How to Help Children's Bad Breath

My son is six years-old. He has very bad breath. I frequently brush his teeth and tongue. He also uses Listerine mouthwash. About an hour later, is breath is awful! Is this normal in children? Any other suggestions?

Question:

Bad breath (i.e. halitosis) usually originates in the oral cavity. Generally, it is due to common oral diseases such as tooth decay, gingivitis or periodontitis. Halitosis can also be caused by bacteria which emit volatile sulfur compounds (VSC). Volatile sulfur compounds form on the tongue as anaerobic bacteria break down amino acids in the presence of saliva. As in adults, oral malodor in children is related primarily to oral factors. Correlations between nasal and oral malodor suggest that postnasal drip plays a major role (Amir et al. 1999).

While brushing the tongue can be helpful, scraping the tongue with a tongue scraper seems to be more effective in reducing VSCs. Mouthrinses are only temporary solutions to the problem. Currently, there are some mouthrinses that claim to alleviate halitosis, but more research needs to be completed to substantiate these claims.

Bad breath can also be caused by sinus infections, tonsillar problems, respiratory illnesses, gastrointestinal problems, and other systemic conditions. For example, Trimethylaminuria is a metabolic disorder (i.e. liver enzyme deficiency) that can causes severe halitosis. This condition is only present in about 1% of the population. I am not aware of a relationship between permanent tooth eruption and bad breath.

Some dentists use portable sulfide monitors to diagnose halitosis. Other dentists argue that these devices are best reserved to chart a patients treatment. The best way to diagnose halitosis is by using your sense of smell.

I commend you for your oral hygiene efforts. Hopefully, you are brushing your son's teeth at least twice daily. Flossing will remove bacteria and food debris between teeth. You might also try disclosing tablets to monitor brushing effectiveness. These are the tablets you chew, swish, and spit in the sink. Any remaining plaque will be stained a reddish color. You can then go back with the toothbrush, floss, and tongue scraper and remove any remaining plaque. Finally, some studies suggest that a copolymer to a triclosan sodium fluoride rinse helps prolong antibacterial activity which, in turn, may prevent halitosis. Look for products containing this ingredient soon.

I encourage you to take your son to the dentist for a complete examination including radiographs. The exam and x-rays will determine if dental caries or gum disease is contributing to your son's bad breath. If the halitosis is not caused by an oral condition, schedule an examination with your pediatrician to eliminate any systemic causes of halitosis.

Reference:

Amir et al., "Halitosis in children" Journal of Pediatrics (1999) 134(3):338-343.

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