Specialist Dental Group - Dental Clinic in Singapore

View original articleThis article first appeared in the May 2013 issue of Shape magazine. We have reproduced it for the information of those of you who missed it when it was published.

What to do when you (or people you know) are huffing and puffing a stench.

We've all been there - reeling and trying to keep a straight face after catching a whiff of someone's odoriferous breath. But what if the smell came from you? Medically termed as halitosis, bad breath might not just be due to the stinky tofu you ate but could belie something more serious.

Not just a morning thing
Halitosis can be transient, as you've probably noticed from your partner's morning yawn. When we sleep, less oxygen flows through the mouth. This allows bacteria to multiply and give off a bad smell, explains Dr Daylene Leong, dental surgeon from Specialist Dental Group Singapore. A good brush of the teeth and tongue should fix this. If despite keeping good oral hygiene (brushing teeth at least twice a day for two minutes each time, brushing the tongue and flossing teeth at least once a day, and visiting the dentist every six months), foul breath is chronic or persistent, warning bells should sound.

66% of Singaporeans said they would never go on a date with someone who had bad breath

Runny nose
Bad breath can also result from an upper respiratory tract infection like a flu or inflamed sinuses. Post-nasal drip, or the accumulation of excess mucus in the throat or back of the nose, provides a prime environment for odour-causing bacteria thrive, explains Dr Lynette Ng, dental director and prosthodontist (specialist in restorative dentistry and full mouth reconstruction) from The Dental Studio. Treatment will depend on the type of infection you have.

Check your diet
Bad breath might also point to digestive problems that often result from an unbalanced diet, skipping meals or overeating. A diet high in processed food and sugar but low in nutrients can lead to an imbalance of  gut flora, wiping out beneficial bacteria as bad ones thrive. This can in turn cause chronic indigestion, explains Dr Ng. "Fermenting undigested food in gut releases a rotting odour into your breath." Gastroesophageal reflux disease (where acidic stommach contents flow back into the oesophagus, or gullet) is another known cause of bad breath, so see a doctor if you also experience symptoms like heartburn.

Quit the ciggies
Smokers usually have chronic bad breath as chemicals in tobacco-based products can cause a significant reduction of saliva flow, leading to dry mouth. "Saliva is a vital part of the digestive process as it helps remove odour-producing particles in the mouth," explains Dr Leong. "It also protects teeth against decay." She adds that smoking changes one's oral environment by favouring the colonisation of more bad bacteria in the mouth, significantly increasing one's risk for gum disease.

79% of Singaporeans have suffered from sensitive teeth, bleeding/swollen gums, tooth decay, bad breath, periodontitis and gingivitis

Tender gums
Bad breath that won't go away is one of the early signs of periodontal disease, says Dr Jerry Lim, a clinical director of Orchard Scotts Dental. An infection of the gums and bones around teeth, periodontal disease starts off as simple gum inflammation (gingivitis) in reaction to bacterial accumulation or plaque around the teeth and gums. "The longer the plaque and tartar remain, the more harmful they become, causing red swollen gums that bleed easily," adds Dr Lim. With good oral hygiene, you can keep gingivitis at bay.

By the time it progresses to periodontitis, however, the infection has spread beyond the gums to the bone surrounding the teeth. The gums pull away from the teeth and become infected, sometimes developing pus. Treatment with a periodontist (gum specialist) will then be necessary. Dr Lim warns that if periodontitis is left untreated, the bone and tissue that hold the teeth may continue to deteriorate, causing teeth to loosen.

Beyond the mouth
Research has also linked periodontal disease to a host of other medical problems, such as diabetes, cardiovascular disease and respiratory problems, says Dr Leong. Expectant mothers with gum disease are at a higher risk of delivering pre-term, low birth weight babies too.

In extreme cases, bad breath could even be a symptom of liver failure, kidney failure, diabetes, cancer or Sjogren's disease (an autoimmune disease where the body's immune cells attack the tear and salivary glands), according to Dr Ng.

Medications for other conditions can also affect oral health, as many reduce salivary flow as a side effect. "Without enough saliva, the mouth is vulnerable to infections," says Dr Lim. Drugs that affect salivary flow include triamterene for high blood pressure, paraldehyde for seizures and anthihistamines for allergies. "Some medicines can even cause abnormal overgrowth of gum tissue, which then makes it difficult to keep teeth and gums clean," adds Dr Lim.

The bottom line: Don't ignore persistent bad breath - alert your dentist so he/she can help you ID the root cause.

Source: Straits Times © Singapore Press Holdings Limited. Reproduced with permission

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