DR. HOOK- Don't say 'ah': Brush and floss to skip halitosis

Garlic is food for the gods! Should I also include goddesses? (In Hollywood they no longer say actors and actresses; everyone is an actor. So to be more equal opportunity, shouldn't I just say gods?)

Back to garlic, I love garlic– overall. I cook with it a lot! But like some women retain water during their menstrual cycles, I retain garlic. Vampires hate me. If I have a garlic-heavy meal, I'm like a walking hummus bowl for days. What happens when you have bad breath?

Halitosis is the fancy-schmancy way of saying, "Girl, your breath stinks! Whew!" It isn't a new concept. Halitosis has been whispered about for centuries in most religions and cultures: the Greeks and Romans, the Talmud, Islam, and book of Genesis. Hmm, provides a new perspective to "Turn the other cheek." 

What is the prevalence of halitosis? There isn't good documentation to really know, but it probably varies according to culture, religion, and socioeconomic class. A co-resident of mine in internal medicine brushed his teeth only once a day and never flossed, and he didn't think his breath smelled bad. Well– perhaps on Mike Rowe's show, Dirty Jobs, he wouldn't be considered to have halitosis.

On the flip side, 25 percent of people are considered to be halitophobic– consumed with fear they have bad breath when they don't. (Isn't Isaiah Washington halitophobic– or was that homophobic?) I remember on the Red Carpet at one event the stars were carrying free samples of Listerine Breath Strips. (I wonder if Tom Cruise uses breath fresheners, or would that be blasphemous to his religion? "Dr. Hong, you are so glib. Don't you know...")

The oral cavity (mouth, tongue, etc.) is the source of halitosis about 85-90 percent of the time. Anaerobic bacteria just love to eat substances left over in the mouth, in particular amino acids. This leads to the production of smell gases called volatile sulfur compounds (VCS). If you don't know what sulfur smells like, smell a rotting egg or drive by a sewage treatment plant. (It puts a new spin on having a "potty mouth" like Kathy Griffin.) Bacteria love to produce VCS in mouths that lack oxygen, have neutral to alkaline pH, and are low in carbohydrates, especially between the teeth.

So those who hate to floss are more likely to have halitosis. Brushing the teeth and the back part of the tongue can reduce halitosis. 

People with gingivitis and periodontal disease usually have halitosis. In my practice, I can often tell a patient has poor teeth as soon as he says, "Ah" because of the anaerobic smell. It doesn't bother me personally, but as a physician I'm concerned about facial bone disease, abscesses, and systemic infections that can develop from poor dentition.

I have "busted" more than a few patients on their tobacco use because of their breath. Smokers or heavy drinkers are more at risk for head and neck cancers, so once in a while halitosis can be a sign of cancer. 

Tonsils rarely cause halitosis, but I've been asked a million times, "Doc, what's that funny stone-like white thing around my tonsils? When I spit it out, it smells like death."

These are called tonsilloliths. Unlike the monolith in 2001: A Space Odyssey, tonsilloliths are clumps of anaerobic bacteria and VCS that look like hardened lint balls. There isn't much you can do about them except gargle. Surgery to close up the tonsillar crypts isn't recommended overall.

There are so many other causes of halitosis– in particular sinus infections and allergies– but you'll have to check that out on DrJohnHong.com because I've run out of room in this article.

Whew, I've gone on so long, I'm out of bad breath.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

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