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Mouth Diseases

Awful taste in mouth always

07/02/2007

Question:

I have a awful taste in my mouth always (bad breath) I can brush my teeth and use mouthwash and it`s still there. Went to the dentist and said my teeth and gums look healthy. I`m very tired and I get swallon glands alot. I was hoping to fnd an answer to this problem, when I drink water it helps alittle for the dry mouth, but if I drink anything else my breath is really bad. I work with the public so this is a real problem..tryed parsley, aloe, taking B-12 and have even tryed rinsing my mouth with salt water. no luck

Answer:

In response to your question on oral malodor or bad breath/halitosis, your problem is not unusual.  The prevalence of this condition effects approximately 2.5% of the adult population (Loesche et al 2000).

I am more concerned with your other symptoms of "being tired and swollen glands". I would suggest you see your primary care physician to further evaluate these complaints.

Currently the general consensus of the ADA and other head and neck practitioners involves the elimination of bacteria, food and blood/saliva/mucous/desquaminated epithelial cells from the oral cavity, especially the tongue (Biofilm removal). Mechanical debridement seems to be the most effective method in conjunction with the use of antimicrobial mouthwashes, such as Chlorhexidine or Cetylpyridinium Chloride.

Good oral hygiene especially before bedtime seems to be associated with decrease in VSCs and VOCs and intraoral bacterial counts, and results in elimination of oral malodor.

Bad breath is a very common problem and approximately 85% of the cases are due to the generation of "Volatile Sulfur Compounds (VSCs) and /or Volatile Organic Compounds (VOCs)" by bacteria that populate the oral cavity. The other 15% of oral malodors may be caused by systemic diseases:

The major sites in the oral cavity that have been implicated in the etiology of bad breath include:

The tongue provides a great place for bacteria to populate and for the production of both VSCs and VOCs to occur. Dentures are also a great source for bad breath to occur, as the denture base acts as a scaffold for bacteria and nutrient sources to adhere.

VSCs (Volatile Sulfur Compounds) include such molecules as:

They are produced by bacteria that populate the oral cavity. The resultant VSC's are the end product of metabolism of sulfur containing peptides and proteins that are in the mouth.

VOCs (Volatile Organic Compounds) include compounds such as:

Bacteria generally involved with the problem include gram negative anaerobes such as T. denticola, B. forsythus, P. gingivalis, F. nucleatum just to mention a few. These are also periopathogens (associated with the development and progression of periodontal disease) and have been isolated from both the tongue and periodontal sulcus in patients with documented bad breath (elevated VSC levels and Rosenberg scale levels).

Malodor is also associated with salivary flow - low flow results in increased malodor. This is one reason that most individuals awake with "morning breath," as salivary flow decreases during sleep. Dehydration is also associated with bad breath, as a result of diminished salivary flow secondary to fluid restriction.

Diagnosis and treatment: There are methods currently available for quantitating VSC levels. One such device is the "Halimeter" that measures sulfide levels. Another is the Zinc oxide sensor that measures halitosis directly within the oral cavity. Other methods include:

Still the "gold standard" is direct unbiased multiple observer smelling of the patient's mouth. Treatment as you have found can run the whole gamut of OTC and web-sale products.

For more information:

Go to the Mouth Diseases health topic, where you can:

Response by:

Richard J Jurevic, DDS, PhD Richard J Jurevic, DDS, PhD
Formerly, Assistant Professor of Biological Sciences
School of Dental Medicine
Case Western Reserve University