumption, alcohol and tobacco
use, unclean dentures, or from bacteria found in the mouth and other parts
of the intestinal tract. Many foods can cause bad breath, especially
garlic, onions, and certain spices (like curry and chili powders that
contain onion and garlic).
Causes of pathologic halitosis in the mouth and nose
areas are: sinusitis, gum disease (gingivitis, peridontitis), an abscessed
tooth, food impaction, or a foreign body in the nose (in the case of a
child). Causes of halitosis from diseases that affect the rest of
the system include: kidney failure, liver failure, bowel obstruction,
diabetes, and a metabolic condition known as fish-odor syndrome (trimethylaminuria).
does not exist but the patient believes that he or she has oral malodor,
the diagnosis would be pseudo-halitosis.
Testing for sulfur gases in the mouth using a gas chromatography is the
most accurate method to make the diagnosis of halitosis. This is a
large and expensive machine found in clinical and research laboratories.
There is also a portable sulfide monitor, called a Halimeter, that
some dentists use in their office practice to measure the levels of sulfur
compounds in a patient’s breath. More commonly the diagnosis is made
by the unsophisticated method of the doctor or dentist smelling the
person’s exhaled breath. An informal diagnosis might also be made by
close friends. However, it is difficult for a person to smell his or
her own breath because we become used to our own personal odors.
Origin of the Mouth-Produced
mouth, bacteria feeding on various substances release airborne compounds
that cause bad breath. These are primarily anaerobic bacteria,
which means they prefer to live without oxygen. The greatest concentration
of these bacteria is on the back part of the top of the tongue.
common breeding ground for these anaerobic odor-producing bacteria is in
the infection and inflammation of the gums and tissues surrounding the
teeth -- conditions known as gingivitis and periodontitis (pyorrhea).
These diseases are usually painless but swelling, bleeding, halitosis and
foul taste are common. Pus and debris can be expressed from the
pockets and the teeth may be loose.
Treatment of Mouth-Produced
Because much of the malodor comes from the tongue’s surface, cleaning the
tongue is more important than rinsing the mouth. The tongue coating
consists of dead and dying epithelial cells, blood cells and bacteria.
More than 100 bacteria may be attached to a single epithelial cell on the
top of the tongue, whereas only about 25 bacteria are attached to each
cell in other areas of the oral cavity.6 Hence, cleaning
the tongue is a very effective measure for improving physiologic
halitosis.6 An infant toothbrush or a tongue scraper works best
for this purpose.
You can buy tongue scrapers for $2 to $23. Here
are some sites where you can look for tongue scrapers:
mostly cover up odor and result in a temporary solution at best.
Most products have only the manufacturer’s claim to support their
efficacy. Research suggests mouthwashes containing zinc, chlorhexidine,
and hydrogen peroxide are effective in reducing mouth odor. However, the
side effects of chlorhexidine mouthwash include tooth stains and allergic
reactions, and the oxidative activity of hydrogen peroxide might be
harmful to the mouth’s soft tissues. Therefore, a mouthwash
containing zinc would be preferable.6 Zinc inhibits odor by
attaching to and neutralizing sulfur compounds.
effective oral health care mouthwashes contain substances that have the
ability to directly oxidize gaseous sulfur compounds to non-malodorous
products. Two such agents are chlorite anion and chlorine
dioxide, and the latter is also a powerful killer of odor-producing
bacteria.7. Examples of this type of mouthwash are:
Mouthwash at $24.95 per bottle, which may be ordered at
(888) 309-1326, and
Mouthwash at $16.95 a bottle at
Disease conditions in the mouth must also be treated
to remove odors. Leaking and broken fillings must be repaired (I
recommend porcelain and plastic rather than mercury amalgams).
Periodontal disease needs to be cured with visits to the dental hygienist
every 3 to 4 months, meticulous flossing and a healthy plant-based diet.
I have seen people change their pockets from 6mm to 2 mm depths in less
than 4 months by using all three of these recommendations.
Morning breath is a particularly bothersome
problem for most people. This may be because the bacteria that cause
the odors like to live without oxygen (anaerobic), so with the mouth
closed during sleep, these bacteria thrive. A recent study evaluated
these techniques: no treatment, brushing the teeth with toothpaste,
brushing the tongue, rinsing with 5 ml of 3% hydrogen peroxide, eating
breakfast, or swallowing two BreathAsure capsules for morning breath.8
The breath air samples were analyzed for sulfur-containing gases with gas
chromatography. Brushing the teeth or ingestion of BreathAsure had
no influence on the sulfur gases. Ingestion of breakfast and tongue
brushing resulted in strong trends toward decreased sulfur gases. Hydrogen
peroxide significantly reduced the sulfur gas concentrations for eight
Large Intestine-Produced Mouth Odors:
Bad breath also comes from the putrefaction of food proteins into
sulfur gases in your large intestine.9 These gases are absorbed
through the intestinal wall into the blood stream where they circulate
until they reach the lungs and are eliminated into the breath. An
investigation of the “gut versus mouth” origin of odoriferous breath gases
was recently performed utilizing the sulfur-containing gases of garlic to
identify the source of these substances.10 Five individuals
each ingested 6 grams of garlic, and sulfur gases in mouth, lung air, and
urine samples were measured. They found that breath odor after garlic
ingestion initially originates from the mouth and subsequently from the
abundant evidence that gases produced by the microflora of the gut, such
as hydrogen and methane, are efficiently absorbed into the blood flow that
drains the intestine and are then excreted into the expired air.11
Cleaning of the oral cavity would not be expected to reduce the breath
concentration of gases derived from the gut. The only way to reduce
this source of sulfur gas is to decrease your intake of sulfur-containing
amino acids, which means avoiding animal products and a few plant foods,
like garlic and onions. (Garlic and onions do not produce the highly toxic
methyl mercaptan, and would not be expected to cause tissue damage.10)
Now you understand the causes of bad breath and you can remedy your
situation by making changes which are free, easy, and without
10 Steps to
Change to a starch-based diet
Minimize intake of animal products (high sulfur)
Avoid garlic, onions and strong spices
Avoid use of tobacco, coffee and alcohol
Use a tongue brush or scraper daily
Floss teeth at least daily
Brush teeth frequently
See your dentist to repair teeth
See your hygienist every 3 to 6 months for a cleaning
As a last resort, use a chlorine dioxide mouthwash
1. Suarez FL, Furne JK, Springfield J, Levitt
MD. Morning breath odor: influence of treatments on sulfur gases. J Dent
Res 2000 Oct;79(10):1773-7.
2. Ratcliff PA, Johnson PW. The relationship
between oral malodor, gingivitis, and periodontitis. A review. J
Periodontol. 1999 May;70(5):485-9.
3. Katz J. Inflammation, periodontitis,
and coronary heart disease. Lancet 358:303, 2001.
W, Millard S, Roediger W. Sulfides impair short chain fatty acid
beta-oxidation at acyl-CoA dehydrogenase level in colonocytes:
implications for ulcerative colitis. Mol Cell Biochem. 1998
5. Bowes & Church’s, Food Values of Portions Commonly Used. 17th
edition / revised by Jean A. T. Pennington.
6. Yaegaki K, Coil JM. Examination,
classification, and treatment of halitosis; clinical perspectives. J Can
Dent Assoc 2000; 66:257-61.
7. Silwood CJ, Grootveld MC, Lynch E. A
multifactorial investigation of the ability of oral health care products (OHCPs)
to alleviate oral malodour. J Clin Periodontol 2001 Jul; 28(7):634-41.
8. Suarez FL, Furne JK, Springfield J, Levitt MD.
Morning breath odor: influence of treatments on sulfur gases. J Dent Res
2000 Oct; 79(10):1773-7.
9. Cummings JH. Fermentation in the human large
intestine: evidence and implications for health. Lancet 1:1206,
10. Suarez F, Springfield J, Furne J, Levitt M.
Differentiation of mouth versus gut as site of origin of odoriferous
breath gases after garlic ingestion. Am J Physiol. 1999 Feb;276(2 Pt
11. Human Colonic Bacteria: Role in Nutrition, Physiology, and
Disease, edited by G. R. Gibson, and G. T. Macfarlane. Boca Raton, FL: CRC,
1995, p. 131-154.