Bad Breath Halitosis Forum

Once we pass beyond the army of a$$holes that relate our chronic halitosis to dental hygiene and tonsils, we step into the super dark and deeply unknown world of GI and/or genetic issues, that may cause a few variations of Chronic halitosis - and they were handed to us mothertruckers.

For this particular category of chronic halitosis, that I personally think, is related to Silent GERD, here is the short detail.



The Mechanisms: Why Silent GERD Causes Chronic Halitosis

• When dental hygiene practices fail to resolve chronic halitosis (bad breath), clinicians increasingly look upstream to the gastrointestinal tract. Silent GERD causes bad breath through several distinct physiological pathways:
  
  Direct Regurgitation of Volatile Compounds: The stomach contents contain putrefactive elements, volatile fatty acids, and sometimes micro-quantities of digested foods and bile acids. When the Lower Esophageal Sphincter (LES) and the Upper Esophageal Sphincter (UES) permit micro-reflux events—especially during sleep or abdominal straining—these gases migrate directly into the oral cavity
  
  Alteration of the Oral Microbiome (Dysbiosis): Chronic exposure to low-pH gastric acid and active pepsin alters the oral environment. Acid lowers the pH of saliva, creating a hostile environment for normal, healthy oral flora while selectively encouraging acid-tolerant pathogenic bacteria (such as Fusobacterium and various anaerobic gram-negative bacteria). These anaerobes break down proteins and generate high concentrations of Volatile Sulfur Compounds (VSCs)—namely hydrogen sulfide and methyl mercaptan—which smell like rotten eggs
  
  Posterior Lingual and Throat Tissue Inflammation: Silent reflux irritates the back of the throat, the tonsillar crypts, and the posterior third of the tongue. This chronic mucosal inflammation produces protein-rich post-nasal drip and cellular debris (mucus stasis), which serves as an ideal breeding ground for bacteria
  
  The Paradox of Medically-Induced Dry Mouth (Xerostomia): Paradoxically, a primary line of defense against GERD—prescription medications like Proton Pump Inhibitors (PPIs) or H2 blockers—can reduce overall salivary output or alter systemic hydration. Saliva is the mouth's natural cleanser, rich in immunoglobulins and oxygen. When saliva drops, oral bacteria thrive unchecked, worsening halitosis despite acid suppression

Some symptoms are

1 - Increase in the bb potency when empty stomach. This specific pattern—where the halitosis worsens significantly when your stomach is empty, disappears or improves right after eating, and then slowly creeps back as hours pass—is a classic clinical hallmark of reflux-related or gas-pouch-driven upper GI issues.
2 - Increase in the bb potency when we workout and do physicals exercises.
3 - Increase in the bb potency when indoors due to dry air coming from the vents. Dry Indoor Air and HVAC Systems: Indoor environments regulated by central heating, air conditioning, or forced-air systems feature significantly lower relative humidity.
4 - Temporary decrease in bb potency, right after we eat a meal but then it slowly creeps up in an hour or so.
5 - Taking antibiotics often provides a temporary masking or relief effect for people suffering from silent GERD-related chronic halitosis, which frequently leads people to think they’ve found a cure—only for the bad breath to return a few days or weeks after finishing the prescription.




Whats on the horizon

Transoral Incisionless Fundoplication (TIF)
An endoluminal procedure performed entirely through the mouth that reconstructs or tightens the anti-reflux valve without external surgical incisions.
Eliminates the underlying mechanical leak (the faulty LES) entirely, stopping the source of gas and vapor transport causing the halitosis.


Lets hope this procedure provides some relief to us who are suffering due to Silent Gerd.

Some more research, that looks promising.


The most significant medical breakthrough in treating severe "silent GERD" (scientifically known as Laryngopharyngeal Reflux or LPR) and its associated chronic halitosis is the shift from blocking stomach acid to directly targeting the stomach enzyme pepsin


Because silent GERD often involves non-acidic gasses escaping into the throat, traditional acid-blocking medications (like PPIs) frequently fail to resolve the underlying issue or the severe bad breath it causes

1. The Pepsin Breakthrough (Anti-Pepsin Therapeutics)

The Culprit: Research confirms that chronic bad breath and throat inflammation in silent GERD are primarily caused by aerosolized pepsin—a digestive enzyme that hitches a ride on gas bubbles into the throat and mouth, binding to tissues and breaking down proteins, which creates foul-smelling volatile sulfur compounds (VSCs) -- THAT'S THE MUTHERFUKKER !!!

The Breakthrough: Scientists discovered that an existing antiviral medication, Fosamprenavir, can be repurposed to successfully bind to and permanently deactivate pepsin.

Current Status: Spearheaded by N-Zyme Biomedical, targeted anti-pepsin formulations—including an aerosolized throat spray and oral medications—are advancing through Phase 2 clinical trials. This marks the first treatment designed to stop silent reflux damage independent of stomach acid


2 - Next-Generation Acid Control (P-CABs)

The Medication: For patients whose silent GERD is aggravated by acid, the FDA approval of Vonoprazan (Voquezna) represents a massive leap forward from older PPIs

Why it helps: Vonoprazan is a Potassium-Competitive Acid Blocker (P-CAB). Unlike traditional medications that take days to start working, P-CABs provide rapid, full acid suppression from the very first dose and control nighttime acid breakthrough far more effectively, reducing the gaseous venting that causes

3 - Mucosal Barrier Devices

The Treatment: Rather than altering body chemistry, newer medical devices utilize formulations of hyaluronic acid and chondroitin sulfate to physically coat the esophagus and throat.

Why it helps: This creates a stable, protective physical barrier that prevents both acid and pepsin from embedding into upper airway tissues, blocking the cellular damage that contributes to chronic halitosis

4 - Advanced Targeted Oral Probiotics
The Science: Recent clinical trials published in the National Library of Medicine show a breakthrough in how we manage the mouth bacteria downstream of reflux

Why it helps: Specific clinical-grade oral probiotics (strains like Streptococcus salivarius K12 and M18) have been shown to significantly reduce VSCs (bad breath gases) by shifting glucose and phosphorus metabolism in the mouth, neutralizing the odor-causing bacteria that thrive in a reflux-damaged environment

This makes sense to me, but Im so tired. Doctor told me 8 years ago I have silent reflux.. tried everything.. did every test.. I am not convinced today this is my culprit. I rarely feel acid in my throat, dont cough, dont clear my throat constanyly or have mucus.. its just dry and as my ENT says its irritated.. I had 4-5 24 hours impedance tests, showed many reflux episodes but none up to my throat.. my score was normal although it showed a coulle of times of alkaline reflux.

Tried everything.. i do take a couple of months oral probiotics with K12. I think it helps but not to the point of eliminating bb.. My bb is constantly there, throat dryness, a

My question is.. Many people have silent reflux, many people have much worse LES than mine (mine is Hill Grade 1 to 2) or other GI symptoms, but they dont have bb. Why? I'm not obese, I dont have a bad diet, I followed at some points strict acid watchers diets that sometimes they worked, some other times not..

Perfect teeth, no gonsils, no periofontal desease..
What I know is that even while eating my bb becomes worse.. not after that.. while I eat.. Even sipping water makes it worse..

I really want to find a solution to this and feel normal, for once.. like everybody else..

mtr wrote: Sat Aug 15, 2026 7:14 am This makes sense to me, but Im so tired. Doctor told me 8 years ago I have silent reflux.. tried everything.. did every test.. I am not convinced today this is my culprit. I rarely feel acid in my throat, dont cough, dont clear my throat constanyly or have mucus.. its just dry and as my ENT says its irritated.. I had 4-5 24 hours impedance tests, showed many reflux episodes but none up to my throat.. my score was normal although it showed a coulle of times of alkaline reflux.

Tried everything.. i do take a couple of months oral probiotics with K12. I think it helps but not to the point of eliminating bb.. My bb is constantly there, throat dryness, a

My question is.. Many people have silent reflux, many people have much worse LES than mine (mine is Hill Grade 1 to 2) or other GI symptoms, but they dont have bb. Why? I'm not obese, I dont have a bad diet, I followed at some points strict acid watchers diets that sometimes they worked, some other times not..

Perfect teeth, no gonsils, no periofontal desease..
What I know is that even while eating my bb becomes worse.. not after that.. while I eat.. Even sipping water makes it worse..

I really want to find a solution to this and feel normal, for once.. like everybody else..

Gas bubbles that raise from the stomach and travel to the throat (whether having acid residue on them or not), are the careers of this aerosolized pepsin— (THE MUTHERFUKKER !!!) in our cases.

If we didn't have this pepsin escaping from the stomach, our breath would be A LOT better.

Why do we create this additional amount of pepsin or why does it escape from our stomachs? We don't know but,

Here is the good news.
I spoke to Dr. Nikki Jhonston at Medical college of Wisconsin who is leading the research trials on Fosamprenavir to bind and fvuck the sh!t out of pepsin, and expressed my interest to join the study.

It looks like I may qualify after we filled out the initial forms. I will need to travel to Wisconsin every month for a year - it will cost me quite a bit but who gives a sh!t ??

I am ready to give my life for it if that results in finding a cure.


As for as probiotic goes .... regulars don't work.

Some of the research that I did is, what we need oral probiotic strain is BLIS K12™ and strain BLIS M18™.

You clean up your throat and tongue with a tongue scrapper, to take out as much as bacteria as you can, brush your teeth and and then drink water that has higher than 8.8 PH as it kills pepsin on contact. And only then you slowly swallow a pill just before you go to the bed. This will colonize the good bacteria with the bad bacteria.

What also seems to help is Gaviscon Advance LIQUID (not pills), it creates a raft effect on top of the stomach contents and resists against pepsin vapors scaping from the stomach. Unfortunately this is not available in USA but if anyone is in Europe, they can give it a shot for a month and try both of the above and see if it helps.

You can search it up Oral BLIS K12™ and strain BLIS M18 and there could be a few off the shelf products available. Use it with Gaviscon Advance Liquid and dental cleaning, tongue scrapping routine.

I am gonna try to get my hands onto Gaviscon Advance Liquid as well. It costs around $70.00 for a small 250ml pill to be shipped to USA from Europe, and that too can be intercepted by the customs.


If you are in UK, order this kit for yourself and get the pepsin breath test done if you like to.

I ordered in the US and I am on the wait list since they are out of stock.

https://refluxuk.com/education-hub/what-is-the-peptest

mtr wrote: Sat Aug 15, 2026 7:14 am This makes sense to me, but Im so tired. Doctor told me 8 years ago I have silent reflux.. tried everything.. did every test.. I am not convinced today this is my culprit. I rarely feel acid in my throat, dont cough, dont clear my throat constanyly or have mucus.. its just dry and as my ENT says its irritated.. I had 4-5 24 hours impedance tests, showed many reflux episodes but none up to my throat.. my score was normal although it showed a coulle of times of alkaline reflux.

Tried everything.. i do take a couple of months oral probiotics with K12. I think it helps but not to the point of eliminating bb.. My bb is constantly there, throat dryness, a

My question is.. Many people have silent reflux, many people have much worse LES than mine (mine is Hill Grade 1 to 2) or other GI symptoms, but they dont have bb. Why? I'm not obese, I dont have a bad diet, I followed at some points strict acid watchers diets that sometimes they worked, some other times not..

Perfect teeth, no gonsils, no periofontal desease..
What I know is that even while eating my bb becomes worse.. not after that.. while I eat.. Even sipping water makes it worse..

I really want to find a solution to this and feel normal, for once.. like everybody else..

And to answer your question, why many people who hog like pigs, have yellow stained crooked teeth, fat tummies, but brush their teeth for 10 seconds in the morning .... and you can put your nose in their mouth when they talk, and you don't smell any odor? ITS BECAUSE PEPSIN ENZYME stays trapped inside their stomachs .... it does not bubble up and escape the stomach, and leaves it's residue in the esophagus and back of the tongue.

This enzyme then starts breaking protein in the esophagus and throat, and bacteria is produced which is a HIGHLY STINKY kind of bacteria - the same that is produced in our stomachs. Do you now know why our p00p smells? lol

The environment in esophagus and in the throat is absolutely and totally helpless against this scavenging bacteria and it grows in leaps and bounds with nobody on top of the food chain to kill and eat it.

In a nutshell
Aerosolized Pepsin enzyme keeps bubbling up, escapes the stomach, - a non-stop factory producing this sh!t in our tummies - leave it's footprint in the food track creating a heaven for stinky bacteria to form and grow and results in chronic halitosis. We are trapped in this vicious cycle.

that is why this is weird to me....i get less feedback when i drink baking soda to combat my acid reflux that I feel sometimes. But my mother has extreme GERD, she has to have elevated bed, she takes pills on occasion and never has bad breath. She says acid comes to her throat too...

Im located in EU and I have been managing to buy gaviscon advance UK many years mostly from fridnds and family travelling to uk they would bring me few bottles everytime and pills.

However there is alternative solution thay you can do it yourself at home. Here's how to do it, havent tried it yet but i might anytime soon when I ran out of gaviscon advance.

To replicate a single 10 ml dose of Gaviscon Advance (which contains 1000 mg of sodium alginate and 200 mg of potassium bicarbonate):

1/2 teaspoon (approx. 1000 mg) Food-Grade Sodium Alginate Powder: Double the standard dose to create the extra-thick, heavy-duty mechanical barrier.

1/8 teaspoon (approx. 200 mg) Potassium Bicarbonate Powder: This serves as the low-sodium gas source that lofts the heavy raft to the top of the stomach.

1/2 crushed Calcium Carbonate Antacid Tablet (approx. 300 mg): Calcium is strictly required here to cross-link the denser alginate concentration into a resilient, solid foam.

Preparation Tips for Denser Gels

Because this formula uses twice the amount of alginate, it will become incredibly thick, much like a dense syrup.

Required Blending: Do not attempt the yogurt or hand-stirring methods for this concentration. You must use an immersion or standard blender with 1/2 cup of warm water to fully hydrate the dense powder.Extended Resting Time: The blended mixture will trap a large amount of foam initially. It must rest in the refrigerator for at least 3 to 4 hours (or overnight) to settle into a smooth, consumable liquid.

Thank you for the tips on pepsin. I used to gargle and spray my nose with baking soda water after a meal. Havent noticed any particular difference however I believe a mire systemic approach might help. The problem is I havent figure out which of all these remedies combined together might help and in which order.

Beyond this I also ordered today an oral microbiome test. I will let you know how that would go.

mtr wrote: Tue Aug 18, 2026 10:12 am Im located in EU and I have been managing to buy gaviscon advance UK many years mostly from fridnds and family travelling to uk they would bring me few bottles everytime and pills.

However there is alternative solution thay you can do it yourself at home. Here's how to do it, havent tried it yet but i might anytime soon when I ran out of gaviscon advance.

To replicate a single 10 ml dose of Gaviscon Advance (which contains 1000 mg of sodium alginate and 200 mg of potassium bicarbonate):

1/2 teaspoon (approx. 1000 mg) Food-Grade Sodium Alginate Powder: Double the standard dose to create the extra-thick, heavy-duty mechanical barrier.

1/8 teaspoon (approx. 200 mg) Potassium Bicarbonate Powder: This serves as the low-sodium gas source that lofts the heavy raft to the top of the stomach.

1/2 crushed Calcium Carbonate Antacid Tablet (approx. 300 mg): Calcium is strictly required here to cross-link the denser alginate concentration into a resilient, solid foam.

Preparation Tips for Denser Gels

Because this formula uses twice the amount of alginate, it will become incredibly thick, much like a dense syrup.

Required Blending: Do not attempt the yogurt or hand-stirring methods for this concentration. You must use an immersion or standard blender with 1/2 cup of warm water to fully hydrate the dense powder.Extended Resting Time: The blended mixture will trap a large amount of foam initially. It must rest in the refrigerator for at least 3 to 4 hours (or overnight) to settle into a smooth, consumable liquid.

Thank you for the tips on pepsin. I used to gargle and spray my nose with baking soda water after a meal. Havent noticed any particular difference however I believe a mire systemic approach might help. The problem is I havent figure out which of all these remedies combined together might help and in which order.

Beyond this I also ordered today an oral microbiome test. I will let you know how that would go.

Did you get the test kit?

I did the Viome Microbiome test. They found a lot of issue , i did the diet as they recommended as well their probiotic but it didn't help. Lately I somehow got Mayo Clinic to take my case. There are few test they will do against my gut and i will know the result on sept 21st. They are considered the best GI in the country but our situation is so unique that i am not sure what will happen. Anyway I will let you know if there is anything positive.I am just running out of ideas and hope but i hope there will be a cure in the very near future.

halitsing18 wrote: Wed Sep 02, 2026 2:34 am I did the Viome Microbiome test. They found a lot of issue , i did the diet as they recommended as well their probiotic but it didn't help. Lately I somehow got Mayo Clinic to take my case. There are few test they will do against my gut and i will know the result on sept 21st. They are considered the best GI in the country but our situation is so unique that i am not sure what will happen. Anyway I will let you know if there is anything positive.I am just running out of ideas and hope but i hope there will be a cure in the very near future.

Interesting.
Even though we would like to stay anonymous but I think you and I can stay in touch to share our experiences and our knowledge, as I am also under the care of a GI at Mayo.
Visited the clinic at Rochester about a month ago. This was for a slightly different reason to have my pancreas checked, but lets connect.

KL123 wrote: Tue Sep 01, 2026 7:44 pm

mtr wrote: Tue Aug 18, 2026 10:12 am Im located in EU and I have been managing to buy gaviscon advance UK many years mostly from fridnds and family travelling to uk they would bring me few bottles everytime and pills.

However there is alternative solution thay you can do it yourself at home. Here's how to do it, havent tried it yet but i might anytime soon when I ran out of gaviscon advance.

To replicate a single 10 ml dose of Gaviscon Advance (which contains 1000 mg of sodium alginate and 200 mg of potassium bicarbonate):

1/2 teaspoon (approx. 1000 mg) Food-Grade Sodium Alginate Powder: Double the standard dose to create the extra-thick, heavy-duty mechanical barrier.

1/8 teaspoon (approx. 200 mg) Potassium Bicarbonate Powder: This serves as the low-sodium gas source that lofts the heavy raft to the top of the stomach.

1/2 crushed Calcium Carbonate Antacid Tablet (approx. 300 mg): Calcium is strictly required here to cross-link the denser alginate concentration into a resilient, solid foam.

Preparation Tips for Denser Gels

Because this formula uses twice the amount of alginate, it will become incredibly thick, much like a dense syrup.

Required Blending: Do not attempt the yogurt or hand-stirring methods for this concentration. You must use an immersion or standard blender with 1/2 cup of warm water to fully hydrate the dense powder.Extended Resting Time: The blended mixture will trap a large amount of foam initially. It must rest in the refrigerator for at least 3 to 4 hours (or overnight) to settle into a smooth, consumable liquid.

Thank you for the tips on pepsin. I used to gargle and spray my nose with baking soda water after a meal. Havent noticed any particular difference however I believe a mire systemic approach might help. The problem is I havent figure out which of all these remedies combined together might help and in which order.

Beyond this I also ordered today an oral microbiome test. I will let you know how that would go.

Did you get the test kit?

Yes I did. Did the test and sent it back to the lab about a week ago. By the end of September I will receive the results. In the meantime I visited an oral maxillofacial surgeon for salivary gland evaluation. He confirmed xerostomia similarly to ENT however before proceeding with any other tests or treatment he will be waiting for me to have my appoinment with the rheumatologist to rule out Sjorgen Syndrome. Let's see..

Yes I did. Did the test and sent it back to the lab about a week ago. By the end of September I will receive the results. In the meantime I visited an oral maxillofacial surgeon for salivary gland evaluation. He confirmed xerostomia similarly to ENT however before proceeding with any other tests or treatment he will be waiting for me to have my appoinment with the rheumatologist to rule out Sjorgen Syndrome. Let's see..

Thanks for the update. Keep us posted please.

As i said Mayo did the first testing and results came barely an hour back, have 3 more tests this week, FYI i dont have any heartburn or any symptom except clearing my throat every few min.have both nasal and mouth based smell which goes 10 ft


EXAM: FL SWALLOW FUNCTION WITH VIDEO AND SPEECH PATHOLOGY, FL ESOPHAGRAM DOUBLE CONTRAST

COMPARISON: None available

FINDINGS: Video swallow: A video swallow study was performed in conjunction with speech pathology using thin liquid, mildly thick liquid, puree solid and regular solid barium consistencies. No laryngeal penetration or aspiration. Minimal pharyngeal residue. Prominent cervical osteophytes.

Esophagram: A double contrast esophagram was also performed. The esophagus is normal in caliber.
Mild dysmotility with mostly preserved primary peristaltic wave and proximal escape in the mid esophagus. There is a small sliding-type hiatal hernia.
Moderate gastroesophageal reflux was witnessed. A 13 mm barium tablet passed promptly into the stomach.


IMPRESSION:
1. No aspiration or penetration.
2. Small sliding-type hiatus hernia and moderate reflux.
3. Mild esophageal dysmotility.


General Information
Ordered by
Reading physician
Resulted on Result status
MAYO CLINIC, PROVIDER MD M.B.B.S. 9/15/2026 8:31 AM Final result

halitsing18 wrote: Tue Sep 15, 2026 5:49 pm As i said Mayo did the first testing and results came barely an hour back, have 3 more tests this week, FYI i dont have any heartburn or any symptom except clearing my throat every few min.have both nasal and mouth based smell which goes 10 ft


EXAM: FL SWALLOW FUNCTION WITH VIDEO AND SPEECH PATHOLOGY, FL ESOPHAGRAM DOUBLE CONTRAST

COMPARISON: None available

FINDINGS: Video swallow: A video swallow study was performed in conjunction with speech pathology using thin liquid, mildly thick liquid, puree solid and regular solid barium consistencies. No laryngeal penetration or aspiration. Minimal pharyngeal residue. Prominent cervical osteophytes.

Esophagram: A double contrast esophagram was also performed. The esophagus is normal in caliber.
Mild dysmotility with mostly preserved primary peristaltic wave and proximal escape in the mid esophagus. There is a small sliding-type hiatal hernia.
Moderate gastroesophageal reflux was witnessed. A 13 mm barium tablet passed promptly into the stomach.


IMPRESSION:
1. No aspiration or penetration.
2. Small sliding-type hiatus hernia and moderate reflux.
3. Mild esophageal dysmotility.


General Information
Ordered by
Reading physician
Resulted on Result status
MAYO CLINIC, PROVIDER MD M.B.B.S. 9/15/2026 8:31 AM Final result

Acid reflux has two main forms. GERD and LPR.
Heartburn is usually associate with GERD.
With LPR, you rarely get heartburn.

However, the aerosolized pepsin enzyme, escaping from the stomach and taking a ride on acid bubbles does not discriminate between GERD or LPR. It causes chronic halitosis in both cases.

Many people who have GERD and/or LPR do NOT have chronic halitosis because they don't have this additional condition of pepsin enzyme escaping from the stomach.

What does your above result mean?

Hello i just read your post and is very interested, i suffer from bb from a very young age and i had an lpr the silent one for many years since it becomes active and i have pain and burn un my throat very very often. Years ago i took medicine for stomach i thinn they were from gerd but didnt do nothing to change my breath , what change my breatj completely was flagyl which i took for 15 days, i used to have huge tonsil stone and they disappeared after flagyl, still have some of them but very little ones and very rarely, than i took ornidazole and helped also more with bb, but bb is not fully cured for me, but it is definitely way much better than before. Before was horrible , but timeto time i still have problems. I used to have runny nose a lot and post nasal drips and now i have very little and very rare because i took a vaccine for respiratory my doctor provude me years ago and helped me a lot . Currently i have lpr almost every day and problem with bb time ti time. Now if the lpr was the main issue how come antibiotics helped me? Whats your opinion. now iam planning to start a lpr cure witt omepranzole and gaviscon