By Shirley Gutkowski, RDH, BSDH, FACE
I’ll give you three guesses as to what bad breath is caused by. I can’t
really hear you but I bet you’re partly right. Some of the reasons for bad breath are:
- Lack of saliva to dilute acids created by bacteria
- Odiferous foods (like that word odiferous?) like garlic and onions
- Bacterial waste products
- Tissue death
At least two of the reasons start with bacteria and the last reason,
tissue death, comes about because of bacteria too. Bacteria in the mouth make smelly gases called volatile sulfur compounds (VSC). My dental hygienist friends tell me to stop talking about my most favorite volatile sulfur compound, cadaverine. I’d like to be known as Cadaverine Slayer, but dental hygienists across the country told
me not to. So I’ll let you be in on my little fantasy.
As you may expect cadaverine is the smell you get from rotting flesh,
meat. The smell of the dead raccoon on a hot summer day is comprised of cadaverine and other VSCs. If you have
periodontal disease your gum tissue is breaking down releasing these gasses. I can’t tell you how many times a dental hygienists said to me: “I could smell perio breath coming from the person ahead of me in line at the grocery store.” If you’re working in a care facility, or working with those who cannot remove the biofilm from their teeth themselves, I’m certain that you know the smell too.
The mixed biofilm that lives on teeth produces some VSC gas as a function of biofilm metabolism. That gas is a trigger to the gum tissue to become spongy and for the distance between the cells to open up. Once the space between the cells opens up bacteria penetrate the tissue. Shortly after that and the cells that make up the gums start to die and decay releasing more VSC gas. Neat huh?
That smell makes it hard for some care givers to provide care, and keeps others at bay. The smell of the VSC is like a shroud encasing the person and negatively impacts their quality of life dramatically. Socialization is impossible, and sharing meals can be a problem for table mates.
Here’s something that I bet you never thought of, though. The gasses are toxic in high concentration, things like methal mercaptan, the smell of moth balls, and hydrogen sulfide, the smell of rotten eggs, both are VSC and you can see the issue developing here. That
person is inhaling those gasses with every single breath, day and night. And those gasses may be causing lung damage. No one has looked yet, because most dependent adults up until now haven’t had any or many teeth. But today’s resident in a long term care facility has more teeth than ever before. Home bound-dependent people also have many more teeth than years gone by. Sweet breath is not only a cosmetic concern.
What can help? The usual of course. But you don’t expect the usual from me I’m sure. Xylitol helps a lot. If the person can chew the gum, great. Expect results in three weeks of using 3 to 5 pieces of gum a day. If gum is not possible keeping the biofilm down going to be a little harder not impossible.
Start with a professional cleaning by a dental hygienist. The dental
hygienist should use an ultrasonic scaler often called a cavitron or Piezo. Then start supplementing their diet with some functional foods like
- Cranberry juice
- Blueberry juice
- Green tea
- Licorice root suckers
Xylitol will always be on my list of things to include in any oral health
protocol. For those who cannot chew gum, foods with xylitol include some puddings, and some ice creams. I know you’re sad about that list of choices.
That’s the beauty of this oral care regimen. Who doesn’t like candy, or sugar, or sweets? Nobody! Don’t be tempted to overdo, too much xylitol at once may cause some stomach gurgling and the aftermath of gurgling.
For more information on bad breath consequences visit www.slideshare.net/shirdent/halitosis-in-long-term-care. Get a dental hygienist on your care team, you’ll be happy you did. She is also an oral care consultant. Contact Shirley via email at crosslinkpresent@aol.com or in an emergency call (608) 213-5865.