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  • Dr. Mercola

Bad Breath: Why It Happens

Most xerostomia is related to medication. More than 400 drugs can affect the salivary glands. These include drugs for urinary incontinence, allergies, high blood pressure, depression, diarrhea and Parkinson's disease. Also, some over-the-counter medications often cause dry mouth. Tobacco, alcohol, drinks with caffeine, snoring and breathing with your mouth open can aggravate dry mouth.

There are ways to improve saliva flow. You can also sip water regularly, try over-the-counter saliva substitutes, avoid breathing through your mouth, and use a humidifier in your bedroom.

If you have dry mouth, you have to pay greater attention to your teeth. Brush your teeth with an extra-soft toothbrush after every meal and at bedtime. If brushing hurts, soften the bristles in warm water. Floss your teeth gently every day.

The bothersome combination of dry mouth and bad breath, also known as xerostomia, can be chalked up as yet another common problem caused by prescription drug use.

Although the article above states there are some 400 medicines that can affect your salivary glands, a study from 2000 found that more than 600 medications have the potential to reduce saliva production and lead to increased tooth decay. Whatever the real number is, it’s clear that there are an awful lot of them that can cause this side effect.

Xerostomia is not to be confused with halitosis, or bad breath, which is typically caused by systemic diseases, gastrointestinal and/or upper respiratory tract disorders, and microbial metabolism from your tongue, saliva or dental plaque.

Common Causes of Dry Mouth and Bad Breath (Xerostomia)

First of all, it’s important to realize that xerostomia is NOT a disease in and of itself. Rather it is a common side effect of prescription- and OTC drugs. It can also be a symptom caused by certain physical disorders and diseases that target your salivary glands and/or tear ducts, some of which are mentioned below.

Specific types of medications that are known to affect your salivary glands include drugs for:

  • Urinary Incontinence

  • Allergies

  • High blood pressure

  • Depression

  • Diarrhea

  • Parkinson’s disease

  • Analgesics

  • Tranquilizers

  • Diuretics

  • Antihistamines

Cancer treatments such as chemotherapy and radiation also tend to cause dry mouth.

Other Non-Drug Causes

  • Nerve damage in your head or neck that affect your salivary glands

  • Sjogren’s syndrome (an autoimmune disease, causes xerostomia and dry eyes)

  • Endocrine disorders

  • Alzheimer’s disease

  • Stroke

  • Anxiety disorders and depression

Interestingly, xerostomia can also be a sign of nutritional deficiencies (some drugs are also known to cause a variety of nutritional deficiencies).

Naturally, if you already suffer with dry mouth and/or bad breath, you can certainly make it worse for yourself by smoking, drinking alcohol, using alcohol-containing mouthwashes, and drinking caffeine. All of these behaviors will exacerbate your problem, so avoid them as much as possible.

Snoring, and constantly breathing through your mouth instead of your nose can also cause your mouth to dry out further. If you’re a “mouth-breather,” pay conscious attention to how you breathe, and train yourself to breathe through your nose. Quitting snoring, however, can be trickier, since it’s happening while you’re asleep.

Why You Should Be Concerned About Dry Mouth

Dry mouth may seem like a trivial concern to many, especially if you’ve never experienced it. But aside from just being bothersome, the most hazardous consequence of dry mouth is the increase of tooth decay, which can impact your overall health if it goes too far. (Naturally, it will also affect your pocketbook, as the cost of dental services keep rising.)

Saliva serves several functions, one of which is to protect and help repair your teeth from the constant assaults mounted by bacteria and your diet. Without sufficient amounts of saliva, your teeth are in large part left unprotected.

To illustrate just how hazardous some drugs can be for your dental health, a previous study, using rats, showed that clonidine (Catapres) – a high blood pressure medication that has also become popular in treating attention deficit hyperactivity disorder (ADHD) in children – resulted in 84 percent more cavities.

Xerostomia can also lead to thrush (oral candidiasis), a yeast infection of the mouth or throat, and can also have a negative impact on quality of life by affecting your:

  • Dietary habits

  • Nutritional status

  • Speech

  • Taste

  • Tolerance to dental prosthesis

What Can You Do?

First of all, if you suspect a drug may be the main culprit, see your doctor about adjusting your medication. You’ll also want to pay particular attention to your dental health, both at home, on a daily basis, and by seeing your dentist for regular cleanings.

I would not advise using fluoride to reduce your risk of cavities, however. Fluoride is not an effective anti-cavity strategy, and comes with a number of serious health risks.

Brushing your teeth with a 50/50 mixture of unprocessed natural salt, such as Himalayan salt and baking soda tends to have a very healing effect on gums, and makes your teeth feel wonderfully clean.

Using a waterpik device is also helpful to keep your gums healthy.

There are also palliative treatments you can use for dry mouth, but keep in mind they will not treat the underlying cause of your problem. These include:

  • Blending your food or preparing moist dishes that are easier to swallow

  • Sipping water as needed

  • Using a salivary substitute (typically a preparation of water and glycerin)

Maintaining good oral health is very important if you suffer from dry mouth, but keep in mind that brushing your teeth too hard and for longer than is necessary may cause more harm than good, as too vigorous a cleaning can cause damage to enamel and gums.

According to previous research, the ideal brushing time is two minutes and the ideal pressure 150 grams, which is about the weight of an orange. They found that when people brushed for longer than two minutes using pressure greater than 150 grams, no additional plaque was removed, so there’s simply no need to brush longer or harder than that.

If you are uncertain about the proper way to brush your teeth, or need advice on the correct size, shape and consistency of your toothbrush, talk to your dentist or dental hygienist.

Eating for Optimal Dental Health

Lastly, don’t underestimate the power of your diet to ameliorate the symptoms of dry mouth by improving your overall nutritional status.

For optimally healthy teeth, I strongly recommend following these dietary guidelines:

  • Find out your nutritional type, and eat accordingly. This will tell you which foods are ideal for your unique biochemistry.

  • Eat at least one-third of your food raw.

  • Avoid processed foods, sugar, refined flour and all artificial flavorings, colorings, and artificial sweeteners. Instead, seek out locally grown foods that are in-season.

  • Enjoy fermented foods like natto, kefir and cultured veggies.

  • Make sure you eat enough healthy fats, including those from animal sources like omega-3 fat, and reduce your intake of omega-6 from vegetable oils.

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