Phone: 910-778-8485 fax: 910-778-8477

2980 Ray Road Spring Lake NC 28390 Near Overhills Schools

Vincent Vissichelli, DMD

Board Certified Pediatric Dentist

Specializing in the treatment of infants, children, teens and special needs patients.

Patient Forms

Bad Breath (Halitosis) – What to do?

· The cause of halitosis is often the coating on the middle third of the tongue. Therefore, gentle daily cleaning of the back (TOP) of the tongue is very important. A tongue cleaner should be used to  gently clean the tongue surface.
· Routine oral hygiene procedures such as brushing and flossing are very important. Remember that children younger than 8 years of age are usually not able to floss on their own. Mouth rinses can also be useful, but only for children who have learned to spit it out..
· When bad breath is due to dry mouth (xerostomia), treatment involves having the child drink lots of sugar-free fluids. Sugarless gum may stimulate salivary flow. In very severe cases, an artificial salivary substitute such as carboxymethylcellulose may be needed.
· If bad breath is due to periodontal disease, an important part of the treatment is to improve oral hygiene at home.
· If bad breath is due to dental disease, treatment will be needed to restore or extract affected teeth.

Preventing Bad Breath
· Children should brush their teeth three times a day with a soft-bristled toothbrush. They should use dental floss every day to help reduce mouth odor. Children younger than 8 years of age will need to have their parents help them floss.

· Children should gently brush the posterior part (dorsum) of the tongue with a soft-bristled toothbrush every day.
· Children should eat a good breakfast, as this will stimulate the flow of saliva and reduce oral microbial levels. Eating fibrous foods is highly recommended.
· Children with bad breath should rinse frequently with water, and drink plenty of fluids to help reduce dry mouth. Chewing sugar-free gum will also help stimulate salivary flow.
· Children should always avoid alcohol-containing mouth rinses, as they dry the oral tissues and may cause oral tissue sloughing. Remember that mouthwashes can poison young children, and should be kept out of reach of toddlers.
· Children should visit their dentist and physician regularly.


Bad Breath (Halitosis) not from the mouth

Nonoral sources of bad breath:
· Bad breath can also be caused by systemic (medical) problems such as:
Liver problems, respiratory and sinus conditions, tonsils, kidney problems, Helibactor pylori infection, diabetes mellitus, timethylaminuria, medications, and menstruation.
· Hepatic problems:
Liver failure and cirrhosis are associated with a sulfur or “rotten egg” smell from the mouth.
Timethylaminuria, a metabolic disorder of the liver, causes the buildup of trimethylamine in exhaled air.
· Respiratory and sinus conditions:
Postnasal drip is probably the most common cause of halitosis in children. Secretions from a sinus infection, runny nose, or nasal allergy drip down the back of the throat and onto the tongue. Odor-causing bacteria thrive on these secretions, and produce volatile sulfur compounds..  These are the gases which cause bad breath.
Asthmatic children who use corticosteroids may develop bad breath due to the development of oropharyngeal candidiasis.
Enlarged adenoids may lead to mouth breathing.
Foreign bodies in the nose and respiratory tract will produce an inflammatory response, a discharge, and eventually a foul odor.
· Tonsils:
If a child’s tonsils have deep crypts, food and debris will accumulate in them, producing some bad breath. Sometimes tonsilloliths form in the crypts. These tonsilloliths are small, soft, whitish-yellow secretions which produce a foul odor as they break up.
· Kidney failure:
Kidney failure causes uremia, which produces an ammonia smell in the breath.
· Helibactor pylori infection:
This gastric infection can cause inflammatory changes in the stomach. Achalasia of the esophagus also can result in halitosis.
· Diabetes:
Uncontrolled diabetes mellitus eventually results in ketoacidosis, causing the breath to have an acetone smell.
· Medications:
Antihistamines, antipsychotics, bronchodilators, antidepressants, and antispasmodics cause dry mouth (xerostomia).
Children who have been taking antibiotics during the last month often have halitosis which is bacterial in origin. This oral malodor is transient, and usually disappears when antibiotic therapy has ceased.
· Menstruation:
Bad breath during menstruation may be caused by transient gingivitis.


Bad Breath (Halitosis) – Where does it come from?

85% of Bad breath is from the mouth
· Dry mouth (xerostomia):
Xerostomia may be due to: mouth breathing, a decrease in salivary flow, sleeping, dehydration, salivary gland disease, chemotherapy, diabetes, and certain medications. Saliva is very important because it cleanses the teeth and mouth, and destroys oral microorganisms.
· The tongue:
The most common source of bad breath is the top (dorsum) of the tongue.
· Dental problems:
An abscessed tooth or tooth decay can cause bad breath. In the case of tooth decay, food stuck between the teeth can cause putrefaction. – producing a foul odor.

· Oral fungal infection:
Children who take antibiotics for a long time may develop a Thrush (Candida) infection in the mouth. Children undergoing chemotherapy, or have a weak immune system, are prone to develop oral fungal infections. Such oral yeast infections produce a characteristic sweet odor.
· Gum disease:
Gingivitis and periodontitis are the most common inflammatory diseases which cause bad breath. The bacteria involved produce a foul smelling gas.

Tomorrow we will talk about bad breath from other places then the mouth.


Bad Breath (Halitosis) – What causes it?

Bad breath, or halitosis, can be a symptom of various conditions including: postnasal drip, dry mouth, dental problems, and sinusitis. Halitosis in children is often due to the decomposition of mucus secretions and debris which accumulate on the tongue, in the nose, and between the teeth.

Halitosis is an offensive odor which comes from the mouth, nose, or airway. It is also defined as exhaled air containing more than 75 parts per billion of odor-producing volatile sulfur compounds.
· Halitosis can be caused by oral sources, non-oral sources, and psychological problems.
· The source of halitosis is the oral cavity in up to 85% of affected individuals. The most common odor-causing sites in the mouth are: the (dorsum) top the tongue, the area between the teeth, and under the gum line.
· The coating on the tongue usually consists of shed surface cells of the tongue, blood cells, and bacteria. It is possible for more than 100 bacteria to attach to just one oral of these cells. The worst oral odor occurs when many shed oral epithelial cells are trapped in the plaque and crevices on the dorsum of the tongue.
· Halitosis results from the action of specific bacteria on oral debris and dental plaque. Sulfur-containing substrates are eagerly devoured by these bacteria. The bacterial breakdown of methionine and cysteine molecules yields hydrogen sulfide and methylmercaptan – both of which produce bad breath. These volatile sulfur compounds (VSCs) have a “rotten egg” smell.
· The oral conditions which predispose to the production of bad breath are:
a decrease in the flow of saliva, stagnation of saliva, bacteria, an increase  protein in the diet, a decrease of carbohydrate in the diet, a rise in the oral pH to a more alkaline environment, and an increase in the number of dead  oral epithelial cells in the mouth.


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