Do you have bad breath?

As a common presumption goes, “One isolated incident of bad breath, like a first time thief who is caught, permanently tarnishes the reputation, and the condemnation sticks for life.”

What is halitosis?

Halitosis is the medical term for bad breath. Dental reports in the United States say there are about 65 million Americans who have bad breath.

In the Philippines, as in other regions in Asia, the incidence, conservatively speaking, may be 75 percent or higher for the general population. This is a rough guesstimate, and the figure, of course, varies in different subgroups in the community.

Halitosis, as a general rule, is less among those who live in the city, compared to rural areas, those who are more affluent, higher in socio-economic status, those who are more educated or professional, and those in the younger generation.

Obviously, the financially handicapped could ill afford the luxury of toothpaste, dental floss, mouthwash, regular dental check-ups and proper dental care. They may also be not as well-nourished and as healthy as those who can afford the care. But realistically, just about anyone, in any profession or walk of life, may have annoying bad breath, persistently or occasionally.

What causes halitosis?

There are a variety of causes of bad breath. Eating food that causes foul breath (like garlic or onion), poor dental hygiene, decayed tooth or infection of the gums or oral cavity, diseases like diabetes, esophageal diverticulum, esophageal reflux, sinusitis and emphysema, among others.

But the most common underlying cause is poor dental hygiene where care of the teeth and mouth is neglected. There are people who do not brush their teeth at all and go to bed at night with food particles stuck in between their teeth. They may gargle and rinse their mouths with water (or water and salt) after each meal, or even use mouthwash, but the food caught in between their teeth (especially meat and fish) rot and stink like dead animals on the street. This is putrefaction and the foul smelling odor is from the volatile sulfur compounds (VSC) produced by the decaying meat, which usually results in gram negative (anaerobic) bacterial infection (and more bad odor), and this makes for a vicious cycle.

Does the tongue harbor bacteria?

Yes, as a matter of fact, the tongue is a major culprit in the causation of bad breath. Bacteria hide in the furrows of the tongue, especially in the back (base) of the tongue. Hence, the regular use of tongue scraper or brushing all the way back to the base of the tongue (until you feel like gagging) at least twice a day is essential.

What can be done for persistent halitosis?

If proper daily oral hygiene is done and if there is no tooth decay or any infection in the mouth or throat, the bad breath may be coming from sinusitis, emphysema or from the stomach (as in esophageal reflex, where the controlling valve between the stomach and the food pipe is not closing — airtight — properly).

A dental, or even medical, evaluation may be needed to ascertain the specific cause of this persistent halitosis.

Can mouthwash eliminate bad breath?

Mouthwash alone cannot do the trick. First, the food particles that can rot must be removed from in-between the teeth immediately after each meal (by dental flossing, since tooth pick alone will not do the job). Then, brushing the teeth using toothpaste (that contains fluoride and other ingredients like Poly (methylvinylether) maleic acid coplymer and triclosan) for added tooth protection, is essential at least three times a day, after each meal. Mouthwash (with Stabilized Chlorine Dioxide) is an impressive regimen that suppresses bad breath. A study made on 15 mouthwashes showed that most masked the bad breath for a few minutes, but only a few were still effective after a few hours. Those with Stabilized Chlorine Dioxide are impressively effective.

What are the dental problems caused by bacteria?

Besides bad breath, the other problems caused by germs in our mouths include cavities, gum problems, plaques and tartar formation. Therefore, the routine regimen of dental flossing, tongue-scraping, tooth-brushing, and gurgling (with mouthwash that contain bacteria killing, and plaque-and-tartar preventing ingredients, like those with Stabilized Chlorine Dioxide), and visiting your dentist at least every six months will not only eliminate bad breath but lead to a healthier dental and oral state.

Can mouth containing alcohol cause cancer?

Yes, according to a 1991 study in the Journal of the American Dental Association, which stated that mouthwashes “containing more than 25 percent alcohol could increase the risk of oral and pharyngeal (throat) cancer by 50 percent.”

Fortunately, most, if not all, mouthwashes in the market today contain less than 15 percent alcohol. The safety of chlorine dioxide “has been confirmed by Richardson et al in an extensive study of the reaction of chlorine dioxide with water borne organics by the EPA (Environ. Sci. Technol., 1994;28:592).”

How effective are breath-fresheners, sprays and gums?

If used as a part of the comprehensive regimen we have outlined here, these various forms of breath-fresheners could be of help, in between flossing, teeth brushing and rinsing with Stabilized Chlorine Dioxide mouthwash. Chewing parsley, cilantro, basil, or mint also helps maintain a fresh breath. In general, the incidence of halitosis is less among vegetarians. But the regimen must include all measures listed above in order to be effective.

Do people know they have bad breath?

It is odd but most people with chronic halitosis do not know they have it. Their own sense of smell is so conditioned to the bad breath in their mouth to the point that they do not even perceive or know they have halitosis. And their friends and relatives (including most spouse) would not even tell them, “to spare” them the embarrassment (which actually leads to more widespread embarrassment because of the persistence of this very offensive but treatable problem, one which can ruin one’s reputation, business, and social life.)

One trick to find out is by licking your forearm and smelling it. The next time you see your lover or a close friend, or relative, beg them to be brutally candid with you and tell you if you have bad breath. This honesty will show them you care and are considerate. The revelation might even change your reputation and love life forever, for the better.


Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA,  a 501(c)(3) humanitarian foundation in the United States. Email:

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