Waiting to exhale

That's because some mouths -- 30 per cent of the world's population by some estimates -- reek.

As social afflictions go, halitosis stinks on several levels.

You can't smell your own breath, so unless someone tells you (fat chance), you may not even be aware that you're fouling the air.

Or maybe you're among the multitudes who have long known their fumes are offensive, but who suffer in silence because they're too embarrassed and ashamed to seek help.

Take it from a man who has stuck his nose near some cringe-inducing oral cavities in the past 16 years: halitosis may not be a life-threatening condition, but it can certainly be a life-diminishing one.

"I've actually had patients who tried to kill themselves," says Dr. Harold Katz, a Los Angeles dentist and microbiologist who founded the California Breath Clinics after dealing with his teenage daughter's seemingly untreatable halitosis.

"When I first starting treating patients for it in 1993, I thought I'd have a few people come in, but I was inundated with horror stories from all over the world. I almost became a psychiatrist."

Instead, the "dentist to the Hollywood stars" packed up his breath-testing machine (the Halimeter) and his line of TheraBreath oral care products and started a second career as an anti-halitosis crusader.

Having inhaled the exhalations of about 50,000 people, Katz can attest that bad breath knows no boundaries when it comes to age, gender or socio-economic status. (One of his offices is located next to 20th Century Fox studios and caters to actors and fashion models. He wouldn't say which ones.)

Yet, there is still a "terrible misconception," he says, that it's solely the domain of the hygienically challenged.

Last week, during a cross-Canada tour, Katz stopped by the Free Press to clear the air -- and to test the breath of five brave volunteers.

The test panel (ages 12 to 50s) was recruited from among the readers who accepted our invitation last month to write in and tell us why you want or need to know if you have bad breath -- and just how bad it is. We heard from seniors, students, moms, dads and grandparents, professionals, musicians, even folks who work in the dental industry. Some writers shared how their bad-breath problem has forced them to withhold hugs and kisses from loved ones.

Virtually everyone who wrote in expressed frustration over how their halitosis has persisted -- for decades in some cases -- despite regular brushing, flossing and trips to the dentist.

Good oral hygiene is important, of course. But while there is a link between gum disease, Katz says most common dental problems, such as tooth decay, don't cause chronic bad breath.

"The reality is that the bacteria that cause bad breath live on the back of the tongue, where the taste buds are, and in the throat," he told our volunteers as he aimed his Halimeter at their open mouths.

Bacteria are a necessary part of everyone's normal "oral flora" because they break down proteins to initiate the digestive process. It's the ones that live in places where there is no oxygen that cause the putrid odour by excreting sulfur waste products (with disgusting names like putrescine and cadaverine). When they take over the oral environment, halitosis results.

These anerobic bacteria feed on sugar, amino acids (the building blocks of protein) and dead tissue. They also feast on proteins in secretions from the nose, as in post-nasal drip.

More than anything, Katz explains, these nasty critters love a dry mouth -- which is why smokers, people who drink a lot of coffee and alcohol, and those who take certain medications tend to have bad breath.

Ken Okrainec admits he drank three cups of coffee before arriving for this morning's breath testing session. His daily intake is around eight cups, plus a two-litre bottle of Diet Coke. The retired police officer also takes blood pressure medication and wears a CPAP mask at night for sleep apnea.

Those lifestyle habits, plus the fact that Okrainec never eats breakfast, are creating an ideal environment for bacteria to thrive, says Katz. Despite its lack of sugar, the Coke is very acidic and acids stimulate bacteria growth.

Katz stressed the importance of eating first thing in the morning to kick-start the salivary glands. "Otherwise your morning breath just keeps on going," he says.

"Saliva is nature's way of keeping your breath fresh. It contains oxygen, which is a natural enemy of these bacteria."

Tabitha Grieve, who's 12, and has braces, takes Listerine breath strips and Tic Tacs to school to keep her bad breath at bay. When it's her turn to exhale into the straw-like tube attached to the Halimeter, Katz notes that her tongue looks dry (a telltale sign of halitosis is a thick white coating on the surface). The machine measures the concentration of "volatile sulphur compounds" in the mouth, in parts per billion. Anything over 100 ppb indicates a problem, and over 200 is severe. Tabitha's reading was 130 ppb. Katz suggests she cut down on her intake of Pepsi, milk and cheese since bacteria love protein, especially when it's fermented.

He also dispelled the popular myth that halitosis can originate in the stomach.

"Bad breath almost never comes from the digestive system; that's an old wives' tale. There are muscles in the esophagus that prevent odours from escaping."

(Incidentally, onions, garlic and cabbage already contain sulfur compounds. When those foods are digested, the sulphur compounds are absorbed into the bloodstream, carried to the lungs and exhaled through the mouth.)

Like many people who struggle with bad breath, Rhonda Boileau, 51, has spent "thousands of dollars" on commercial oral care products that promise to kill germs and leave your breath minty fresh. She brushes her teeth up to six times daily and scrapes her tongue at least twice. Penny Mahon and Jacob Phillips have similar stories.

"I chew gum literally all day and I go through two big bottles of mouthwash a week," says Phillips, 19, who uses Listerine Pocket Mist when he's out and about.

Most of those products essentially cover up the odour and sour, bitter tastes produced by sulphur compounds with other stronger tastes (either minty or medicinal) and fragrances, Katz says. Worse yet, they usually contain alcohol and sodium lauryl sulfate, which dry out the mouth and actually perpetuate the problem.

It turns out that Mahon and Phillips also suffer from a common, but little-known, phenomenon known as tonsil stones.

Often mistaken for food particles, these foul-smelling, whitish globs -- the scientific term is tonsilloliths -- are actually made up of dried mucous, dead cells and other debris that accumulate and get trapped in the pockets of the tonsils. (They often cause the sensation of having something stuck in the back of the throat.) Post-nasal drip is a leading cause.

The only clinically proven way to treat halitosis, Katz says, is to oxygenate the mouth and thus create an oral environment in which odour-causing compounds cannot be produced.

During their initial test with the Halimeter, our volunteers' levels of bacteria-produced sulphur ranged from 83 ppb to 404 ppb. After using one of the TheraBreath products Katz brought with him -- Mahon and Phillips were given nasal drops and sinus sprays for their tonsil stones -- their scores dropped to between 41 and 65. (A reading in the 30s is ideal.)

carolin.vesely@freepress.mb.ca.

Freshen up

The popular do-it-yourself breath test where you blow into your cupped hands doesn't work. Instead, lick the back of your hand, wait about five seconds and then take a whiff. Once the saliva evaporates, the sulphur stays behind and you'll be able to smell it. Or, scrape the back of the tongue with a plastic spoon and smell the residue as it dries.

Don't just brush your teeth; clean your entire mouth -- roof, cheeks and tongue. A tongue scraper is 10 times more effective than a toothbrush for removing that bacteria-friendly coating. Rinse after scraping.

Avoid mouthwashes that contain alcohol. They'll only mask the odour, plus they dry out your mouth and actually make your breath worse. Ditto for toothpastes that contain the foaming agent sodium lauryl sulfate. Opt instead for oxygenating products, such as TheraBreath, Oxyfresh and Smart Mouth.

Brush after every meal -- or at least rinse with water to remove pollutants that feed bacteria.

Eat breakfast to kick-start your salivary glands and drink lots of water through the day to prevent dry mouth

Know someone with bad breath -- maybe a friend, a co-worker, or (gulp) your boss -- but you're too polite and/or chicken to tell them? Let Dr. Harold Katz break it to them gently with a virtual breath mint. Go to www.therabreathcanada.com and click on "Tell a friend about their bad breath." Katz will send a "very nice and explanatory" anonymous email, informing the recipient that he or she has a (treatable) problem.

Winnipeg has its own fresh-breath guru: Dr. Ken Hamin, a dentist in private practice and instructor at the University of Manitoba Faculty of Dentistry for the past 16 years, runs a Halitosis Clinic out of Reflections Dental Health Centre (717 Harrow St.). An initial assessment, which takes around two hours, costs between $500 and $600. It includes a comprehensive oral examination, any pertinent X-rays, a Halimeter test, and products.

Republished from the Winnipeg Free Press print edition November 10, 2009 D1