Posted on August 15, 2014
Bad Breath and Children
In my practice, I get questions from parents about their child’s bad breath almost everyday. Ironically, I also talk to parents with bad breath almost everyday. In reality, I suppose parents and children also talk to a dentist with bad breath, me! That’s why I don’t have onions on my subway sandwich at lunch. Regarding bad breath, the questions are where does it come from? What can we do about it?
Bad breath or Halitosis can come from a variety of sources including food odor, tobacco products, and oral injury. Rarely will bad breath be noticeable from a large cavity that packs food or an abscessed tooth. Bad breath can also come from dehydration of the oral tissues, as in when a person sleeps with their mouth open all night or is a chronic mouth breather. Draining congestion into the throat or infected tonsils are also significant sources of malodor, albeit usually temporary. These sources of bad breath can be addressed through medication, therapy, removal of tonsils or possibly braces. Oh yeah, don’t wrestle your brother with a toothbrush in your mouth like my daughter did!
What most people mean when they talk about bad breath is the chronic unpleasant odor children or adults have, often called “morning breath.” Morning breath is caused by the bacterial breakdown of saliva proteins and the bacterial metabolites. Some of these metabolites contain volatile sulfur or amines. In lay language, that means bacteria in a person’s mouth are feeding off protein in the saliva and producing waste products that smell like rotten eggs (sulfur) or ammonia (amines.)
These bacteria live on the soft tissues of the mouth, mainly the tongue. On the tongue, the bacteria that produce most of the problem are gram negative anaerobic bacteria. They like the deep grooves and papilla of the posterior dorsum of the tongue, way in the back. You know, near your child’s carefully protected gag reflex!
Because the cause of bad breath is bacteria, we can treat chronic bad breath like a bacterial infection and fight it with antimicrobials. These antibacterial products come in several varieties: antibiotics, general antimicrobial prescription rinses, toothpaste products and cosmetic rinses. Don’t forget the toothbrush to physically remove bacteria either!
In general, unless a child has and underlying systemic infection, antibiotics are not used to treat halitosis because of the possible side effects, diarrhea, yeast infection, or drug resistance. Physical debridement or posterior tongue scrapping remains the gold standard for fighting bad breath. Lessening the bacterial load by frequently brushing the posterior tongue with a toothbrush or a tongue scraper should be part of the daily routine. The gag reflex will get better over time, and it often helps if a child can brush their own tongue.
Recently stannous fluoride has been reintroduced into toothpaste as the active ingredient. Crest originally used this form of fluoride but switched to sodium fluoride because of the taste and short shelf life of stannous fluoride. These problems have been worked out and there is good evidence to show the stannous ion (tin) is antibacterial and will help fight bad breath as well as gingivitis. We have a stannous fluoride gel in the office and Crest Pro Health toothpaste is now on the market.
A host of mouthrinses have been part of a billion dollar industry to fight bad breath and make us all paranoid. Most mouthrinses are categorized as cosmetic, in that they MASK bad breath rather than fight the underlying causes. Scope is a good example, its active ingredient is a weak bacteriostatic, but the alcohol gives the soft tissue a zing and the mint smells fresh, at least what we have come to accept as fresh in our society.
Listerine is more of a therapeutic mouthrinse in that the proprietary essential oils will stick to tissues for long periods of time and actually kill bacteria. It is also high in alcohol so a caution for unsupervised use by children. Consistent use of this product will help to reduce halitosis.
Another over the counter product that is effective is marketed as Closys II ( the original name Retardant was not a hot seller!) It contains chlorine dioxide which will kill bacteria and bad breath for up to eight hours. It is particularly effective on those bacteria which produce the volatile sulfur and amine compounds.
Prescription rinses are available, most have the main ingredient of Chlorhexidine. While Europe has stronger dosages, our FDA has only approved a 0.12% solution in alcohol. This rinse is great for fighting cavities, periodontal disease, and bad breath of children with a compromised immune system. Long term use can produce a metallic aftertaste and staining on teeth. Use of chlorhexidine for two weeks has been shown to repress oral bacterial counts for 3-6 months.
Other rinses, including ACT, Listerine tooth sluth and smart rinse do not contain ingredients that will fight bad breath. If you have questions about who should use what and when, don’t hesitate to email me at firstname.lastname@example.org . In conclusion, brush the back of that tongue, use rinses appropriately and remember when you were first married morning breath wasn’t a big deal! Just give your kids a smooch on the forehead before breakfast. Dr. Greg