When Mints Don’t Cut It

Illustration by Peter Arkle

Masking a tuna sandwich after lunch is one thing, but if your breath is duck-and-cover foul all the time, you may have halitosis, the medical term for chronic bad breath. “The first thing to do is see your dentist,” says American Dental Association spokesperson and Manhattan dentist Ada S. Cooper. In healthy adults, “the major cause may be not cleaning your teeth, tongue, and gums well enough,” says Cooper. But if you’re brushing twice a day, flossing regularly, and still breathing fire, you may have “geographic” tongue (extra patchy and bacteria-harboring) or a systemic issue—like a chronic organ condition.

“The only way to understand the problem is to look under a microscope and see if there is an excess of anaerobic bacteria in the mouth,” says Steven Fox, D.D.S., of Fox Fresh Breath in midtown. A normal mouth naturally maintains a balance of aerobic and anaerobic bacteria, the latter of which feeds off proteins in your yap, excreting a foul-smelling odor that can’t be fought with over-the-counter maskers. Of the 13,841 active, licensed dentists in the city, any of them is prepared to address bad breath, but treatments and costs will vary. Fox, who sees about 200 halitosis sufferers a year, usually arms his patients with prescription drugs and mouthwashes. Manhattan otolaryngologist Yosef P. Krespi, meanwhile, uses lasers to shave off the surface of the tonsils, another haven for smelly bacteria.

In other cases, your mouth may not be the problem at all. A dentist could root around, find nothing to treat, and send you off to see a physician who can screen for chronic diseases. Sometimes the smell is the giveaway: Ammonia-scented breath can be a sign of kidney disease; rotten-egg breath may indicate liver malfunction; and a bowel obstruction coupled with vomiting can lead to breath that smells like, well, use your imagination. Doctors will also screen for bronchitis, sinus infections, diabetes, and other ailments associated with halitosis. In short, if your breath is consistently room-clearing, ditch the Tic Tacs and pursue serious treatment.

How Bad Is Your Breath?
The Quick-Fix Face-Off

When Mints Don’t Cut It