For seniors, bad breath can be a symptom

Teenagers may fret about bad breath, but older people are the ones who should worry. Not only are they more likely to develop halitosis caused by dry mouth, gum disease and other age-related problems, they also are more vulnerable to the bacteria that cause it and contributes to heart disease and other problems.

That's why, embarrassing as it may be, you should gently inform people you care about that they have bad breath. They probably can't smell the odor themselves, but they need to know in order to protect their health.

"I had a man in his late 50s come to me recently," said Craig Valentine, a Lakeland dentist and a spokesman for the Academy of General Dentistry. "His teeth, gums and tongue were healthy, but I noticed his breath smelled like acetone, or nail polish remover, so I suspected he might have diabetes. I suggested he go to the doctor and get a glucose tolerance test; he called back to thank me because now he was taking medication to keep his blood sugar under control."

Diabetes is just one of the diseases that can cause bad breath. Lung cancer, throat cancer, liver disease and infections also give the breath a distinctive odor.

The most common cause of bad breath, however, is bacteria that grow in the mouth. But killing all the bacteria is not the solution.

The mouth is a tiny ecosystem in which good bacteria (which need oxygen) battle anaerobic bacteria (which don't). Anaerobic bacteria lurk in places oxygen can't easily reach, such as between the teeth or under the gum line, and release chemicals that often have a foul smell.

Anaerobic bacteria tend to thrive beyond a toothbrush's reach. A favorite refuge is the back of the tongue, where tiny mushroom-shaped papillae trap food particles, skin cells and other sources of protein. After eating these particles, the bad bacteria produce a thick goo that provides an ideal medium in which they can multiply.

The body is not helpless against these parasites. Saliva contains immune cells and washes away both the bad bacteria and food debris that nourishes them. These defenses, however, need the assistance that comes from flossing, brushing and scraping the tongue. Mouthwash may help, at least temporarily, especially if it reaches far enough to the back of the tongue.

The ultimate goal is to tip the balance in favor of the good bacteria, said Ann Bosy, one of the founders of the Fresh Breath Clinic in Toronto. As people get older, however, the bad bacteria gain several advantages.

"Older people often develop dry mouth," said Bosy. "They no longer have enough saliva to wash away food particles and bacteria, or to absorb the volatile sulfur compounds produced by some of the bacteria. Also, the elderly sometimes can't clean their teeth as well. Their manual dexterity decreases. Their gums may have receded, and they'll have some periodontal disease, which provides another place for anaerobic bacteria to proliferate."

Research suggests that anaerobic bacteria contribute to the build-up of plaque in the arteries if they get into the bloodstream. "When people get their teeth cleaned, we probe the gums," said Bosy. "If we find bleeding points, well, it's obvious that bacteria can get into the bloodstream at those points, and that could be really injurious to a person's health."

Because so many bacteria can thrive in the mouth, preventing bad breath is an ongoing struggle. "We know of at least 500 bacteria that live in mouth," said Bosy, "but there are at least 500 more we haven't identified."

Tom Valeo is a freelancer who writes about medical and health issues. Write to him c/o Seniority, the St. Petersburg Times, P.O. Box 1121, St. Petersburg, FL 33731 or e-mail features@sptimes.com

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