Odor Alert: What’s Causing Your Chronic Bad Breath? with Karyn Kahn, DDS

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host. The global breath mint market is expected to grow to more than 8.5 billion dollars within the next few years. It's safe to say those sales are a pretty clear indication that a lot of us are walking around with a less-than-delightful smell coming out of our mouths.

That brings us to today's topic: bad breath- and specifically, breath that smells like poop. What causes this sort of extreme odor? It seems like a question for dentist Karyn Kahn, who's on the front lines when it comes to facing bad breath. Dr. Kahn is one of the many experts at Cleveland Clinic who pop into our weekly podcast to help us better understand our bodies. So, with that, let's figure out what's driving these breath mint sales and what we can do about it.

Dr. Kahn, welcome back to the podcast. It's always great to have you on.

Dr. Karyn Kahn:

Thank you. It's nice to be here.

John Horton:

So today, we're going to talk about bad breath - and most of us, you come across somebody with bad breath and you're maybe a little grossed out. I take it as a dentist, you look at bad breath and say, "There could be a sign of something bigger going on."

Dr. Karyn Kahn:

That's correct. Nobody wants bad breath. Let's start right there. But let's talk about what some of the factors are in having bad breath, and I think it can be divided into local factors like odor-causing bacteria in the mouth. Just imagine, the bacterium in our mouth is necessary to a certain extent. It keeps the fungi and the other organisms under check. But if the bacteria are allowed to stay around the teeth and around the gum line and under the tissues, then we can't reach it to clean our mouth every day, and so this bacterium then metabolizes the sugar and carbohydrates. It's the beginning of digestion in the mouth, and the byproducts of the bacteria can produce a salt-smelling odor. And so, if we are not cleaning our mouth - brushing at least twice a day, flossing between the teeth, removing all the food particles that the bacteria use to metabolize and grow - then we can suffer from a local factor of bacteria being in the mouth.

The other obvious reason for bad breath is certain foods we eat. Garlic, onion, certain herbs, even alcohol can come through as bad breath. What happens after we ingest certain foods, it goes through the system of digestion, but some of the byproducts - the compounds produced by these foods - are expelled through the lungs. And so, if you've eaten garlic, you'll notice maybe you taste it for the next day or two, and it will last until such time as it's totally expelled from the body. So, foods can cause bad breath.

Smoking: chronic daily smoking can result in bad breath because the tongue can be affected from smoking and you can get what we call nicotine stomatitis, where you get the bacteria build up on the tongue. There are other reasons like dry mouth without your, saliva has a very important effect on reducing or neutralizing the bacteria in the mouth. So, if we have a very dry mouth, the bacteria can go to town producing these noxious, odorous compounds.

John Horton:

Dr. Kahn, I feel like you just walked us through halitosis 101 there with all the things that can cause just that basic bad breath. When is there a point where that really stinky breath is a sign of a much larger concern, other than just what you had for lunch or your brushing habits?

Dr. Karyn Kahn:

Right. If you've been brushing your teeth regularly, flossing, removing food on a daily basis, and you've had any gingivitis, which is an inflammation of the gum tissue treated by your dentist, if your dentist has cleared you for any periodontal disease that could harbor bacteria, then I would probably say that it's time to talk with your physician. Because such health conditions like diabetes; sinusitis, drippage from the sinuses, gastric reflux can bring up gastric juices from the stomach, certain lung diseases like bronchitis and chronic liver and kidney disease can result; certain metabolic disorders also. So, if your bad breath continues after you've done everything that has been recommended with daily cleanings, regular dental checkups, treatment of periodontal disease, then I would say, please, see your physician - have a good conversation regarding what might be contributing to the bad breath.

John Horton:

And I think that's the key here is that people should look at chronic bad breath that isn't really explained by just normal day-to-day activities, that there may be an indication there's something larger going on and you do need to see somebody about it.

Dr. Karyn Kahn:

Yes, chronic bad breath could be an indication of some rather serious systemic problems, and as we mentioned, some of the metabolic disorders and sinusitis and gastric reflux, all these things, lung disease. It also might be associated with a chronic lesion in the mouth or in the throat. Maybe some oropharyngeal cancer can cause a bad taste, a bad odor in the mouth, too, so don't ignore it, and seek a conversation with your physician or ENT.

John Horton:

Let's go over some of the things, I have a little list here of some items that could cause bad breath, and you can let us know a little bit about how common they are and how often you see them. Just an abscessed tooth - it sounds like that can really cause some odor coming out of your mouth.

Dr. Karyn Kahn:

An abscessed tooth can originate from the periodontal structures, and we call that a periodontal abscess. They're usually not significantly painful, so patients may not even know they have a periodontal abscess. A chronic apical abscess from a dead nerve in a tooth can actually burn its way through the bone and leave a little fistula so patients don't have severe pain with the abscess. All of these things are draining infection, and that can lead to bad breath, too. So chronic bad breath should be checked out with your dentist and with X-rays and checking out all the teeth.

John Horton:

And I know you had mentioned sinus infections, too, and I know we all deal with that from time to time, where you get that drainage coming down. I take it that's one of those things where it can cause that, too.

Dr. Karyn Kahn:

Right. And, well, sinus infections would drain into a common area in the throat, and that can be brought up into the mouth and cause bad breath, too.

John Horton:

You had mentioned gastro reflux, which is a topic we have covered on the podcast before, but that's just that bubbling up from the stomach, and that just creates some issues also.

Dr. Karyn Kahn:

The acid produced by the stomach is very harmful, and it's so very strong that gastric reflux can not only cause bad breath, but it also can result in erosion of the teeth. So, dentists can look to see if there's a certain type of wear on your teeth that is not associated with tooth-to-tooth contact, like grinding your teeth. This erosion is shown as a smooth-surface acid erosion. So, if you have bad breath, have your dentist check to see if there's any evidence of acid erosion in your mouth, and then you need to contact your physician to talk about any anti-acid therapy.

John Horton:

Another item that comes up, which seems obvious, is vomiting, which obviously has a very bad smell, but I take it as a dentist, if you come across somebody who's having those issues and you find out it's from vomiting, it could tell you that there's something more serious going on with them.

Dr. Karyn Kahn:

Well, chronic vomiting is something that should be definitely addressed by a patient's physician. That indicates either a habitual type of disorder or a gastric reflux problem, and of course, this is something that should be addressed by the physician and if there is any other help out there available for chronic vomiting. The problem with that is, of course, the acid in the mouth, and it can result in, as we said, erosion of the teeth and bad breath, too.

John Horton:

Now, you had mentioned that bad breath could be caused by something like diabetes. How does that work? I mean, what would be the signs of that?

Dr. Karyn Kahn:

It has to do with kidney, liver function, the mechanism of which I'm not really sure, but we know that it has been studied that some of the metabolic disorders such as diabetes can result through the production of different chemicals, and breakdown of certain elements in the system can cause bad breath. It's just another sign of an underlying problem, which should be addressed, especially, again, if it's a local factor such as your cleaning, brushing of the tongue, removing your dentures every day and cleaning them after every meal. All of these things can help us eliminate some of the causative factors. But if it persists, then you have to look for an underlying systemic issue. No one's better than your personal physician because they can refer you to the proper provider to whatever is suspected.

John Horton:

When should somebody talk to their doctor about their chronic bad breath instead of just popping more breath mints to cover up that problem?

Dr. Karyn Kahn:

That bothers me more than anything because using a mint to cover up a problem can cause another problem — and what happens, especially if it's a sweet, sugar-containing mint that sits in the floor of your mouth, if there's bacteria, which there are in the mouth, the bacteria have to metabolize. They're a living, breathing organism, so they have to eat, too. And what they'll do is they'll metabolize that sugar, but the byproduct of their metabolism is an acid. And so, if you take a breath mint, in 20 minutes, all it takes is that bacteria to produce an acid, which we call sugar-zapping to the tooth can cause decay. And if you multiply those times, some multiple times sitting with a sugar lozenge in your mouth for that … it can cause a real problem with decay. So, I'm very concerned about lozenges to treat bad breath. I'm concerned about lozenges for dry mouth, unless of course they're totally sugar-free.

John Horton:

And when should you look at or be aware of your bad breath and go, "I really need to talk to somebody about this"? Is there a certain amount of time? I'd guess as soon as possible, if it's that bad.

Dr. Karyn Kahn:

When bad breath becomes very chronic and everything you do at home is not helping, that's the time to get a clearance from your general dentist. They will do periodontal probing. They will look for any evidence of decay in teeth that are harboring bacteria. They'll look for abscesses and periodontal abscesses. But if you are cleared from a dental perspective, that's the time to see a physician to find out if there's any other underlying causes for the bad breath.

John Horton:

Well, we've covered a lot of ground here, Dr. Kahn. So, before we sign off, do you have any other words of wisdom to offer when it comes to bad breath?

Dr. Karyn Kahn:

Well, some things that we didn't talk too much about is brushing your tongue. The bacteria in the mouth can breed around the little papilla of a tongue and cause bad breath. And there's also denture halitosis. Bacteria can breed in a denture, and so it's very important … if you even are fully edentulous — have no teeth but wear dentures — you have to have regular dental checkups at least once a year, and the dentist will look for any sores in your mouth. They'll evaluate the fit of your dentures. They can run it through an ultrasonic cleaner to clean any debris, and also recommend possibly a lab-fashioned reline if the denture's not fitting properly. All of this breeds bacterium, and so we are looking, as a source of information for our patients to help them with their bad breath. A lot depends on what you do at home, and you do it every day.

John Horton:

Well, Dr. Kahn, I think I'm going to go get an extra toothbrushing in just after this discussion to make sure I'm covered. So, thanks very much for coming on, and always a great time talking with you.

Dr. Karyn Kahn:

Thank you very much.

John Horton:

Bad breath that smells like poop is, well, bad, and not just because of the smell. That odor may be a sign of a larger health issue that can't be solved by popping breath mints. So, if it lingers, get checked out. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.