The Bad Breath Checklist

[KeepTrying09]

Hey Everyone,

I think everyone has probably gone through the same trials and errors when it comes to curing bad breath. I know I tried a lot of the stuff that others have mentioned on this forum at least once in my life. There's so much good information and possible cures on this forum, but it's scattered and spread out over thousands of threads. That's why I wanted to make a kind of bad breath checklist for those that are trying to tackle this problem. I wish I had some kind of checklist back when I began my search for a cure. Hopefully this will help someone who is just starting their journey! I tried to make this list so you could just go down and check off the things that you have already tried, and focus in on the things you haven't.

1.) First, and probably the easiest and most often tried, is to maintain proper oral hygiene.

This includes:

a) Brush your teeth at least twice a day. You can try whatever toothpaste you like. There are hundreds of them out there, some better than others. Try the inexpensive ones first like Crest, Colgate, Oral B, etc. If those don't work then move on to the more expensive ones like OxyFresh, Therabreath, etc.

b) If you are going to use any kind of mouthwash, you should choose an alcohol free one, as alcohol dries out the mouth which can exacerbate bad breath. Try to go for one that has natural ingredients or herbs. Again, start with the cheaper ones and then work your way up if it's not working. OxyFresh makes a mouthwash that supposedly has oxygen in it that kills anaerobic bacteria in the mouth. They also make one which includes Zinc and lemon, which is supposed to help. I have no idea what's in Threabreath's mouthwash, but since they are sponsoring this site now I thought I'd mention them.

c) It's important to clean your toothbrush with some kind of antiseptic, such as hydrogen peroxide. The mouth is a dirty place, with tons of bacteria. If you are not disinfecting your toothbrush after brushing, you are just letting all those bacteria and germs from your mouth multiple on your brush. Think about putting that back in your mouth 12 hours later! Not a good idea. Even with cleaning your toothbrush, it's important to buy a new one every 30 days.

d) Don't forget to brush the tongue, including the back. You might have a gag reflex at first, but try and look at yourself in the mirror while doing it, and make sure you are not hitting the dangly thing that hangs down in between your tonsils (I know, so scientific). If you can not hit that your gag reflex won't be so bad.

e) Using a tongue scraper will help remove whatever leftover food particles and bacteria that your brush can't get. Place the tongue scraper on the back of your tongue and then gently pull it to the front. Wash it off and then repeat the process. Don't scrape it too hard though! You can damage your tongue, or make it bleed, which you don't want. Just scrape it gently.

f) If you have an electronic water pic, or some kind of syringe that can squirt water, you can use this to clear any leftover food or debris out of your tonsils or around your wisdom teeth in the back of your mouth. Sometimes food and other gunk can get trapped in these areas, so it's important to clean them out often.

g) FLOSS BETWEEN YOUR TEETH. You should be doing this both in the morning and at night before bed. You should also do it after you eat. I can't stress how important this is.

2.) If your bad breath still persists, it's time to visit the dentist.

Make sure you ask about the following:

a) First, it's important to get a proper cleaning every six months. Ask your dentist if they offer the deep cleaning service, which is more thorough than a regular cleaning. I don't know about you, but I actually like getting a cleaning from the dentist. My mouth always feels super fresh afterwards. Also, your dentist will be able to see any problems you might have while doing your cleaning, such as cavities or gum disease. Which lead me too...

b) Ask your dentist to check for cavities, gum disease, impacted teeth, a tooth infection, etc. All of these can cause bad breath so it's important to ask your dentist to check for them. If you have any metal fillings in your mouth from previous cavities, have them removed and replaced with clear fillings. Metal fillings are just dangerous!

c) If you still have your wisdom teeth, ask your dentist to remove them (and I mean all of them). Food particles can get stuck back there around your wisdom teeth which can cause bad breath. Also, if your wisdom teeth are impacted or infected, that could be the reason for your bad breath too. I don't really think the wisdom teeth serve any purpose. You won't miss them, so I say get those suckers taken out if you have bad breath!!! After you have them taken out, make sure you are flushing out the holes with water to remove any food, dried up blood, and other gunk that can get stuck in them. Use your electric water pic or syringe to flush them out.

3.) If the dentist doesn't solve the problem, your next route should be an ENT doctor.

Ask them about the following:

a) Check to make sure that you don't have sinusitis. Sinusitis is a condition consisting of inflammation of the sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. This could be a cause of your bad breath. Usually you would be able to tell if you had a sinus infection, but maybe your case is mild. It's best to have an ENT doctor check just to make sure. Also, ask your doctor to take a culture swab from your sinuses and check it for both bacteria AND fungus. Doctors are increasingly finding that fungal sinusitis is more common than they once thought. If they are only checking for bacterial sinusitis, then they might miss something.

b) Tell your ENT doctor if you have post nasal drip, as this is a common cause of bad breath. Post-nasal drip (PND) occurs when excessive mucus is produced by the sinuses. The excess mucus accumulates in the throat or back of the nose. It can be caused by rhinitis (allergic or non-allergic), sinusitis (acute or chronic), laryngopharyngeal acid reflux (with or without heartburn), or by a disorder of swallowing (such as an esophageal motility disorder). It is frequently caused by allergies, which may be seasonal or persistent through the year, depending on the allergen(s) involved. Birth control pills or pregnancy can also cause post-nasal drip because of the elevated levels of estrogen hormones. Be careful though, because your doctor might prescribe you a medicine that will reduce the amount of mucous that's produced. While this drying up effect may seem good, it can also dry out your mouth, which can lead to bad breath. See if your doctor has any other solutions for dealing with post nasal drip.

c) Make sure that you don't have any blockages in your sinuses. Your ENT doctor should be able to verify this by either a visual examination or through x-rays or CT scan. Of course CT scan is the most revealing, so i'd go for that, but it's also the most expensive. X-rays or visual inspection might have to suffice if your insurance won't pay for the CT scan. If you do have any blockages, your ENT doctor can easily remove them.

d) Finally, you should ask your ENT doctor about your tonsils. Your tonsils could be the cause of your bad breath if they are prone to infection, or they collect food particles which turn into Tonsil Stones (Tonsilloliths). Tonsil stones are irregularly shaped, whitish/yellow, foul-smelling globs of mucus and bacteria that get caught in the back of the throat. They form in the tonsil crypts which are simply small pockets or divots that appear in everyones tonsils. Personally, I would not go into your ENT doctor and tell them you want your tonsils removed because you think it will cure your bad breath. If you do that chances are you will not be having your tonsils removed anytime soon. Instead, just go in and say that you get frequent infections such as tonsillitis or strep throat, and you want to have them removed due to that.

4.) If the ENT doctor is unable to find the cause of your bad breath, it's time to move on to the gastrointestinal doctor.

I'm a bit biased here because this is the kind of doctor who found the cure for my bad breath.

a) If you are suffering from any kind of acid reflux (GERD) a gastrointestinal doctor is the doctor that you should see. Sometimes acid reflux can be the cause of bad breath because food mixed with your stomach acid is traveling back up into your esophagus causing pain, inflammation, and damage the esophageal sphincter and wall. If there is damage to the esophageal sphincter which is supposed to close off your esophagus from your stomach, odor from your stomach could be traveling back up through your esophagus and out of your mouth. Most likely the doctor will prescribe you proton pump inhibitors, such as omeprazole, lansoprazole, rabeprazole, pantoprazole, esomeprazole, or Zegarid, a rapid release form of omeprazole. These drugs will reduce the amount of stomach acid that you produce, which will give your esophageal sphincter and wall a chance to heal.

b) Next you should ask your gastrointestinal doctor to do an Esophagogram to make sure that your esophagus is functioning properly. When I say functioning properly, I mean that it is moving the food down your throat and into your stomach in a normal pattern. This exam also evaluates your swallowing function. After all, if your swallowing function is not normal, or your esophagus cannot move all of the food into your stomach, this small amount of food could start to break down in your lower esophagus and give off odors that could come back out of your mouth. During this examination, you will drink a barium liquid and the doctor will take x-rays while you swallow. They will take several x-rays as the barium liquid travels down your esophagus. After you finish, they should be able to detect if you have any ulcerations or masses in your esophagus, if you have smooth mucosal folds, if you have any gastro-esophageal varices, or if you have a hiatal hernia. Basically they will be able to tell if your esophagus is functioning normally and moving food down into your stomach without any problems.

c) Tell your gastrointestinal doctor if you think you suffer from IBS (Irritable Bowel Syndrome), Crohn’s Disease, Leaky gut syndrome, or Small Intestinal Bacterial Overgrowth. You can do a google search on all of those conditions to find the symptoms, but as their names suggest, they are disorders of the bowels (intestines). All of these illnesses could play a part in your bad breath, so it's important to be checked by your doctor to see if you have any of these illnesses.

d) Next (and this was my cure) you should ask your gastrointestinal doctor about a possible Candida infection. Candida is a yeast that is present in everyone's body, except for some people this yeast goes crazy and starts to overgrow and cause problems. When it overgrows, it usually turns into it's dangerous fungal form. When in it's fungal form, it can affect any part of the body such as the intestines, esophagus, mouth, sinuses, skin, nails, etc. It can even travel into the bloodstream, although that's very rare and quite serious. The cause of my bad breath was a Candida infection in my esophagus (which i've wrote about extensively on this forum). My doctor was able to find this because she did an upper endoscopy on me and she saw the Candida all up and down my esophagus. After I was diagnosed with Candida, I was prescribed an anti fungal which I took for 14 days. After I finished with my treatment, my Candida infection cleared up and my bad breath went away. For anyone who is suffering from bad breath, I encourage you to ask your doctor to test you for this some way or some how. Either through blood test, stool test, or upper/lower endoscopy. If it can happen to me, it can happen to anybody, so don't let your doctor tell you that Candida is make believe or it only affects AIDS patients. That is simply BS! And as always, i'm here to help if anyone needs it.

5.) If all of the previous doctors fail, perhaps an Immunologist will be able to help you.

Ask your Immunologist for the following:

a) You should have a food allergy test done. Perhaps your bad breath is caused by an intolerance to dairy products, or grain products, or some other kind of food. Often in life we eat a lot of food that makes us feel sick or bloated, but we just kinda ignore it, take some over the counter medicine, and call it a day. That's not the way to go. If eating ice cream is making you get diarrhea or constipation, or if eating grains is causing you to get an upset tummy, you should check with the doctor to see if you have an intolerance or allergy to them! It doesn't have to just be dairy or grains though. You could have an intolerance or allergy to almost anything you eat, so it's best to get this checked out.

6.) Believe it or not, a General Practitioner may be able to help you.

Ask your General Practitioner to test you for the following:

a) You should check yourself for Diabetes. Diabetes occurs because the body can't use glucose properly, either owing to a lack of the hormone insulin, or because the insulin available doesn't work effectively. There is some supposition that blood glucose levels and bad breath are related. The excess glucose in the system may make it harder for the body to rinse away germs and bacteria, both of which are leading causes of mouth odor. Also, most people who have diabetes find that they also have severe cases of dry mouth because most diabetics are often very dehydrated; they are always thirsty and urinate frequently. This dry mouth can cause bad breath too. Also, diabetics can develop ketoacidosis, in which the body starts burning fatty acids for fuel rather than carbs. While this is rare and extremely dangerous, it can cause bad breath. However, ketoacidosis can be life threatening for diabetics, so usually they will be treated for it urgently.

b) Next, ask your GP doctor if they could check your cortisol levels. A cortisol test is done to measure the level of the hormone cortisol in the blood. Cortisol is basically your body's "stress" hormone. It is produced when you come under a stressful situation or a threatening experience. It is responsible for the "fight or flight" response that happens during one of these situations. Sometimes this hormone is good because it protects you during one of these stressful situations, but if cortisol levels remain elevated in your body for long periods of time, it can have detrimental effects. Higher and more prolonged levels of cortisol in the bloodstream (like those associated with chronic stress) have been shown to have negative effects, such as: Impaired cognitive performance, Suppressed thyroid function, Blood sugar imbalances such as hyperglycemia, Decreased bone density, Decrease in muscle tissue, Higher blood pressure, Lowered immunity and inflammatory responses in the body, slowed wound healing, dry mouth, and other health consequences. Of course, bad breath is a symptom of a larger problem within your body. If you are constantly under stress, then your body cannot heal itself, and your bad breath will not go away. Have your cortisol checked to see if you are within the normal range.

7.) If you have gone through all the medical doctors, and you are still unable to find the cause of your bad breath, then maybe it's time to turn to alternative therapies.

Try these following alternative therapies:

a) If you are able to find a naturopath (a doctor who specializes in alternative medicine) maybe they would be able to help you. Naturopaths are generally not able to prescribe prescription medication, however they are extremely knowledgeable in natural herbs, vitamins, minerals, and other possible treatments for bad breath. Sometimes they can also perform tests on their patients as well, such as food allergy tests, Candida tests, Gut Fermentation Tests, etc. Sometimes Naturopaths are more open to listen to their patients as they might not have an overinflated ego. While I have much respect for Naturopaths, I would urge caution and careful judgement when choosing one. Unfortunately, some Naturopaths are only interested in playing off their patients fears and then selling them some super expensive therapy that has little scientific research or evidence to back it up. Basically, you should feel comfortable with your Naturopath, just as you should with your medical doctor. If at anytime you feel like you are being ripped off or swindled, you should just see someone else. But for the most part I think most Naturopaths have good intentions, just as most doctors do. Just see what your Naturopath recommends!

b) If you can't find a naturopath, then you could try going to a health food store in your area and buying some natural herbs or supplements there. Usually health food store owners are quite knowledgeable as well, and might be able to offer you some assistance. Just tell them sometimes you have bad breath, and you'd like to know if they have any products they could recommend. Again, I'd do your own research before you buy any natural product. Not because I don't believe in them, but just because some natural products are better than others, and some are just expensive crap with fancy labels.

c) If you can't find a Naturopath, and you don't have a health food store in your area, then just spend your time browsing the internet for possible alternative (and/or medical) therapies. With the invention of the internet, you can pretty much buy anything online now, and have it shipped directly to your house! As always, do your research before you hit that order button though.

8.) I know you'll hate me for saying it, but a psychiatrist might be able to help you if all the previous medical doctors and alternative therapies fail.

a) Halitophobia is real. While I hate to mention it, I must admit that some people do indeed suffer from it. The reason I hate to mention it is because if anyone had told me I had halitophobia, I would have been so mad at them. I think when trying to figure out if you have bad breath or not, the only way you can know 100% is if someone just flat out tells you. Sure, you can know by indirect comments that people make, or the reactions you get from people when you are speaking to them or near them. But one thing i've learned is people react differently to different people. Just because someone rubs their nose when your talking to them, or they offer you a piece of chewing gum, that doesn't mean 100% that you have bad breath. Sometimes a person's nose just itches. And usually if I am going to chew a piece of gum, if my friends are around I will offer them a piece too, even if they don't have bad breath. It's called just being polite. Now some reactions or comments are obviously more blatant. My only advice here would be to step back, really analyze the situation, compare it to other situations, ask yourself would you do or say the same thing, and try to look at it objectively. Regardless of whether you have halitophobia or not, a psychiatrist can at least be someone that you can trust in and talk to about your problem. There's no doubt that bad breath, whether real or imagined, causes anxiety or depression. If bad breath, or the fear of bad breath has got you so anxious or depressed that you can't function in life (such as you can't work, you can't go to school, you can't socialize, you can't meet a significant other) or if you are contemplating suicide, then I would highly recommend seeing a psychiatrist. They could possibly get you on some prescription drugs that could alleviate your depression or anxiety, and possibly save your life! Plus you could just ask your psychiatrist if you have bad breath or not. I do not think all psychiatrists are evil. I don't think their goal is to lie to patients. Just open up and be honest with them, and try to let them help you. Also, as a side note, if you are suffering from depression or anxiety, and you think you have bad breath, then there could be a connection. Either you have bad breath which has caused your depression/anxiety, or your depression/anxiety has caused your bad breath (either real or imagined). Either way a psychiatrist might be able to help you.


So that's my checklist everyone. Feel free to add more to it. By no means is this a complete list, but I think I've listed some of the biggest possible causes of bad breath.

Cheers!

[vilenin89]

I'd add looking into TMAU and other metabolic disorders. There's a good support forum on bodyodorsupport.com for people with breath and body odor problems. TMAU can be subjective. It may explain why some people can notice your odor (objectively confirm), while others really can't. Why it comes on suddenly and intermitanty in some cases.

Worth looking into for some people here. Overall a good post here.

[HaveFaith]

Thank you for this! I might try some..

[feelinblue81]

Hey everyone this is my first post here..... thanks for this info, i will try again... a lot of nice people on these boards!

Keeptryin, i am on the antifungal pills for about a week now, still no improvement really but maybe because candida is not my problem altough my tongue is always white,,,,, maybe its not fungus but bacteria... can they take a culture and find out what it is?

[KeepTrying09]

[feelinblue81]

i have until tuesday.... my diet has always been high protein, no carbs, no sugar.... except sometimes ill have cereal which has 4 grams of sugar in it....

[KeepTrying09]

I've heard that people who follow the high protein, no carb diet get bad breath. Something about ketosis???

[KeepTrying09]

I just wanted to add achlorhydria & hypochlorhydria to the list of things you should check for when trying to figure out what is causing your bad breath.

Thanks halitosisix for mentioning them.

[Renato]

Hi all, this is my second post in here, I found this site great and it gave me hope to find a cure someday.

I have BB since my childhood, Im in my 30's now and still suffering of that.

I would like to share my experience with some of the points listed in the check list kindly posted by KeepTrying09 .


I had my wisdsom teeth removed 10 years ago.
I had my tonsils removed 15 years ago.

I have been done two endoscopies to my esophagous which resulted normal. One 15 years ago and the other done just the last year.

I have been checked for acid reflux, with no ovious signals.

I have been checked for peristaltic motility of the esophagous, which resulted normal.

I have taken medicines for acid reflux with no results.


My symptoms are:

Chronic BB
Sensation of fullness
Sensation of reflux( but no acid reflux)
White coated tongue ( yet hours after scraping with a tongue brush).

Worse BB on mornings


Bad taste, worst when eating food rich in sugar, milk or starch.

I'm lactose intolerant

ALmost all fruits(apple, orange, melon, water melon, pears, grapes , etc) cause me excesive gases so I avoid them.

When lying down on my sides I feel fluid coming up to my esophagus, but Drs found nothing when they inserted a probe into my esophagous to sense fluids during bed time.


I use mouth washes which makes me feel my mouth fresh and better taste, but the BB breath still there ( I think is comes from my back throat). Note: (when I accidentally swallow a little of the Thera breath mouth wash, makes my BB worse)

I have been prescribed with a strong oral antifungus to treat a onicomycosis last year ( the drug was Terbinafine) taken for three months, which cure my nail problem but not my bad breath.

I have noticed that oral antibiotics can cure my BB just during the time taking the medicine, but it comes back after stopping the treatment.

SO now I still think that my problem is overgrowth of bacteria in my mouth and throat, but the oringin may be from my stomach or intestine. So finding the cure of this may cure my BB

I have suggested to my doctors to perform the Fundoplication
(Anti-Reflux Surgery), which can tightly close the sphinter between my esophagus and stomach and avoid bad breath coming up to my mouth, but obviously they have denied to perform such as surgery (two Drs).

My Dr last week prescribed me carefate to treat possible bile reflux and also to be tested for Helicobater pilory. I stated my treatment today and I will know the lab results next week.

Im also planning to see the ENT to have my lingual tonsils removed (as I learned from this site that could be a possible cause, if not the cause, it may attenuate the BB).

I will keep posting to any positive
results.

Sorry for my bad english, Im a spanish speaker.

[Renato]

Just to let all you know.


my reflux (no acidic) was not responding with Carafate (supposedly to neutralize bile reflux), but it made my BB worst.
I think it happened just because the supension is extremely sweet and it seems that it was fermented for the bacteria in my mouth and troath/esophagous.

My BB became worst and my taste horrible just after the fist oral dosis. Im in the third day treatment and thinking to stop.

May be hypochloridia is my problem.

[:(]

My doctor said he coudnt do anything, a lot of his patients have bad breath and its common

My dentist said he'd just clean my teath for me

Is it just me or do these people suck

[Bishop]

[elliott]

[Renato]

Thanks Elliot for your advice.


There was something interesting, four months ago I tried to change my diet by eating just little on dinners. I included some vegetables and little meat. The vegetables caused me bloating which exacerbated my BB. I kept this diet for two months until I definitively removed the vegetables. I also avoid eggs, milk derivatives and meats at nights since these cause me the worst of the BB.

I really think now overgrown of bacteria (perhaps in lingual tonsil) has to be related with the reflux.

I do not know what is causing me the reflux, but almost all the time a feel this fluid in my throat. When I drink water, immediately I can feel the water coming back to my esophagus.

Im planning to ask Dr to perform full monitoring of stomach and intestines and see if they agree.

I started taking betaine-HCl to role out the posibility of achloridia just two hours ago.



Did you find the cause of your reflux?

[bbsux]

I am not gonna lie , i find it very hard to motivate my self to brush my teeth 2+ times a day when i see absolutely no improvement in my bb. I usually spend 15-25 mins in restroom brushing my teeth and when i come out get in the car with my mom withing 5mins of brushing my teeth and i notice the reactions right away. It makes it feel like i just wasted 25 minutes of my life.