Bad Breath Caused by Disease

Although most cases of halitosis are caused by poor oral hygiene and chronic dry mouth by promoting anaerobic bacterial growth, this problem can be the result of disease affecting other parts of the body. For example, certain systemic diseases affecting multiple organs and tissues such as diabetes, rheumatoid arthritis, metabolic disorders, and hypertension, also referred to as "blood-borne" halitosis diseases, can induce non-oral bad breath.

Volatile sulfur compounds (VSCs) emerge when an amino acid called cysteine is converted to hydrogen sulfide (the primary cause of "rotten egg" odors). These malodorous sulfur compounds are released by anaerobic bacteria occurring naturally in the oral environment. Certain diseases cause the bacteria and VSCs to proliferate.

Metabolic Disorders

When an enzyme deficiency exists within the body, metabolic processes are disrupted, resulting in extreme chemical imbalances that produce unusual and sometimes dangerous symptoms. A genetic disease called trimethylaminuria (TMAU), or "fish odor syndrome" is a metabolic disorder causing breath, saliva, sweat, and urine to smell like rotting fish. Reduced levels of a specific enzyme needed to break down trimethylamine in the body allows high amounts of this chemical to remain in the blood, where it is eventually forced to be excreted in bodily fluids.

Trimethylamine, manufactured by intestinal bacteria, is necessary for breaking down amino acids, choline, and carnitine. All these compounds are found in egg yolks, liver, fish, and beans. This is why someone suffering from TMAU has distinctly foul breath, as well as an overall "fishy" body odor. In addition, TMAU patients are known to have elevated levels of anaerobic bacteria living in their mouths, the same bacteria responsible for non-disease related halitosis.

Currently, no cure exists for TMAU, however, people affected by this disease can reduce the severity of halitosis by:

  • Avoiding foods such as eggs, beans, liver, peas, and soy products (these foods contain rich amounts of choline and carnitine)
  • Taking antibiotics to decrease bacteria living in the stomach and intestines
  • Taking activated charcoal and copper chlorophyllin supplements to lower concentrations of urine-based trimethylamine
  • Brushing and flossing twice daily, drinking plenty of water, and visiting a dentist every six months for a complete check-up and cleaning

In addition to chemical imbalances prevalent in metabolic disorders, odorous breath is further exacerbated by dry mouth (xerostomia) and lack of sufficient amounts of saliva (which also contains oxygen molecules). When the mouth is dry, without oxygen, and impacted by the side effects of an enzyme deficiency, anaerobic bacteria capable of emitting vast amounts of VSCs overwhelm the mouth and create chronic, unremitting halitosis.

Fortunately, foul breath caused by incurable metabolic disorders such as TMAU, diabetes mellitus (which produces a decaying, fruity odor), and diabetes ketoacidosis (a high blood sugar condition that dehydrates the body and reduces saliva flow) can be effectively reduced. This is accomplished by using alcohol-free, oxygenated oral hygiene products that stimulate saliva flow and oxygen content in the mouth. Anaerobic bacteria cannot live in hydrated, oxygenated environments and will stop producing VSCs under these conditions.

Gum Disease

Gum disease is the second most common cause of halitosis and is more prevalent in people ages 35 and older. In mild cases (called gingivitis), the gums become red, swollen, and bleed easily, but there is usually very little or no discomfort. Gingivitis is often caused by inadequate oral hygiene, however, it is reversible with professional treatment and good oral home care. When gingivitis is left untreated, it can progress to more serious periodontal disease, also known as periodontitis.


Periodontitis (also called "pyorrhea"), is a serious inflammatory disease affecting the gum tissues surrounding teeth. Over time, plaque caused by bacteria calcifies and pushes down between the gums and the dental roots, causing the formation of periodontal pockets. These pockets are so deep they cannot be cleaned out without professional help. They provide an ideal place for colonies of bacteria to collect. The waste products from these bacterial colonies have such a distinctive, characteristic odor, many dentists are able to diagnose gum disease simply by smelling a patient's breath.

Tooth loss, gums that bleed after brushing, recessed gums, and severe halitosis are primary symptoms of periodontitis. Periodontis can also lead to progressive deterioration of the bone structures supporting teeth. Poor oral hygiene habits that allow bacteria to form a hard biofilm (plaque) over teeth are the main causes of periodontitis, along with the extremely aggressive response enacted by the immune system on these destructive microorganisms.

Some research studies indicate untreated periodontitis may contribute to myocardial infarction and strokes due to the increase of Interleukin-6 and C-reactive proteins in the body. These inflammatory markers can exacerbate existing conditions and may lead to strokes or heart attacks by irritating damaged vessels and enlarging blood clots.

Patients suffering from diabetes mellitus often suffer more frequently from periodontitis, especially if they have trouble regulating blood glucose levels or do not follow a prescribed treatment plan. When periodontitis is detected, immediate treatment by a dentist specializing in this disease is necessary to prevent further destruction of bone, teeth, and gums. Using TheraBreath products concurrently can help reduce the severity of bad breath caused by periodontitis decay and the rapid growth of anaerobic bacteria feeding off the infection.

Other Medical Conditions Known to Cause Halitosis

Kidney disease: When kidneys are damaged, they are unable to filter toxins from the blood and release them through urination, causing levels of toxins to increase in the bloodstream. These toxins are then forced to be excreted through sweat and saliva, which makes breath smell strongly acidic and similar to unfiltered urine.

Liver disease: The liver also filters toxins from the blood, especially lipids contained in fatty food. Blood impurities remaining in the blood due to liver disease are excreted through saliva and sweat, leading to fishy smelling breath.

Cancer: Halitosis may be a sign of lung, throat, esophageal, or tongue cancer if open lesions are present. The lesions can attract bacteria that digest dead tissue. Lung and mouth cancers are sometimes detected by a device called Cyranose, which checks the breath of the patient. Chemotherapy medicines can cause dry mouth, and subsequently bad breath.

Acid reflux (GERD, or gastrointestinal reflux disease): The acid coming up from the stomach into the esophagus and back of the throat smells rancid and is full of partially digested proteins on which anaerobic bacteria thrive.

Crohn's disease: This intestinal inflammatory disease produces ulcerations in the stomach and intestines, and is often accompanied by GERD.

Bad Breath Disease Treatment

Most name brand toothpastes and mouthwashes contain alcohol, a known drying agent, and sodium lauryl sulfate, a harsh surfactant that contributes to halitosis by providing anaerobes with food in the form of abraded tissue. TheraBreath® Oral Hygiene products do not contain alcohol or sodium lauryl sulfate. They have natural powerful ingredients that help oxygenate, hydrate, and lessen offensive tastes and odors. They are specifically designed for tackling dry mouth, pH imbalances, and the excessive activity of anaerobic bacteria. These products can help you alleviate bad breath associated with disease and prevent it from recurring.

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These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, or cure, or prevent any disease. The information contained herein is for educational purposes only. Before initiating any new oral treatment, please consult your oral care professional.

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