Diabetes, Bad Breath and Halitosis

Some confusion exists around whether or not diabetes causes bad breath or halitosis. Unless a diabetic person is in a state of very high blood sugar known as ketoacidosis, no change in breath odor is expected. However, bad breath may be more prevalent in individuals with diabetes, simply because certain types of odor-causing bacteria tend to thrive in a high-sugar environment.

The term ketoacidosis refers to the presence of high concentrations of keto acids in the body. This typically results when a person’s body is burning stored fat at a high rate as a result of untreated type I diabetes mellitus. This condition can be detected by checking the pH level of the individual’s blood. Additionally, diabetic individuals with ketoacidosis often suffer from dehydration, which can also cause oral dryness, another contributing factor to halitosis.

Certain extreme nutritional restrictions, such as a high-protein low-carbohydrate diet like the Atkins diet, can induce a mild state of ketosis. The rapid rate at which fat is burned in this state causes ketones to be present in the urine, but this should not be confused with ketoacidosis. Regardless of whether a person is in a state of ketoacidosis or ketosis, an abnormal change in their breath odor can result. Specifically, the breath takes on a fruity smell, often described as sickly-sweet. Similarly, patients with chronic kidney failure experience a change in breath odor, resulting in “fishy” halitosis or bad breath that reeks of a urine smell.

If you have neither changed your diet nor been diagnosed with a serious medical condition, yet you detect yourself as having strange-smelling breath, seek medical evaluation from a professional immediately. Alternatively, if you have been diagnosed with diabetes, or you are consuming an Atkins-style diet that causes your breath to emit this fruity odor, you’ll most likely want to treat or camouflage the scent. Take some time to browse through Dr. Katz’s broad spectrum of products designed to treat and prevent bad breath or halitosis.

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Bad Breath and Halitosis in Animals (dogs, puppies specifically)

He’s your best friend and confidante, and when you look into those big brown eyes, it’s pure puppy love. Maybe you could stand more face to face time with your furry friend, if only his doggie breath wasn’t so terrible! It may help to know you’re not alone, as veterinarians everywhere field the common question: why is my dog’s breath so bad?

For starters, it’s good to know that bad breath and halitosis in animals should not go unchecked. Besides being an inconvenience for the pet’s owner, bad breath can be a sign of hidden health problems, and a trained professional can give your pet a thorough examination to determine the cause of its bad breath. Most commonly, tooth and gum problems are the source of puppy halitosis, caused by tartar buildup around the animal’s teeth. The decomposition of bacteria caused by undigested food in the mouth is what ultimately causes the foul breath smell in most dogs and animals.

In puppies and young animals, halitosis is often caused by a different reason. As these young pets shed their baby teeth, the significant amount of accompanying drool can lead to bad breath. Diseases causing halitosis in older pets can include conditions of the kidneys and liver, or may include feline leukemia in cats, all of which are serious and should be treated immediately.

The best way to treat or prevent bad breath and halitosis in animals is to visit your veterinarian for yearly checkups. Additionally, dry commercial pet food and rawhide treats and bones can chip away at tartar while massaging the pet’s gums, plus dental buildup will not develop as quickly with dry food as it will in pets with soft food diets. Brushing the dog’s teeth is a practice that is gaining widespread acceptance, and is generally readily recommended by veterinarians to prevent dangerous buildup of plaque. Dr. Katz offers a number of effective and simple to use oral care products for your pet, including an oxygenating solution designed to systematically treat your puppy’s bad breath.

Copyright © 2006 bad-breath.org

How to prevent bad breath and halitosis

Imagine you’re dining with friends at an elegant restaurant. The conversation is sparkling, your jokes are witty and well-timed and everyone is laughing and enjoying themselves. The evening is shaping up to be a grand success until your sweetheart leans over and whispers in your ear, “Honey, your breath is terrible.” Suddenly, you feel mortified as you wonder who else knows about your horrible breath and you scramble to think what you can do about the offensive odor.

Unfortunately, everyone has a most embarrassing bad breath moment. Luckily, there are a number of ways to prevent bad breath and halitosis. It’s common knowledge that the best way to prevent bad breath and halitosis is by exercising proper and consistent oral hygiene. The gold standard includes brushing your teeth after each meal and flossing at least once per day, but adding the use of a tongue scraper will boost your results significantly. Some forms of chronic halitosis are so persistent that the bad breath will not subside even with a rigorous oral routine.

Anti-bacterial rinses are among the most powerful forms of prevention of halitosis and bad breath. While mouthwashes typically provide only temporary relief, rinses can actually destroy the bacteria that cause offensive odor on the breath. Skip the rinses containing alcohol, as these will dry out your mouth and only exacerbate the problem. The best rinses contain ingredients such as chlorhexidine, chlorine dioxide or zinc gluconate.

Additionally, a number of other products may be helpful to prevent halitosis. Chewing sugarless gum can stimulate the production of saliva and prevent dry mouth, a frequent cause of bad breath. Dr. Katz offers a broad range of products to combat halitosis including: sprays, specialized toothpaste and tooth gels, tongue scrapers, mints, drops, freshness strips and much more. Browse through his complete line of products designed to prevent bad breath and halitosis.

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As distressing as halitosis or bad breath can be for adults, the condition is often even more distressing for children and their parents. A number of factors can contribute to halitosis in children, specifically, thumb-sucking and constantly breathing through the mouth instead of breathing through a combination of the nose and mouth. Infections of the sinus and throat can also cause halitosis in infants and children, although these are less common reasons for bad breath.

In approximately 85 percent of all cases of halitosis in children in infants, the source of the bad breath lies in the oral cavity. Typically, specific bacteria are to blame, and these can be found between the teeth, below the gum line or on the back of the tongue. As the tongue sheds cells, these can remain on the back of the tongue, forming a breeding ground for odor-causing bacteria.

Most frequently, the cause of halitosis in children is post-nasal drip, usually caused by chronic sinus infections, allergies or common colds. Invariably, mucous secretions and other discharge can accumulate in the back of the throat or on the tongue, which can decompose and cause bad breath. When the child or infant is congested and must breathe through its mouth, dry mouth can result, causing halitosis.

It’s a good idea to establish habits of proper dental hygiene with your child at as early an age as possible. Parents can introduce a daily routine of using a toothbrush and baby toothpaste (fluoride-free) with the appearance of the first tooth. Children should be flossed daily as soon as two or more teeth touch each other, as plaque can develop between the teeth. Older children who wear braces or orthodontic devices such as retainers are subjected to potential halitosis from improper cleaning and oral care. Be sure to browse through Dr. Katz’s extensive line of oral care products designed to prevent and treat halitosis in children.

Chronic bad breath and halitosis

Whether it’s just before a first kiss or after a meal that unexpectedly included garlic and onions, almost everyone has worried about having bad breath at some point in their lives. More than half of the population struggles to maintain fresh breath throughout their day, using temporary fixes such as mints or gum. Unfortunately, one-fourth of all people are persistently plagued with chronic halitosis, also known as ever-present bad breath. When the condition escalates to this point, the result can be a person who is frustrated, embarrassed and socially unacceptable.

While it’s true that proper and consistent oral hygiene is the best prevention for halitosis, many people who suffer from chronic bad breath possess outstanding oral care habits. Most often, the likely culprit is odor-causing bacteria that live on the back of the tongue. In many cases, daily use of a tongue scraper can remove these pesky bacteria and alleviate the symptoms of chronic halitosis.

Over-the-counter breath fresheners often lack a lasting effect, and may have minimal impact on chronic halitosis. Antibacterial mouthwashes have been proven to provide relief from chronic halitosis in many people, but be sure to choose a brand without alcohol, which can dry the mouth and exacerbate the condition. Certain premium mouthwashes are known to neutralize the volatile sulfur compounds that cause chronic bad breath, and these may be helpful in treating chronic halitosis. Typically, these specialized mouthwashes are only available via internet or mail order, and the slightly higher price is certainly worth it to the person whose life is affected by chronic bad breath.

If chronic bad breath persists despite these suggested treatments, it could be an indication of periodontal disease or some form of systemic disorder. Seek evaluation from a medical professional to determine the true source of your chronic bad breath. For a complete selection of treatments for chronic halitosis, feel free to browse Dr. Katz’s line of fresh breath products, including specialized mouthwashes and rinses, toothpaste, tooth gels, mints, gum, sprays, drops and more.

Dealing with bad breath and halitosis

Halitosis is a word that evokes a certain stigma as being one of the most socially unacceptable conditions in our culture, and a taboo subject to boot. Bad breath or halitosis is also responsible for a significant amount of fear and insecurity in social interactions, as it can be difficult to know if your own breath is offensive. This widespread insecurity is not without merit, as approximately one-fourth of the population is plagued with some form of chronic halitosis.

Fortunately, dealing with bad breath and halitosis does not necessarily have to be expensive, difficult or time-consuming. A number of remedies are available on the market today to treat both persistent and transient halitosis. Basically, two methods can be applied to treat halitosis: seeking professional help vs. the buy-it-and-try-it method.

A number of medical professionals are available to assist you in determining the cause of your halitosis. Physicians and dentists are often approached for solutions to this disheartening condition, and bad breath clinics are growing in popularity and prevalence. While some bad breath clinics use highly specialized equipment or microbiology techniques to assess the underlying cause of the halitosis, these tests can cost a pretty penny and you can expect to be “sold” on that clinic’s preferred form of treatment.

The buy-it-and-try-it method of treating halitosis is the most frequently used route for alleviating both transient and chronic halitosis. With so many remedies available on the market today, consumers have an abundance of options for dealing with bad breath and halitosis. Certain cures will work on certain types of bad breath, and some people will experience more profound results than others using the same product. Since results can vary among individuals and from product to product, it is important to try many forms of treatment and stick with what works. Dr. Katz offers a variety of bonus packs and starter kits, enabling you to simply and affordably sample a range of products to discover what works best for you.

Causes of bad breath and halitosis

No one likes to discover that their breath is offensive, but have you ever stopped to wonder what causes bad breath or halitosis? In a word, the culprit is simply and most often: bacteria. When your mouth is overpopulated by particular types of bacteria, the result is smelly breath. Specifically, streptococcus mutans is the worst bacterial offender causing nasty halitosis. However, bacteria are not the only potential cause of halitosis.

You’ve probably noticed that when your mouth is dry, a condition known as xerostomia, bad breath can result. Fortunately, this can often be quickly relieved by consuming water or liquids to moisten the mouth while treating the breath with mints, gum, breath strips, or other conveniently accessible remedies. This condition can often be prevented by remaining well-hydrated, or by chewing breath-freshening gum.

More serious medical and systemic conditions can cause symptomatic halitosis, and naturally these diseases should be addressed immediately by a medical professional. For example chronic liver failure can cause a specific type of bad breath known as fetor hepaticus, and diabetes mellitus can cause a sweet-smelling fruity odor on the breath caused by ketosis. Additionally, a high-protein low-carbohydrate diet can put the body into a different type of fat-burning ketosis, which can result in the same fruity breath. Some people find the odor pleasant, while others prefer to camouflage the smell with breath strips, mints or chewing gum.

If you find yourself with any of these types of halitosis, you’re not alone. Chronic bad breath affects 25 percent of the population, but the good news is that help is available. Dr. Katz offers an abundant variety of halitosis remedies, including mouthwashes, rinses, specialized toothpastes and tooth gels, plus gum and other oral goodies. Don’t let halitosis ruin your personal interactions — take action to treat or prevent bad breath today.

Copyright © 2006 bad-breath.org

Symptoms of bad breath and halitosis

How is your breath right now? Unfortunately, one of nature’s cruel jokes is that we can rarely assess our own bad breath. Thanks to a biological phenomenon known as habituation, we are increasingly less sensitive to our own smell, simply because of our constant exposure to it. Unless you experience symptoms of halitosis such as extreme oral dryness or a bad taste in your mouth, you could be completely unaware of your own foul breath.

Naturally, no one wants to remain blatantly unaware of their own bad breath, as this could result in unpleasant social and professional interactions, as well as an embarrassing eventual discovery of halitosis. Fortunately, there are a few ways in which you can evaluate your breath to determine whether you have halitosis. First, you could ask a trusted friend or close relative to check your breath for you and offer honest feedback. While this method is not always feasible depending on the circumstances, two other alternatives are available for use in nearly any situation.

One way to check for halitosis is to lick the back of your wrist and let the saliva dry for a minute or so before smelling it. Alternatively, you can scrape the back part of your tongue by inverting a spoon or using a strip of dental floss. By smelling the dried remains, you’ll know exactly how your breath smells at that time, but keep in mind this can change throughout the day.

For a more scientific approach, consider purchasing a home test kit that uses tongue swabs to check for the presence of sulfur compounds and polyamines. If your breath is not as fresh as you’d imagined, a number of treatments and preventative measures are available from Dr. Katz. Be proactive and keep bad breath at bay with treatments close at hand. You never know when you (or someone near you) may need a quick remedy for embarrassing symptoms of bad breath.

Bad breath and halitosis

Few episodes are as embarrassing as the discovery that you have bad breath or halitosis. Unfortunately, this socially taboo condition is rarely discussed in social circles until the odor becomes unbearable and someone close to you is brave enough to let you know. For many people, halitosis is an embarrassing yet easily treatable condition. Did you know that chronic bad breath affects approximately one out of every four people to some degree? Unfortunately, halitosis or bad breath can have a negative impact on a person’s business interactions, social relationships and dating experiences and personal self-esteem.

The word halitosis was first coined by the Listerine Company in 1921 and is simply the medical term for bad breath. Halitosis was derived by combining the Latin word for breath (”halitus”) with the Greek suffix “osis,” meaning condition. Some forms of halitosis, such as morning breath, are considered transient bad breath. Typically, these indicate a temporary condition created by factors such as smoking, dry mouth, stress or hunger. Additionally, the consumption of certain types of foods can cause transient bad breath, such as garlic or onions.

Although halitosis and bad breath plague many people for a variety of reasons, there’s no need to suffer silently or to restrict your social interactions. Fortunately, a number of outstanding products are available today to treat and prevent halitosis from interfering with a normal life.

Take some time to browse through the many products available from Dr. Katz. You’ll find everything you’re looking for to prevent and treat halitosis, including mouthwashes, rinses, gum, mints, strips, sprays, drops, special toothpastes and more. Starter kits and bonus packs are available at a considerable savings. Don’t let halitosis prevent you from enjoying a date or outing with friends, getting that promotion at work or closing the all-important sale — take action today to eliminate halitosis and bad breath.

Copyright © 2006 bad-breath.org

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Phone: 800-97-FRESH
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Copyright © 2006

Here’s a website that will help you banish your fears arising out of bad breath and Halitosis. Discover all the basic facts about bad breath and include the remedies into your life so you can have fresh breath all day, all night!

Next time you turn away after a conversation with someone, make sure you don’t leave them pinching their noses.

Bad breath? Yes, it’s an embarrassing problem. It affects our social and professional relationships, and the stigma attached can be quite agonizing.

Oral care for decades has concentrated on cavities, plaque and gum diseases. But today’s gregarious and hip and happening generation needs much more. No wonder there are so many products, from toothpastes to mouthwashes, mints to bubblegum, stocked in shopping malls.

However, what’s important here is to understand the cause for bad breath. This is because each individual has different sets of problems such as peculiar food habits, dental problems and diseases, stress, smoking etc. Each problem needs to be identified and treated suitably.

Before we get into the nitty-gritty of bad breath and halitosis, here are some facts and myths you should know about them:

• Commercial toothpaste and mouthwash manufacturers have been lying to you
• Tongue Scraping alone accomplishes nothing
• The Bad Breath Bugs actually live UNDER the surface of your tongue
• The only thing that really kills bad breath is Oxygen (OXYD-8)

These are just a few of several facts and myths brought to light so you understand bad breath and halitosis better. But there is so much more for you to learn about this sensitive issue that can make or break your social and professional image. This eBook is your guide to good oral health.

The single downloadable eBook has all the information on bad breath you have been looking for – from its true causes to symptoms that will let you know before anyone else, as well as how you can stop bad breath at the root of the problem. Well-researched and condensed, this eBook is your ‘Bad Breath Bible’.

by Pontefract H, Hughes J, Kemp K, Yates R, Newcombe RG, Addy M.
Division of Restorative Dentistry, Dental School, Bristol, UK.

The Journal of Clinical Periodontology, 2001 Apr;28(4):319-24

BACKGROUND: There are both anecdotal clinical and laboratory experimental data suggesting that low pH mouthrinses cause dental erosion. This evidence is particularly relevant to acidified sodium chlorite (ASC) formulations since they have plaque inhibitory properties comparable to chlorhexidine but without the well known local side effects.

AIM: Studies in situ and in vitro were planned to measure enamel erosion by low pH mouthrinses. The study in situ measured enamel erosion by ASC, essential oil and hexetidine mouthrinses over 15-day study periods. The study was a 5 treatment, single blind cross over design involving 15 healthy subjects using orange juice, as a drink, and water, as a rinse, as positive and negative controls respectively. 2 enamel specimens from unerupted human third molar teeth were placed in the palatal area of upper removable acrylic appliances which were worn from 9 a.m. to 5 p.m., Monday to Friday for 3 weeks. Rinses were used 2x daily and 250 ml volumes of orange juice were imbibed 4x daily. Enamel loss was determined by profilometry on days 5, 10 and 15. The study in vitro involved immersing specimens in the 4 test solutions together with a reduced acid ASC formulation for a period of 4 h under constant stirring; Enamel loss was measured by profilometry every hour.

RESULTS: Enamel loss was in situ progressive over time with the 3 rinses and orange juice but negligible with water. ASC produced similar erosion to orange juice and significantly more than the two proprietary rinses and water. The essential oil and hexetidine rinses produced similar erosion and significantly more than water. Enamel loss in vitro was progressive over time, and the order from low to high erosion was reduced acid ASC, ASC, Essential oil, and hexetidine mouthrinses and orange juice.

CONCLUSION: Based on the study in situ, it is recommended that low pH mouthrinses should not be considered for long term or continuous use and never as pre-brushing rinses. In view of the plaque inhibitory efficacy of ASC, short- to medium-term applications similar to those of chlorhexidine would be envisaged.

Biofactors 2000;12(1-4):65-70

Zinc deficiency and taste dysfunction; contribution of carbonic anhydrase, a zinc-metalloenzyme, to normal taste sensation.

by Komai M, Goto T, Suzuki H, Takeda T, Furukawa Y.

Division of Life Science, Graduate School of Agricultural Science, Tohoku University, Sendai, Japan. mkomai@biochem.tohoku.ac.jp

The present study was designed to clarify the effect of zinc deficiency on sodium chloride preference, the lingual trigeminal and taste nerves transduction, and carbonic anhydrase (CA) activity of the tongue surface and salivary gland. Male SD rats, 4 weeks old, were divided into four groups, and fed zinc-deficient (Zn-Def), low-zinc (Low-Zn), and zinc-sufficient diets with free access (Zn-Suf) and pair-feeding (Pair-fed). After taking part in the preference tests for 42 days, the rats were provided for the chorda tympani and lingual trigeminal nerves recordings, then finally sacrificed and the tongue and submandibular gland excised to measure CA activity. Sodium chloride preference increased only after 4 days of the feeding of zinc-deficient and low-zinc diets, which means that the taste abnormality appears abruptly in zinc deficieny and even though in marginal zinc deficiency. Reduced CA activities of the taste-related tissues in zinc-deficient group paralleled well with the decreased taste and lingual trigeminal nerves sensitivities.

Effect of Different Mouthrinses on Morning Breath.

by van Steenberghe D, Avontroodt P, Peeters W, Pauwels M, Coucke W, Lijnen A, Quirynen M.

Department of Periodontology, Oral Pathology and Maxillo-Facial Surgery, Faculty of Medicine, Catholic University of Leuven, Belgium.

BACKGROUND: Morning breath odor is an often-encountered complaint. This double-blind, crossover, randomized study aimed to examine the bad breath-inhibiting effect of 3 commercially available mouthrinses on morning halitosis during an experimental period of 12 days without mechanical plaque control.

METHODS: Twelve medical students with a healthy periodontium refrained from all means of mechanical plaque control during 3 experimental periods of 12 days (with intervening washout periods of at least 3 weeks). A professional oral cleaning preceded each period. During each experimental period, as the only oral hygiene measure allowed, the students rinsed twice a day with one of the following formulations in a randomized order: CHX-Alc (a 0.2% chlorhexidine [CHX] solution); CHX-NaF (CHX 0.12% plus sodium fluoride 0.05%); or CHX-CPC-Zn (CHX 0.05% plus cetylpyridinium chloride 0.05% plus zinc lactate 0.14%).

After 12 days, morning breath was scored via volatile sulfur compound (VSC) level measurements of the mouth air and organoleptic ratings of the mouth air, the expired air, and a scraping of the tongue coating. At the 12-day visit, a questionnaire (subjective ratings) was completed and samples taken from both the tongue coating and the saliva for anaerobic and aerobic culturing and vitality staining. The de novo supragingival plaque formation was also recorded. All parameters were correlated with the baseline registrations.

RESULTS: Although oral hygiene during the 3 experimental periods was limited to oral rinses, bad breath parameters systematically improved, with the exception of a slight increase in VSC levels while using CHX-Alc, a finding which was associated with the direct influence of the CHX on the sulfide monitor. The oral microbial load after the use of CHX-NaF remained unchanged, while for the CHX-Alc and CHX-CPC-Zn, significant reductions in both aerobic and anaerobic colony forming units (CFU)/ml were noticed in comparison with baseline data for both tongue coating and saliva samples. The composition of microflora, on the other hand, did not reveal significant changes. The supragingival plaque formation was inhibited, in descending order, by CHX-Alc, CHX-CPC-Zn, and CHX-NaF. The subjective scores for the rinses indicated a higher appreciation for CHX-CPC-Alc and CHX-NaF because of a better taste and fewer side effects. CONCLUSIONS: The results of this study demonstrate that morning halitosis can be successfully reduced via daily use of mouthrinses. CHX-Alc and CHX-CPC-Zn mouthrinses result in a significant reduction of the microbial load of tongue and saliva.

Publication Types:
· Clinical Trial
· Randomized Controlled Trial

PMID: 11577950 [PubMed - indexed for MEDLINE]

J Clin Periodontol 1996 May;23(5):465-70

The effect of mouthrinses containing zinc and triclosan on plaque accumulation, development of gingivitis and formation of calculus in a 28-week clinical test.

by Schaeken MJ, Van der Hoeven JS, Saxton CA, Cummins D.

Department of Periodontology and Preventive Dentistry, University of Nijmegan, The Netherlands.

Experimental mouthrinses containing 0.4% zinc sulphate and 0.15% triclosan, which differed in base formulations were compared to a commercially available non-active control mouthrinse. Following baseline clinical examinations for plaque, gingival bleeding and calculus, the volunteers were provided with a dental prophylaxis and given oral hygiene instruction, stratified into 3 groups and given 1 of 3 mouthrinses.

Further clinical assessments were performed after 4, 16 and 28 weeks. Salivary mutans streptococci were also monitored during the study. At 4 weeks, plaque and calculus scores in all groups were low compared to baseline. During the remainder of the study, these improvements were not maintained and both plaque and calculus levels increased in all groups. Plaque was significantly lower (P < 0.05) than in the control at all time points. Calculus was significantly lower (P < 0.05) than in the control at all time points. Calculus was significantly lower at week 28 for experimental mouthrinse group 2. Gingival bleeding also decreased in the initial 4 weeks but increased thereafter in the control group. In contrast, gingival bleeding was significantly (P < 0.05) lower in the two experimental groups than in the control group. No significant changes in mutans streptococci were observed.

Ann Pharmacother 1996 Feb;30(2):186-7
Zinc Deficiency and Taste Disorders.

by Heyneman CA.

Idaho Drug Information Center, Idaho State University, Pocatello 83209, USA.

Elemental zinc supplementation in daily dosages of 25-100 mg po appears to be an efficacious treatment for taste dysfunction secondary to zinc depletion. Insufficient evidence is available to determine the efficacy of zinc supplementation for the treatment of hypogeusia or dysgeusia secondary to drug therapy or medical conditions that do not involve low serum zinc concentrations.

Ther Umsch 1995 Nov;52(11):732-7

[Article in German] Huttenbrink KB.

Klinik und Poliklinik fur Hals-Nasen-Ohren-Heilkunde der Medizinischen Fakultat Carl Gustav Carus, Technischen Universitat Dresden.

Disorders of olfaction and taste are infrequent, but a complete loss of smell or taste reduces the quality of life significantly. The sensitivity of human olfaction is remarkable, even for specific stimuli: Just a few molecules are enough to induce the correct identification of sterilised and ultraheated milk.

Olfaction and taste are called ‘chemical senses’ because in both cases the adequate stimulus consists of molecules that bind to receptors of the sensory cells. The perceptions of smell and taste are often combined. Taste differentiates only four qualities: sweet, sour, salty, and bitter. The typical flavor of food or drink is detected by olfaction. Disturbances of olfaction can be due to respiratory disorders such as nasal polyps, a deviation of the nasal septum or chronic sinusitis. Such conditions can reduce airflow through the olfactory cleft at the roof of the nasal cavity. They can be corrected by modern endoscopic surgery of the nose.

Epithelial disorders involving the sensory cells are most often caused by viral infections (influenza-anosmia) or toxic destruction of the sensory epithelium (solvents or gases). Epithelial disorders can be cured only rarely by any treatment. Corticosteroids, zinc, and vitamin A are tried frequently. Neural disorders occur after frontobasal trauma and during neurological diseases such as Parkinson’s or Alzheimer’s disease. Disorders of olfaction can be an early sign of such neurological diseases and sophisticated examination of this sense can contribute to their early diagnosis. However, no specific treatments have yet been identified. Disorders of taste can be due to toxic, chemical or inflammatory damage to the sensory cells of the tongue.

Indian J Physiol Pharmacol 1993 Oct;37(4):318-22

Zinc Taste Test in Pregnant Women and its Correlation with Serum Zinc Level.

by Garg HK, Singal KC, Arshad Z.

Department of Pharmacology, J. N. Medical College, A.M.U., Aligarh.

Pregnant women in different trimesters of pregnancy were divided into control (n = 58) and study (n = 104) groups. Study group subjects were given 45 mg zinc/p.o./day as 200 mg ‘zinc sulphate tablets from the day of reporting till term. Body zinc status was clinically assessed by ‘zinc taste test’. Blood samples were drawn at the same time and serum zinc levels measured. Zinc taste test scores decreased with advancement of pregnancy (P < 0.05) and increased significantly following zinc administration (P < 0.05).

Serum zinc level declined significantly with advancement of pregnancy (P < 0.001). Following zinc administration, serum zinc level increased significantly (P < 0.001). Accuracy of zinc taste test in individual cases ranged between 70 and 100 percent. On the whole, zinc taste test was well correlated with serum zinc level, and provides a fair idea of zinc deficiency.

Nutrition 1993 May-Jun;9(3):218-24

Zinc deficiency in elderly patients.

by AS, Fitzgerald JT, Hess JW, Kaplan J, Pelen F, Dardenne M. - Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI.

Zinc is needed for growth and development, DNA synthesis, neurosensory functions, and cell-mediated immunity. Although zinc intake is reduced in elderly people, its deficiency and effects on cell-mediated immunity of the elderly have not been established. Subjects enrolled in “A Model Health Promotion and Intervention Program for Urban Middle Aged and Elderly Americans” were assessed for nutrition and zinc status. One hundred eighty healthy subjects were randomly selected for the study. Their mean dietary zinc intake was 9.06 mg/day, whereas the recommended dietary allowance is 15 mg/day. Plasma zinc was normal, but zinc in granulocytes and lymphocytes were decreased compared with younger control subjects. Of 118 elderly subjects in whom zinc levels in both granulocytes and lymphocytes were available, 36 had deficient levels.

Plasma copper was increased, and interleukin 1 (IL-1) production was significantly decreased. Reduced response to the skin-test antigen panel and decreased taste acuity were observed. Thirteen elderly zinc-deficient subjects were supplemented with zinc, and various variables were assessed before and after zinc supplementation. Zinc supplementation corrected zinc deficiency and normalized plasma copper levels. Serum thymulin activity, IL-1 production, and lymphocyte ecto-5′-nucleotidase increased significantly after supplementation. Improvement in response to skin-test antigens and taste acuity was observed after zinc supplementation. A mild zinc deficiency appears to be a significant clinical problem in free-living elderly people.

Arch Otolaryngol Head Neck Surg 1991 May;117(5):519-28

Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center.

Deems DA, Doty RL, Settle RG, Moore-Gillon V, Shaman P, Mester AF, Kimmelman CP, Brightman VJ, Snow JB Jr. - Department of Otorhinolaryngology and Human Communication, School of Medicine, University of Pennsylvania, Philadelphia.

Smell and taste disorders are common in the general population, yet little is known about their nature or cause. This article describes a study of 750 patients with complaints of abnormal smell or taste perception from the University of Pennsylvania Smell and Taste Center, Philadelphia. Major findings suggest that: chemosensory dysfunction influences quality of life; complaints of taste loss usually reflect loss of smell function; upper respiratory infection, head trauma, and chronic nasal and paranasal sinus disease are the most common causes of the diminution of the sense of smell, with head trauma having the greatest loss; depression frequently accompanies chemosensory distortion; low body weight accompanies burning mouth syndrome; estrogens protect against loss of the sense of smell in postmenopausal women; zinc therapy may provide no benefit to patients with chemosensory dysfunction; and thyroid hormone function is associated with oral sensory distortion. The findings are discussed in relation to management of patients with chemosensory disturbances.

J Periodontol 1990 Jun;61(6):352-8

Clinical efficacy of a dentifrice and oral rinse containing sanguinaria extract and zinc chloride during 6 months of use.

Harper DS, Mueller LJ, Fine JB, Gordon J, Laster LL. - Fairleigh-Dickinson University, Oral Health Research Center, Hackensack, NJ.

The efficacy of combined use of toothpaste and oral rinse containing sanguinaria extract and zinc chloride was compared to placebo products in a 6-month clinical trial. Sixty subjects with moderate levels of plaque and gingivitis were randomly assigned to active and placebo groups. Noninvasive measures of plaque and gingivitis were assessed at baseline and at 2, 6, 8, 14, 20, and 28 weeks. Bleeding on probing was measured at baseline and 6, 14, and 28 weeks. Active group scores were significantly lower (P less than .0001) than placebo scores at each post-baseline time point for all indices, with the exception of plaque at 2 weeks. The 28 week active group scores were 21% lower than the placebo group for plaque, 25% lower for gingivitis, and 43% lower for bleeding on probing. No dental staining or taste alteration was reported in the active group. Three of 30 active group subjects exhibited minor soft tissue irritations that resolved spontaneously without discontinuation of product use. Results indicate that the test products showed good levels of safety and efficacy when administered in a combined use regimen for 6 months.

Clin Prev Dent 1990 Apr-May;12(1):13-7

Clinical evaluation of anticalculus dentifrices.

Kazmierczak M, Mather M, Ciancio S, Fischman S, Cancro L.

One hundred and eighty-seven patients participated in a six-month study to evaluate the calculus-inhibiting effect of a zinc citrate dentifrice compared to Crest Tartar Control and a placebo, Crest Regular. The findings demonstrate a statistically significant calculus prevention benefit over Crest Regular for both Crest Tartar Control and a 2% zinc citrate/silica product. Compared to the control, the zinc citrate product reduced calculus formation by 32.3%, and Crest Tartar Control reduced it by 21.4%. These findings also demonstrate no statistically significant difference in stain or soft tissue status among the three dentifrices. All products were found to be safe to oral tissues and acceptable for taste.

J La State Med Soc 1989 Sep;141(9):9-11

Disorders of taste.

Rareshide E, Amedee RG.

At least 2 million Americans suffer with chemosensory dysfunction or disorders of taste and smell. In addition to the obvious aesthetic deprivation, loss of taste may affect an individual’s health and psychosocial situation. Most taste disorders are associated with antecedent upper respiratory infection, trauma, or allergic rhinitis, or have an idiopathic etiology. They may reflect underlying neoplastic, neurologic, endocrine, infectious, or nutritional disturbances; only 1% of these patients have a functional disorder. Evaluation consists of a history and physical, followed by a screening test battery searching for any of the treatable etiologies. One third of patients will respond to exogenous zinc therapy after a treatment period of 2 to 4 months. The remainder must rely on supportive measures such as additives, flavor enhancers, and rinses.

Here’s the fascinating story behind the most revolutionary addition to oral care since the introduction of OXYD-8® and TheraBreath® back in 1994, TheraBreath Aktiv-K12 ProBiotics.

In the Spring of 2003, I came across a very interesting research article in The Journal of Clinical Microbiology, with the “mysterious” title: Diversity of Bacterial Populations on the Tongue Dorsa of Patients with Halitosis and Healthy Patients. It was written by three groups of scientists, one from Harvard University, the second from the Forsyth Institute of Boston, and the remaining group from the University of Michigan. Their study “hit me like a brick”, because over the past ten years I had heard countless times from people, just like you, pleading for a method to reverse the negative effects of the sulfur producing “bugs” in their mouth. In essence, they requested an “introduction of good bacteria” into the oral cavity. (Some wanted to know if their tongue could be reshaped or smoothed-out – others asked if they should stop kissing their offending spouse!).

Unbeknownst to me, and completely across the world (and I mean across the world) Professor John Tagg and his research team from the Department of Microbiology, University of Otago in New Zealand, had been working diligently to identify beneficial strains of naturally occurring bacteria, which, by their production of antibacterial protein chains, help protect humans against infection by other destructive bacteria. The term used for these natural antibacterial peptides is B.L.I.S., an abbreviation for Bacteriocin Like Inhibitory Substances. A “bacteriocin”, by definition, is a protein chain produced by beneficial bacteria to inhibit the growth of related bacteria. They are at the forefront of medical/dental research because they are made by non-pathogenic bacteria that normally colonize the human body.

Loss of these harmless bacteria following use of antibiotics may allow pathogenic bacteria to invade the human body. [This is another bit of evidence that supports my call to end the use of antibiotics such as Tetracycline and Minocycline for acne. A large percentage of patients at my clinics reported use of these antibiotics during their teens and now have chronic halitosis.]

Looking at our concept of natural bacterial intervention, or “Bacteriotherapy”, (the use of strains of beneficial bacteria to control infection by undesirable bacteria), we have learned that certain strains of micro-organisms produce BLIS substances, acting as natural antibiotics, harmless to humans, which control the growth of undesirable bacterial infections. The goal is to use nature’s strengths, instead of artificial antibiotic or questionable therapies that have lead to the fact that many antibiotics no longer work, because of their overuse and misuse.

The Theory Behind ProBiotics: A Mutually Beneficial Relationship Between Bacteria

In humans our internal tissues are normally free of micro-organisms. However, the surface tissues, such as the skin and mucous membranes (inside of the mouth, nasal passages, etc), are constantly in contact with the external environment and become easily colonized by certain micro-organisms. The mixture of organisms regularly present at any site is referred to as the normal flora. (In the mouth it is known as the normal oral flora or microflora). This is usually a mutually-beneficial relationship. The normal flora utilizes the supply of nutrients provided by the host, a stable environment, a constant temperature, as well as protection and transport. The host may obtain from the micro-organisms some nutritional benefit, some stimulation of the development of the lymphatic tissues, but the most important general benefit is that colonization by the well-adapted normal flora can exclude other harmful micro-organisms from colonizing the host.
Aktiv-K12 Probiotics - BLIS

The top two circular areas of the photo show the inhibition of bacterial growth coming from BLIS producing bacteria.

As an example of the strength of these “good guy” bacteria, the photo at the right shows the following:

The top two circular areas of the photo show the inhibition of bacterial growth coming from BLIS producing bacteria, versus the five smaller circular inhibition areas on the bottom of the plate, using the same, but “non BLIS producing” bacteria.

Studies show a direct link between low levels of Streptococcus salivarius in the mouth throat and tonsils and the development of halitosis. This is because in-vitro testing has shown that Streptococcus salivarius K12 inhibits the key pathogens responsible for halitosis. Moreover, in-vitro testing has also shown that Streptococcus salivarius K12 inhibits the key pathogens responsible for ear infections and tonsillitis and clinical trials are underway in these indications.

These trials have shown that for the majority of sufferers of chronic bad breath tested, use of the TheraBreath Aktiv-K12 System resulted in a significant improvement in breath scores. The 13 subjects in one trial averaged pre-treatment breath readings which placed many of them in the range of bad breath odor being noticeable several feet away. Following use of TheraBreath Aktiv-K12, a week later 11 of the 13 recorded Halimeter scored below the range associated with bad breath even when tested first thing in the morning before any oral care. Eight of these 11 maintained good breath levels when tested first thing in the morning a further week later. The results of this trial were presented at the TheraBreath sponsored International Conference for Breath Odour in London, on 22 April 2004.

The following readings represent an additional study, showing the significant drop in VSC readings following the use of TheraBreath Aktiv-K12.

Aktiv-K12 Probiotics - VCS Readings

(The VSC levels of eight subjects were significantly lower when tested at one and two weeks after commencing treatment. Average results are presented in the following table)

Some of my dental colleagues are finally getting around to acknowledging the significance of the tongue in the production of breath odor. However, simply brushing, scraping, or cleaning the tongue is NOT enough. Here’s the proof:

A control group of three subjects were also monitored using ONLY tongue cleaning and chlorhexidine (an oral antibiotic rinse not available in the US), and showed no improvement in VSC levels at the seven-day point versus pre-treatment VSC levels. In other words, just cleaning your tongue and using strong-tasting mouthwash will not work.

Other measures in the trial such as organoleptic scoring of incubated saliva (smell test), reduction of protein activity and changes in the bacterial profiles and cultural analysis of the oral microflora also generally correlated with the observed reduction in VSC levels. In other words, the study proved that this was a long-term benefit to oral health.

The Safety of S. Salivarius K12

Streptococcus salivarius is a naturally occurring bacterium, a predominant inhabitant of the back of the tongue and the throat area of humans. S. salivarius becomes established in the human oral cavity within two days after birth. The levels of S. salivarius in swab samples taken from newborn infants represent 10% of the total streptococci isolated, increasing to 25-30 % by one month of age. However, only 2% of the population harbors S. salivarius strains that produce BOTH Salivaricin A and Salivaricin B. Fortunately, The California Breath Clinics are now able to provide to nearly everyone, a reproducible method allowing colonization of these “good bugs” onto the tongue and in the oral cavity, so that bad breath can be controlled for much longer periods of time.

In spite of Streptococcus salivarius being one of the predominant organisms in the oral cavity of humans, a search of the literature on this bacterial species found few references linking it to any disease. The only cases that were reported were those that were specifically related to cases involved with infection following surgical intervention with poor hygiene control, major tissue trauma or were opportunistic infections in immune-compromised individuals. Where antibiotic therapy was instituted treatment was successful. No deaths or significant long term illnesses have been reported to result from any case of infection from S. salivarius. Furthermore, S. salivarius has no reported virulence factors that have been described for pathogenic streptococci. A review of the literature in respect of toxicity, carcinogenicity, reproductive and embryo fetal toxicity raised no issues of safety.

One major reason for its history of safety is that Streptococcus salivarius is closely related to Streptococcus thermophilus, the safe bacteria widely used in yogurt and cheese manufacturing.

The idea that Streptococcus salivarius strains may provide some protection against pathogenic bacteria was reviewed by Tagg and Dierksen (2003) and has also been the subject of earlier reports from other groups Huskins and Kaplan (1989); Sanders and Sanders (1982), and Fantinato, Jorge, Schimuzu (1999). 15 In a very recent study to compare the bacterial populations on the dorsal surface of the tongue in healthy subjects and people with halitosis, Streptococcus salivarius was found to be the predominant species in healthy subjects, but was typically at low levels or absent in those subjects suffering from halitosis (Kazor et al, 2003). In fact, sales of BLIS K12 began in New Zealand in May 2002. To date over 50,000 courses have been sold with no adverse reports related to the use of the active organism.

Additional Safety Studies:

* Streptococcus salivarius is an indigenous organism of the oral cavity in humans. It is found in the highest amounts on the dorsal surface of the tongue and the pharynx (throat).
* Streptococcus salivarius was tested for mutagenicity in the Ames test and all test results were negative.
* Streptococcus salivarius K12 was originally isolated from a healthy individual who showed high relative resistance to infection by undesirable oral bacteria.
* Testing of Streptococcus salivarius K12 has been carried out which showed that theorganism is susceptible to most commonly used antibiotics for upper respiratory conditions, and carries no known virulence factors.
* In colonisation trials with the product containing Streptococcus salivarius K12, no adverse effects were reported.
* Since May of 2002, post-marketing surveillance following sales of over 70,000 courses of the active ingredient in Aktiv-K12, has only led to one report of infection which proved not to be Streptococcus salivarius.
* Streptococcus salivarius is listed in the USA as an organism considered to pose no threat to health or the environment.

Overall, it may be concluded that administration of Streptococcus salivarius K12 to humans in the manner proposed is safe for everyone and is unlikely to result in adverse effects of significance.

The Ingredients of Aktiv-K12 ProBiotics

* More than 100 Million Cells of Beneficial Bacteria, Streptococcus Salivarius K12
* Trehalose
* Maltodextrin
* Natural Peppermint Flavor

by: Drs. G. Acikgoz, I. Devrim, M. Aldikacti, A. Kayipmaz, G. Keles - Professors of Periodontology at The Ondokuz Mayis University Dental School, Department of Periodontology - Samsun, Turkey

This independent study was presented abt the 4th International Symposium on Oral Malodor, held at The University of California, Los Angeles (UCLA) in August of 1999.

There are several etiological roles which play a role in the ethiopathogenesis of bad breath. However, the major role is the bacterial production of hydrogen sulphide. These anaerobic bacteria live in areas where oxygen cannot reach them, including the back of the throat and tongue, interproximal areas of the teeth, periodontal pockets and enlarged tonsilla. A benefit to those who suffer with bad breath would be the use of an oxygenating agent which would eliminate the hydrogen sulphide and the anaerobic bacteria.

Twenty-five subjects suffering with bad breath were treated with TheraBreath brand stabilized chlorine dioxide mouthwash, toothgel, and spray. Their progress was monitored by using 3 scientifically reproducible methods:

Flame Gas Chromatography, used to measure the production of Volatile Sulphur Compounds in laboratories.

The Interscan Halimeter, which is used by some dentists to monitor the production of sulphides in their dental offices.

Periotron 8000, which measures the concentration of anaerobic bacteria and sulphides in collected saliva.

Results showed the following:

The Flame Gas Chromatography readings of Volatile Sulphur Compounds decreased significantly following use of the products.

A statistically significant decrease in Halimeter readings, showing that the oxygenating effect of TheraBreath reduced volatile sulfur compounds.

Readings on the Periotron 8000 with regards to patient’s saliva showed that TheraBreath had a beneficial effect.

Notes: This study was translated from Turkish so that it could be presented at the 4th International Symposium on Oral Malodor, August 20-21, 1999 at the University of California at Los Angeles.

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The following independent study was performed over several weeks at the office of Fred Heller DDS, San Francisco, CA on patients who had bad breath and were then instructed on the use of TheraBreath products.

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Reduction of Oral Malodour by a Chlorine Dioxide Containing Mouthrinse; Likely mechanisms of Action in Vivo
H. Chang, J. Greenman, R. Allaker, and E. Lynch

Department of of Conservative Dentistry, Saint Bartholomew’s and the Royal London School of Medicine and Dentistry, QMW, University of London and the University of West England, Bristol, UK

The change in volatile sulfur compounds (VSC) levels intraorally as recorded by a Halimeter was studied as a potential method to investigate the mode of action and efficacy of a chlorine dioxide (ClO2) mouthwash used as an anti-halitosis agent. The Halimeter was used to monitor the levels of H2S (hydrogen sulfide) every 2 minutes following a 0.1% (w/v) cysteine mouthrinse, which was held in the mouth for one minute prior to expectoration.

The results from an initial study with three participants showed that the VSC response reached a maximum recorded level at either 4 or 6 minutes and returned to around baseline levels after approximately 30 to 40 minutes.

Furthermore, a second cysteine mouthrinse applied within 1 to 2 hours following the first rinse gave a trend towards a larger H2S response, indicating inducibility of VSC production. This experiment involved application of a control rinse (water) on day 1 and a chlorine dioxide rinse (test) on day 2, 75 minutes following a first recorded cysteine-H2S response and one hour prior to a second recorded cysteine-H2S response, on 20 participants.

The results showed that the second cysteine-H2S response was significantly reduced (43% reduction; p< 0.05) following the chlorine dioxide rinse test agent, compared to the water control. These results indicate that the mechanism of action of the chlorine dioxide reduction of VSC production is unlikely to be primarily mediated by oxidation of substrate or VSC product.

Microbiological sampling of the tongue flora following cysteine, water, and chlorine dioxide mouthrinses shoed no significant differences in the recovery of aerobic, facultative anaerobic, or strict anaerobic tongue species, suggesting that one of the main mechanisms of action of chlorine dioxide may be irreversible inhibition of the major cysteine to H2S enzyme, cysteine desulfhydrase.