Dr. Jorgen Slots, USC

[Pleasehelp]

Hi everyone,

So I was reading yet ANOTHER article online, hoping to glean some info I hadn't yet found, when. I came across an article published by a dental office who had asked Dr. Slots, who is the professor of periodontology and microbiology at USC, how to treat halitosis, and he said use Hibiclens, which is .40% chlorhexidine. Well I was apprehensive because like a lot of you, I did try. 20% chlorhexidine and was successful until the bacteria became resistant to it. So I emailed him and asked him and he did recommend the Hibiclens, even though I told him I had already tried a weaker version of it. He said to put a few drops on the very back of my tongue and scrub. He also said the bacteria is from my stomach. So I just picked it up from Target but I am so nervous to try it, because I feel like every time I try something it makes it worse. Currently I have room filling fecal breath that is also nasal as well as oral. Has anyone tried this Hibiclens before?

[KL123]

I have had direct email communication with Dr. Slots.

And this is one of his responses.

"The treatment below works completely in all tested cases of halitosis. One can buy 4% chlorhexidine ('Hibiclens') over the counter. This of course shows the bacterial component of halitosis.

================

Chlorhexidine is an efficient antiseptic in combating halitosis. Severe halitosis can be socially unacceptable and numerous remedies for oral malodor have been proposed throughout history (286). Persistent halitosis is caused by the volatile sulfur compounds produced by anaerobic bacteria that mainly reside on the dorsum of the tongue (121, 190, 259). Halitosis can be markedly reduced by applying 4% chlorhexidine to the most posterior part of the tongue dorsum using a toothbrush or a cotton swab tip (own unpublished data). The ability of chlorhexidine to bind to and be slowly released from the mucosal surface of the tongue makes it the preferred antiseptic agent against halitosis bacteria (132)."

And this actually helps me in my case.


My personal routine to combat the stinky oral bacteria is this.

Get up in the morning and step out in the open fresh air or open the window and put my face out where I gently breathe deeply for about 50 times at least.
When you breathe in, bloat your belly out to get the max amount of fresh air go deeper in your lungs, hold it there for a couple of seconds and breathe out by squeezing your belly in - so that max air gets out.
The idea is to remove and replace all the stinky air and odors elements that the blood stream has off loaded into your lungs over night (this process actually never stops and keeps on happening 24/7), and also infuse the blood with fresh oxygen that helps fight the stinky sh!t in the blood. This stinky sh!t and odorous elements and gasses are probably picked up from our stomach by the blood stream and then gets off loaded into the lungs. And when we breathe, most of it gets trapped in the throat and back of the tongue area. So when we talk, this sh!t flies out of our mouths.

Once I clear my lungs (temporarily) from this stinky elements, and have infused some fresh oxygen into my blood, I get back to the restroom and first thing I do is to thoroughly scrape my tongue and dorsum to remove all the sh!t (off white or very mildly yellow/brown colored). The tongue becomes pink, and then I brush my teeth and my tongue for a good three minutes. I use a medium soft toodthbrush with Pronamel toothpaste by sensodyn. And finally, I rinse the brush and put a couple of drops of Hibiclens on my tooth brush and take it all the way inside my mouth and gently rub it on the dorsum (the very back of the tongue), and then face my mouth towards the ceiling and gently simulate as if I am gargling. The idea is to have to Hibiclens spread out all around in the throat and nasopharynx area.

Whatever little liquid that has formed in my throat, heck, I swallow it so that it scrubs some stinky sh!t on the walls of my food pipe.

The property of hibiclens is that it sticks to the throat skin a little longer than conventional mouth washes and gives somewhat of a longer relief time.
Eventually the bb comes back. So even though Hibiclens provides some temporary relief, it's not a whole lot different than a mouth wash that covers up the sh!t but it does NOT cure the root cause of the problem (that no one seems to know in our particular cases).

It's very important that you must not use more than a max of two drops of Hibiclens to be placed on the dorsum. A higher amount could cause injury to the delicate skin of the mouth and throat area.

After applying the hibiclens to your dorsum, you will feel like as if you are in some sort of a medical trauma center where injured soldiers are treated in a war zone. This feeling will go away after a few minutes.

Sometimes it's also a good idea to get up in the morning, simple rinse your mouth with water and before doing anything to clean your mouth n lungs, is to eat the breakfast - and then do all of the above, so that you don't have to eat or drink anything after applying Hibiclens to the dorsum. It has then a longer effect.

This mouth cleaning process can be repeated two or three times during the day; however, for the second and third time, use only one drop of Hibiclens to be placed on the dorsum. And even if that's too much, skip it.

[Stevian]

@ Pleasehelp: “ Currently I have room filling fecal breath that is also nasal as well as oral.”

Sounds to me like a serious case of bacterial overgrowth (biofilm) on the tongue, possibly including serious periodontitis. A few questions if you don’t mind:
1. Do your gums bleed when you brush?
2. Do you have a whitish or greyish coating on your tongue?
3. Do you have any loose teeth?

[Pleasehelp]

No to everything except the slight white coating. I've already seen a periodontist. And gastro and ENT. I have some tonsil stones once in a while but that's it. What about you?

[Stevian]

No to everything except the slight white coating. I've already seen a periodontist. And gastro and ENT. I have some tonsil stones once in a while but that's it. What about you?

As I previously mentioned, I had significant improvement after getting my periodontitis treated. The rest, for me has been managing my bacteria overgrowth on the tongue, especially the dorsum (back).
Never had tonsil stones.
Another question if you don’t mind. How old were you when you acquired this condition, and how long have you had it?

[Stevian]

@ KL 123
“ Eventually the bb comes back. So even though Hibiclens provides some temporary relief, it's not a whole lot different than a mouth wash that covers up the sh!t but it does NOT cure the root cause of the problem (that no one seems to know in our particular cases).”

It’s not that no one knows the root cause. It’s fairly well known that the root cause of oral malodor is the off-gassing of *persistent* anaerobic oral bacteria. It’s not a mystery disease.

[KL123]

@ KL 123
“ Eventually the bb comes back. So even though Hibiclens provides some temporary relief, it's not a whole lot different than a mouth wash that covers up the sh!t but it does NOT cure the root cause of the problem (that no one seems to know in our particular cases).”

It’s not that no one knows the root cause. It’s fairly well known that the root cause of oral malodor is the off-gassing of *persistent* anaerobic oral bacteria. It’s not a mystery disease.

Again, what you are saying is the aftermath. The disaster happens before that.
As we already know, there are may be different kinds of chronic halitosis but as I mentioned the term "in our particular cases".
We know the overgrowth of stinky bacteria on the dorsum but what exactly causes it? Why it happens in us and not 100 and millions of people who have poor dental hygiene, their teeth look yellow and out of shape, their food habits are horrible - but you put your nose in their mouths when they talk, and you won't pick any bad odor. What exactly is different in their system that automatically and systematically and naturally chokes the overgrowth of VSC?
Is it genetic (SELENBP1)? Probably yes. Is it something to do with the liver? Probably.

We simply don't know the exact root cause in our cases where exceptional dental hygiene is practiced, regular visits to dentists take out any possibility of decaying roots or periodontics issues, no tonsil stones or tonsils removed altogether, no nasal or throat infection exists, where we watch our diet, we exercise, and we have a good and healthy life style yet, the breath stinks like sh!t.
I have visited a few places in the third world and have met many people in the remote villages and in thickly populated rural areas, and noticed that people with very minimal dental hygiene who are out of shape, no exercise, and eat whatever they want, have zero breath odor. Why?

Do you know the root cause?

I will stand firm on my opinion unless I get more information. Our practice of keeping excellent oral hygiene and living a healthy life style is just a cover up to get temporary relief from chronic and acute halitosis. We don't really know the true root cause of the issue in our particular cases.

[Stevian]

@ KL123
I understand your frustration, but I think you’re using a shotgun approach here that’s unhelpful.

First, I don’t think our individual cases are necessarily equivalent, or even necessarily have the same root cause, not to mention there are limitations to seeking root causes. Sometimes the root cause of a condition is unknown, and thus by necessity we end up treating the symptoms.

You mentioned SELENBP1. It’s rare by best estimates, but yeah, it’s a real thing.
I know exactly one person with this condition, and it’s not relevant to my case, perhaps yours.
I don’t know enough about your case to say, but the documented cases originate in childhood, so if yours became known and evident post-puberty, you can likely eliminate it as a cause.
If your condition responds (or did earlier in life) to chlorhexadine or other unscented, unflavored mouthwash, say, diluted bleach, or diluted hydrogen peroxide, or even Listerine Original, you can likely eliminate SELENBP1 as a cause.

Something to do with the liver? Well, sure enough, an alcoholic with advanced sclerotic liver will have strange and unpleasant breath, but if it smells fecal (like sh!t), then it’s not the liver.
Late stage, low functioning liver disorders produce fetor hepaticus, which smells musty, and it’s dimethyl sulphide. Not at all fecal, nope.

My advice? Get used to the fact that fecal-smelling breath (except for rare cases of SELENBP1) is caused by the off-gassing of volatile sulfur compounds (VSCs) produced by persistent anaerobic oral bacteria.
Why do the off-gasses of some oral bacteria have a fecal smell? Because they have a cellular metabolism similar to some gut bacteria.

So lastly, why do most people not have serious and chronic halitosis despite poor oral hygiene? It’s reasonable to suspect some of us have a genetic susceptibility, as is likely the case with serious to severe periodontitis, which globally afflicts about 10% of most studied populations. Yes, diet, oral hygiene, and access to dental care are factors.

There is a positive correlation, btw, between chronic periodontitis and chronic halitosis. Many (about 58%) periodontal patients have chronic halitosis. I’ll post a link below to a study on that correlation. One theory or hypothesis about susceptibility to harmful oral bacteria is that it has something (as yet undefined) to do with the character, constituents, or chemical balance of the saliva, and that in turn might have a genetic factor.

All for now, and best of luck in your search.

[KL123]

@ KL123
I understand your frustration, but I think you’re using a shotgun approach here that’s unhelpful.

First, I don’t think our individual cases are necessarily equivalent, or even necessarily have the same root cause, not to mention there are limitations to seeking root causes. Sometimes the root cause of a condition is unknown, and thus by necessity we end up treating the symptoms.

You mentioned SELENBP1. It’s rare by best estimates, but yeah, it’s a real thing.
I know exactly one person with this condition, and it’s not relevant to my case, perhaps yours.
I don’t know enough about your case to say, but the documented cases originate in childhood, so if yours became known and evident post-puberty, you can likely eliminate it as a cause.
If your condition responds (or did earlier in life) to chlorhexadine or other unscented, unflavored mouthwash, say, diluted bleach, or diluted hydrogen peroxide, or even Listerine Original, you can likely eliminate SELENBP1 as a cause.

Something to do with the liver? Well, sure enough, an alcoholic with advanced sclerotic liver will have strange and unpleasant breath, but if it smells fecal (like sh!t), then it’s not the liver.
Late stage, low functioning liver disorders produce fetor hepaticus, which smells musty, and it’s dimethyl sulphide. Not at all fecal, nope.

My advice? Get used to the fact that fecal-smelling breath (except for rare cases of SELENBP1) is caused by the off-gassing of volatile sulfur compounds (VSCs) produced by persistent anaerobic oral bacteria.
Why do the off-gasses of some oral bacteria have a fecal smell? Because they have a cellular metabolism similar to some gut bacteria.

So lastly, why do most people not have serious and chronic halitosis despite poor oral hygiene? It’s reasonable to suspect some of us have a genetic susceptibility, as is likely the case with serious to severe periodontitis, which globally afflicts about 10% of most studied populations. Yes, diet, oral hygiene, and access to dental care are factors.

There is a positive correlation, btw, between chronic periodontitis and chronic halitosis. Many (about 58%) periodontal patients have chronic halitosis. I’ll post a link below to a study on that correlation. One theory or hypothesis about susceptibility to harmful oral bacteria is that it has something (as yet undefined) to do with the character, constituents, or chemical balance of the saliva, and that in turn might have a genetic factor.

All for now, and best of luck in your search.

We are saying the same thing in two different ways.
There are different kinds (categories) of chronic halitosis ... yours could be different than mine. This is already understood.

And the bold part is the same as to what the gist of my post was. The true underlying cause is unknown. We only experience the aftermath of it, and that is, VSC or overgrowth of odorous bacteria on the dorsum.
(I am sure the odorous elements/gases in some cases of chronic bb, also reside in our lungs. So even though we may have clean/killed the stinky bacteria on the dorsum (temporarily), the gases coming out of lungs may contribute to having a bad odor when we speak or breathe.

Jimi's theory is that our livers are weak when it comes to breaking down oils and fats. And in his cases, he has done quite a few trial n error experiments to arrive at the conclusion that avoiding oils and fats (of any kind) in the food intake helps reduce the odor. Again, just a theory that I won't rule out for some kind of halitosis.

And you don't really need to post the link as you can easily debunk the theory of chemical imbalance in the saliva.

Take this test.
Get up in the morning and before brushing your teeth or scrapping your tongue, use your index finger to gently take a saliva sample from your dorsum. Let it dry on your finger and then sniff if, obviously there is going to be an obnoxious smell.

Now, use your small finger and take a saliva sample from UNDER your tongue, and smell it. It will be odor free.

This should indicate to you that there is perhaps nothing wrong in the balance or imbalance of saliva produced in our stinky mouths.

And so for your advice go? Thank you.
Been dealing with it for 45 years to have build enough of a thick skin.

[Stevian]

@KL123
“This should indicate to you that there is perhaps nothing wrong in the balance or imbalance of saliva produced in our stinky mouths.”

The chemical imbalance of the saliva is just one theory, so I don’t get wound up about it, but I would say that the difference between an odor sample from the dorsum versus under the tongue proves or disproves nothing, except that the dorsum is a more likely repository for bacteria, in the same way that periodontal pockets are a more likely repository than under the tongue.

[Stevian]

@KL123
A minor point, but the bold text was accidental on my part. No special emphasis intended.

[Pleasehelp]

@Stevian

It was morning breath that started in college, but went away with brushing until I was in my early 30s. During this time some specific things happened that may or may not have contributed to an imbalance. I started Enbrel for arthritis (about a year before this began, although I was simply switching from Humira) and I took antibiotics for travelers diarrhea. But one product that really seemed to accelerate it was Smartmouth. I think it created a resistance in my mouth. Before I started it daytime, stubborn halitosis was still occasional. After, it became every day, incurable halitosis. Something that I find odd is that ot used to be simply fart/fecal smell, but after doing smartmouth and chlorhexidine it can be anything, including sulfur or garbage. I am wary of mouthwashes now.

[Stevian]

@Stevian

It was morning breath that started in college, but went away with brushing until I was in my early 30s. During this time some specific things happened that may or may not have contributed to an imbalance. I started Enbrel for arthritis (about a year before this began, although I was simply switching from Humira) and I took antibiotics for travelers diarrhea. But one product that really seemed to accelerate it was Smartmouth. I think it created a resistance in my mouth. Before I started it daytime, stubborn halitosis was still occasional. After, it became every day, incurable halitosis. Something that I find odd is that ot used to be simply fart/fecal smell, but after doing smartmouth and chlorhexidine it can be anything, including sulfur or garbage. I am wary of mouthwashes now.

Good morning, P, and thanks for your reply.

Yes, it’s well known that bacteria become resistant to antibiotics, less well known is that they can become resistant to antimicrobials as well, including chlorhexadine. I’ve no idea what’s in Smartmouth, but growth inhibitory substances for sure.

Question: how do you know the character of your breath? Normally this’s not possible in any direct fashion, blowing into cupped hands, etc. The gauze swab off the back of the tongue is indicative, but doesn’t give much measure of intensity. Do you have someone giving you regular feedback, or are you somehow able to tell?

Question: have you investigated or consulted any breath clinics, particularly those that promote laser tongue debridement (LTD) or laser tongue rejuvenation? I don’t know about Europe, but I think there’re at least 2 such clinics in North America, one in Texas, one in or near the Capital region.
I haven’t consulted, but my impression is it ain’t exactly cheap, typically costing several thousands of dollars. My own case seems under control, so I don’t think I’d go to that extent. Just asking..

[telpar]

Each of us has tried chlorhexidine.
None of us were cured of chlorhexidine.

Chlorhexidine is useful in case of intraoral halitosis, as an initial therapy for 1 week, on the doctor's prescription.

Bacteria cannot be killed. Smartmouth is very good for type 1 bad breath, it contains zinc chloride and sodium chlorite. The combination of these two elements inhibits sulfur compounds without killing bacteria.
So I don't think it can lead to microbiotic resistance. It's safe, I suppose.

If smartmouth is useful to you, it is a clue to intraoral bad breath.
If Smartmouth is useless, maybe it's not intraoral halitosis.

For intraoral bad breath, the best product seems to be Halitosil Zn, a recipe from Aydin Murat. Unfortunately it is not available outside of Turkey.

Friends, we don't need chlorhexidine, we don't need antibiotics.
I don't think we have "bad" bacteria. I think we have an underlying sublicnic cause that is difficult to diagnose. But it is not impossible.

I think our cases should be studied by the university's oral pathology department.
I dream of a hospital where you go and there is a team of doctors (oral medicine, Orl, gastroenterology, endocrinology) who collaborate to work out a diagnosis.

It's possible. We deserve it.

[Stevian]

@ telpar

“For intraoral bad breath, the best product seems to be Halitosil Zn, a recipe from Aydin Murat. Unfortunately it is not available outside of Turkey.”

The best nonprescription intraoral product I’ve used is Therabreath Maximum Strength. Good results up to several hours. Haven’t tried Smartmouth, but I know some rate it highly.