Tongue

Normal tongue

The tongue is a muscular organ located on the floor of the mouth. The healthy tongue has moist and pink mucous membrane.  There are two types of papillae that contain taste bud on the top of the tongue; filiform and fungiform. 

The function of the tongue is to assist in:
1.  Swallow
2.  Tasting
3.  Manipulate food for chewing
4.  Pronunciation
5.  Mixing food with saliva to begin digesting process by enzyme in saliva

Tongue condition:
1. Geographic tongue (Benign Migratory Glossitis) or Geographic Stomatitis (if it appears other places in the mouth)

Single or multiple lesions may occur on the top of the tongue, buccal mucosa, lip, and the floor of the mouth.  In multiple lesions, they appear in irregular forms that gradually widen, change shape and migrate over the tongue.  The degree of migration is different in each person.  It is a painless condition, characterized by a small pink to red smooth, shiny patch, slightly depressed due to the loss of filiform papillae. 

The redness is more intense near the periphery, and it borders by a color gray to a white band. When there are multiple lesions on the tongue, it resembles the map. The pattern may change rapidly and persist for months. No treatment is necessary, but palliative treatment is helpful when a patient experiences pain.

The cause of Geographic tongue is unknown but tends to run in the family. Irritation from spicy food, alcohol may increase the risk of geographic tongue.  The symptom tends to associate with allergies, emotional stress, diabetes, vitamin deficiency, eczema, celiac disease, psoriasis, and change of hormone such as during pregnancy, taking birth control and ovulation.

The lesion occurs and resolves on its course and may persist for years. While it is a harmless condition, it can cause discomfort. Evaluation of the sensitivity to toothpaste,  foods, and other products, is beneficial; avoid using toothpaste that contains tartar control.  Avoid citrus fruits, strawberries, tomatoes, pineapples, alcohol drinks and sour candies and food that contains yeast. To discover the food that you are allergic to, leave all foods mentioned above from your diets and add back one item at a time.

Some of the remedies used to suppress the symptom are:

• Use zinc lozenges (Zincum Gluconium 2x, 13.3 mg)  if you have zinc deficiency


• Take vitamin B supplement (a synthetic form - folic acid or natural form - folate), 400 mcg per day (daily allowance recommended) if you have vitamin B deficiency


• Consume food that contain water-soluble B vitamin (folate) such as are green leafy vegetables (lettuce, spinach), legumes


• Place honey on the affected area for 10-15 minutes every day


• Apply Benedryl paste to the affected area with a Q-tip.  Benedryl paste is a mixture of powder inside the capsule with water, mixed until it becomes a paste. This remedy causes a burn sensation at first and later, numb the area. The symptom seems to improve after few days.


• Rinse with diluted hydrogen peroxide 50/50 solutions


• Take Molybdenum100 mcg, 3 times a day

2. Hairy Tongue  

Hairy tongue is a benign and harmless condition with no symptom. Hairy tongue occurs on the top of the tongue.  It is a result of an imbalance between exfoliation and new epithelial growth with the color pickup from the color of food (it is normally white).  Hairy tongue may develop in people who associated with:

1. Poor oral hygiene
2. Prolong use of antibiotics (the most common cause), steroids, and birth control pills
3. Dry mouth
4. Tobacco Smoker
5. Taking Pepto-Bismol (Bismuth combine with sulfur in the saliva to become a black salt, bismuth sulfide)
6. Radiation therapy (head and neck area)
7. Antibiotics users: antibiotics change the natural balance between yeast (fungi) and bacteria, caused overgrowth of fungi.
8. Regular mouthwash users who use the solution that contains peroxide, peroxide-base, oxygenated or astringent agents, such as Witch hazel or menthol.  These mixtures contain an oxidizing agent that can kill bacteria causing imbalanced oral flora situation on the top of the tongue.

The black coating on top of the tongue persists for several days and frequently desquamates.   After removing the cause(s) or when the oral flora become balanced, the tongue returns to normal.  No treatment is necessary.

Symptom: A discoloration and hairy appearance tongue, metallic taste or altered taste in mouth, halitosis, gagging sensation in some people

Treatment:

• Remove the causes or irritants
• Use tongue scraper
• Use saliva substitutes that are available over the counter (e.g., Biotene or Oasis mouthwash)
• Maintain proper hydration through adequate fluid intake
• Add the yogurt with lactobacilli in the diet to increase the number of good bacteria

 3 Smooth tongue 

The tongue appears red and smooth due to the enlargement of the fungiform papillae. Smooth tongue caused by a nutritional disorder such as vitamin B complex (the most common one).

4. Candidiasis (Thrush) Candidiasis or Thrush is a condition caused by an overgrowth of fungus (yeast) called Candida albicans.  In normal condition; the amount of Candida and good bacteria in the mouth and digestive tracts are in proper balance.

When the immune system becomes weak from illness, chemotherapy, HIV or not fully developed as in the case of infants, the Candida will overgrow and lead to infection.

The most common cause for Candidiasis is; prolong use of medications such as antibiotics, steroid drugs that upset the microorganisms balance (bacteria and yeast) in the mouth.

The typical appearance of candidiasis is white or yellow raised patches located on:

• Top of the tongue
• Inner cheeks
• Roof of your mouth,
• Back of the throat 
• gums 

The lesion can be painful and may cause bleeding when try to remove them by scraping or brushing.

The treatment for Candidiasis is antifungal medications. Since candida infection can spread to other parts of the body, consultation with a physician for medical care is necessary.

Oral thrush is a very common infection in infants younger than six months old and older adults. It can lead to vaginal (yeast) infection and diaper rashes. 

Summary of the causes of microorganism imbalance are:

  1. Prolong use of antibiotics, steroids, birth control pills
  2. Uncontrolled diabetes
  3. Aids
  4. Cancer
  5. Dry mouth
  6. Pregnancy
  7. Dentures that do not fit properly
  8. Smoking 
  9. impaired immune system, secondary to disease (diabetes, HIV)
  10. Regular use of mouthwash that contains peroxide or other oxidizing agents

Treatment:

• Remove the causes or irritants
• Use saliva substitutes that are available over the counter (e.g., Biotene or Oasis mouthwash)
• Maintain proper hydration through adequate fluid intake
• Use antimycotic medication
• Add the yogurt with lactobacilli in the diet to increase the number of good bacteria. 
• Avoid using the tongue scraper, an attempt to scrape the white patch off can cause bleeding.

Developmental Abnormalities of Tongue
Tongue-Tie (Ankyloglossia)

In the early development of tongue, the lingual frenum extends almost to the tip and gradually recedes in time.  Occasionally, the lingual frenum fails to retreat, results in a tongue tie. In an adult, intervention by laser surgery seems to release the tongue to the standard functionality.   In a baby, surgery is not indicated unless t becomes an obstacle for feeding.

Trismus

Trismus is an inability to open the mouth in the normal range. Once it occurs, it is very difficult to treat. Prevention and early treatment are the better ways.

To locate the Orofacial Pain Specialist, go to American Academy of Orofacial Pain.

How trismus occurs:

• Trauma to the jaw muscles and nerves
• Jaw muscles spasm, provoke by injection on lower jaw (mandibular nerve)
• Muscle stress due to prolonged mouth opening
• After radiation to the head and neck 
• Displacement of a segment of the temporomandibular joint; the most common one is the articular disc

Normal Jaw Function
The jaw is a pair of bones forming the framework of the mouth and teeth. The upper jaw is called a maxilla; lower jaw is called mandible. The lower jaw connects to the skull at the temporomandibular joint (TMJ).

Several muscles and nerves around the jaw area work together to open and close the mouth. Mouth opening ranges vary from person to person. Average is 35-55 millimeters that are equal to the width of three fingers.

Surgery and radiation can injure the tissues involved with opening the mouth.

Scarring (fibrosis) can cause muscle and other fibers shorten and tighten as the tissues begin to heal from surgery. Fibrosis can build up and become apparent years after radiation; results in difficulty in opening the mouth.

When you cannot open your mouth well; you may also have other problems such as:

• Cleaning your mouth and teeth; lead to bad breath, cavities, and infections

• Chewing and swallowing; make it difficult for you to eat and drink

• Talking

• Having a breathing tube placed if you ever need general anesthesia

• Difficulty in routine dental examination and treatment

How to prevent trismus
There are 4 ways to help prevent trismus.
• Maintain good oral hygiene.
• Maintain good posture.
• Massage your jaw muscles.
• Exercise your jaw muscles.

Maintain Good Oral Hygiene
• Brush your teeth and tongue after each meal and at bedtime.
• If you have removable dentures or a dental prosthesis, take it out and clean it each time you brush your teeth. Do not sleep with removable prostheses.
• Floss your teeth once daily at bedtime.

Maintain Good Posture
Good posture means sitting and standing with your ears, shoulders, hips, knees, and ankles aligned. To maintain good posture, you need to keep your neck and shoulders strong and flexible. The exercises listed below will help improve posture. Do these exercises twice a day.

Exercises and massage the muscles
During the exercises, breathe normally, without holding your breath. If any of these exercises cause pain, numbness, or tingling, stop them right away and call your doctor. If you have had surgery, check with your doctor before you begin these exercises.

Neck Stretching
Sit or stand with your arms at your side. Hold each stretch for 30 seconds.

1. Bend your head down
2. Extend your head backward
3. Rotate your head to the right
4. Rotate your head to the left

5. Bend your left ear to your left shoulder
6. Bend your right ear to your right shoulder

Chin Tuck
Sit or stand with your arms at your side. While looking forward tuck your chin. Pull your head back to line up your ears with your shoulders. Hold for 3 seconds, repeat slowly 10 times.

Shoulder Blade Pinch
Sit or stand with your arms at your side. Hold the chin tuck above. Pinch your shoulder blades together as tightly as possible. Hold for 3 seconds, repeat slowly 10 times.

Massage Your Jaw Muscle (Masseter Muscle)
Place your index and middle finger on your cheek bone. Run your fingers down over your Masseter muscle (located in front of your ear) ends at your bottom jaw. As you move your fingers, find points that feel tender or tight. Massage each area in a circular direction for 30 seconds.

To keep your jaw muscles relaxed, avoid clenching your jaw at all time.

Exercise Your Jaw Muscles
Use a mirror for these exercises to help you do them correctly. These movements should cause a stretching sensation but should not cause pain.


Active range of motion and stretching exercises
Position: Sit or stand with your head still during these activities.

1. Move your jaw as described, hold each position for 3 seconds and repeat 5 times:

• Open your mouth wide.
• Move your jaw to the left.
• Move your jaw to the right

2. Repeat each position once more. This time, stretch each for 30 seconds.

3. Combine these movements to move your jaw into a circle. Open and close your mouth as you rotate your jaw left to right. Make 5 circles.

4. Repeat another 5 circles in the opposite direction.

Passive stretching exercises
Place one thumb on your upper teeth in the middle of your jaw. Place the index finger of your other hand on lower front teeth at the middle of your jaw. Stretch your jaw opens by pushing your bottom jaw down with pointer finger. Hold this stretch for 30 seconds.

What to do if you develop tightness of muscle when Opening your mouth?

After above practicing If, you still notice any tightening in your jaw call your doctor right away. They can refer you to:

• Speech/Swallowing specialists and physical therapists. They can help you maintain and restore your ability to open your mouth using techniques such as exercise, stretching, and massage or using special devices to help to open your mouth.

• Rehabilitation doctors who will assess your ability to open your mouth. They may use medicine for pain or spasms or suggest other treatments. The earlier you start treatment for trismus the easier it will be to restore your jaw function.

Read more details concerning Temporo Mandibular Disorder (TMD) at the National Institute of Dental and Craniofacial Research (NIH).

TMJ or Temporo Mandibular Joint

TMJ (Temporomandibular Joint) connects the lower jaw (mandibular) to the skull at the temporal bone, hence the name Temporomandibular Joint.  The function of this joint is to allow the jaw to move in different directions and make chewing food possible.

TMJ pain can cause a great deal of pain in the jaw, face, neck, and shoulder. The causes may be the effect of physical stress on the structures approximate to the joint, these structures include:

• The teeth; the variation between centric relation and centric occlusion caused by clenching and grinding of your teeth as in Bruxism
• The jaw, neck, and face muscles, e.g. muscle spasm neurosis, clenching or biting your teeth during stress or habits 
• The cartilage disk; a systemic disease that affects the cartilage such as arthritis

The cause
Temporomandibular Joint disorders (TMD) are problems of the chewing muscles and joints that connect the lower jaw to the skull. Often when jaw muscle tightens and stays tight causing the misalignment of TMJ results in pain at the joint area and sometimes extending to the ear causing ear pain.  Clenching the teeth, bad occlusion (malocclusion) contribute to tightening the muscle and cause TMJ pain or ear pain. Early diagnosis and treatment for TMJ are crucial. Find a dentist in your area who treats TMJ disorders through this site, use "state" function.

TMJ disorders can vary from being very mild to severe. A mild case may not cause any discomfort and may even go unnoticed and resolved on its own. But a severe case can be very painful.  In a chronic case, the jaw may be locked when open wide or yawning.

Symptoms of TMJ disorders may include any or all of symptoms listed below:

1. Radiating pain to the ear
2. Difficulty in chewing, biting, opening and closing of the mouth due to a limitation of jaw movements and facial muscle tensions
3. Clicking sound during opening and closing jaw due to a slipped disc at the TMJ
4. Muscle tenderness in front of the ear on the affected side
5. Headache
6. Pain at jaw joints, shoulder, or back
7. Deflecting of the lower jaw from its usual path, caused by occlusal disharmonies
8. Dizziness
9. Jaw locking when open wide caused by prolonging problem with TMJ.  The damaged disc allows a condyle (the end part of the lower jaw) to travel further than normal range and slip in front of the disc and lock in that location during jaw opening.  The dislocated condyle prevents jaw closing. Occasionally, the person can unlock the jaw back to the original position by shifting the lower jaw in a downward (to release the locked condyle) and then backward toward the back of the neck.  But it is better to let the dentist assess the problem.

Examination of TMJ problem

1. Visual exam for any premature contact during occlusion that causes the bite to shift
2. Tenderness at the front of lower third of the ear
3. Clicking sound during opening and closing of the jaw
4. X-ray of the jaw helps identify the damaged disc

Differential diagnosis of TMJ disorders:

The dentist sometimes misdiagnosed Temporomandibular Joint Disorder or TMJ disorder due to the similarity of the location of the pain.

From toothache
The offending tooth (or teeth) is sensitive to tapping. Pain seems to be localized to the front of the ear causing ear pain on the affected side. The dentist may need to take an x-ray to differentiate the cause of pain to be certain whether the cause originates from TMJ disorder or the tooth (teeth).

From sinusitis
Sinusitis may involve one or both sides of the cheek. Often, sudden changes of posture may result in pain or dizziness. Patients may have a history of allergy accompanied by a postnasal drip and loss of olfactory discernment. An x-ray may show clouding of the affected sinus.

From a migraine headache
A migraine headache is a chronic condition, and the patient has been diagnosed and aware of the condition. The most Migraine headaches case involves nausea, vomiting, intolerance to light.

From Ernest Syndrome

Click to enlarge

Ernest Syndrome arises when Stylomandibular ligament becomes inflamed due to trauma, injuries to the head, excessive movement of the jaw, excessive yawning, wisdom tooth surgery or general anesthesia. Ernest syndrome can be unilateral or bilateral.

Stylomandibular ligament originated from a styloid process (a bony protuberance attached to the temporal bone) and attached at the posterior medial border of the mandibular (lower jaw).

Symptoms:

1. The pain of the Stylomandibular ligament has a referral pattern, commonly described as Orofacial pain.  In the early stage; the pain begins from feeling tenderness below the ear to the angle of the jaw (gonial angle). In the later stages, pain may radiate to the ear, cheekbone (zygomatic arch), TMJ, temporal, lower posterior teeth, eye, throat, and other facial areas. 
2. In some cases, Stylomandibular ligament restraint causes posterior displacement of the lower jaw, results in clicking and locking jaw during jaw opening and closing
3. Restricts jaw movements and impairs normal functionality of the jaw

Diagnosis

• Patient has a history of injuries in the head and neck areas, trauma to the head, recent surgeries or wisdom tooth removed


• By pressing the posterior medial border of the gonial angle with a small blunt instrument and the patient experiences intense pain.  The pain often refers to one or more sites; such as ear, cheekbone, TMJ, temporal, lower posterior teeth, eye, throat, and other facial areas. 
  
  Gonial angle located 10-15 mm from the inside of the angle of the jaw.


• Testing the Stylomandibular ligament with local anesthesia is the best method to differentiate Ernest syndrome from other similar pain originated by other sources in the same areas.
  
  The dentist uses a blunt, small head tool to locate and mark the attachment of the Stylomandibular ligament.  Then, he inserts a 30-gauge needle with plain 1/2 cc local anesthesia (i.e. 3% carbacaine)  10-15 mm depth at the location marked by the blunt head tool.  The dentist aspires the needle before slowly injects anesthesia solution. 
  
  If the pain stops, the source of pain is likely from the Stylomandibular ligament.  If the pain reduces, the area is re-evaluated after 10 minutes. If only partial pain reduction is experienced, a second injection may be needed.  But if complete remission occurs, a diagnosis of Ernest syndrome is suspected. Often during injection, the patient feels the pain is being referred to one or more referral sites.
  
  Prior to injection, the patient should be worn, the possibility of anesthesia to the facial nerve.

Treatment for TMJ

• Practice muscle exercise
• Massage the muscles
• Avoid hard to chew or crunchy foods, eat soft food like soup
• Learn to relax, stress can tighten the muscle
• No chewing gums
• Avoid opening your mouth very wide
• Use a mouth guard for teeth grinding at night; stop using if the appliance causes pain
• May use over-the-counter non-steroidal anti-inflammatory drugs: Ibuprofen (Advil, Motrin), Acetaminophen (Tylenol), Naproxen (Aleve, Naprosyn) 

At the early stage of TMJ problem- the pain starts from the jaw or a tooth, radiates to the ear, you may hear the clicking sounds of jaw opening and closing, with or without pain.

If the problem arises from clenching and grinding of teeth, teeth damaged may occur. If the damage occurs to a canine (cuspid) tooth, you will lose the ability to guide posterior teeth to the proper position in accordance to upper and lower teeth while chewing.  Without this important guidance, the chewing pattern changes, and this change can affect the TMJ; causing the clicking sound.

The dentist can restore the canine guidance.  But the patient needs to wear a night guard to prevent the re-occurrence of TMJ problem.

Various TMJ or Temporo-Mandibular Joint home remedies can be used for temporary relieve of pain. Dentist often recommends night guard (mouth guard) for a patient who grinds their teeth at night.  The night guard helps protect the teeth from cracking and protect the Temporo Mandibular Joint from stress.

Exercise for the muscles

See also Trismus

1. Stretching the muscle: this can be done by slowly opening your mouth as wide as you comfortably can and then slowly closing. Next, slowly open while shifting your jaw to the left as wide as you comfortably can, then slowly close to normal position. Next, slowly open while moving your jaw to the right as wide as you comfortably can, and then slowly close to normal position.

Place the hot moist towels on each side of your face while doing these exercises to improve circulation. Change the towels when they become cold. You can continue to re-heat the towels and repeat the exercise until your muscles feel better.

The hot moist towels can be accomplished by putting the wet towels in the microwave oven, or soak them in hot water.

Repeat these movements until your muscles feel better before moving on to (2). These stretching exercises can be done while driving, watching TV, shopping, and during other activities.

2. Repeat the same movement as in (1) but this time use your hand to push gently a little further in all directions in the first exercises.  Do not apply too much force. If the activities cause a lot of pain, stop the exercise.

3. The yawn-sigh exercise relaxes throat, jaw, face muscles. Practice this exercise after your mouth can open wide without pain.  Take a deep yawn while opening your mouth as wide as possible. Slowly exhale and relax all of your muscles completely. Perform this exercise several times during the day.

Massage the Muscles

In addition to muscle exercise, massaging the muscles around the joint will also help them relax.  The areas to message are:

1. In front of the ears

2. The back and bottom of your jaw

3. Temple area

4. Along your neck

5. Massage muscles from inside your mouth:

Press your finger inside your mouth where the cheekbone is.  You’ll find tender areas. Just press or gently massage for several seconds until you feel improvement as your muscles begin to relax.

If you don't think you can do it yourself, find an acupuncture or acupressure therapist or a massage therapist who familiars with TMJ to help you.

6. Lastly, use your finger to find any other tender spots that typically present in tense muscles. Gently massage these areas.  After massaging the muscles few times, the muscles will begin to relax. Now you may increase pressure to massage the deeper muscles.  Perform the massage 2-3 times a day.  Each time adds a little more weight without causing too much pain.

Be cautious about any nonreversible treatment, such as reconstructive surgery, joint replacement, or orthodontics, that permanently alter the occlusion.  Studies shown that the result is often worse than prior to surgery.

Bad Breath - Halitosis

Halitosis or bad breath is an unpleasant, distinctive, or offensive breath odor, usually created by a group of anaerobic sulfur-producing bacteria. According to Academy of General Dentistry; more than 80 million people suffer from chronic halitosis.  The odor can either come from an oral source or some disorders from other organs that will produce specific, characteristic odors to the breath.

Halitosis is estimated to be the most frequent reason to visit a dental office, following tooth pain, tooth decay, and gum disease.  For healthy individuals, temporary malodor may arise from consuming certain foods that are natural odor-producing such as garlic, onion; normal salivary flow will eventually eliminate the odor. Individual who has dry mouth, lack of saliva may cause a long-term halitosis. Saliva helps wash food particles and bacteria away from the mouth.  While sleeping at night, saliva glands slow down the production of saliva, allowing more bacteria to grow inside the mouth and on top of the tongue, creating bad breath in the morning.

Halitosis is a symptom of an underlying tissue, not a disease itself. Therefore;  any attempts to address the bad breath requires identifying the underlined issues that originated bad breath.  Those issues are sometimes but not always a dental origin. Halitosis patients should consult a dentist and a physician for proper evaluation of the symptom.

The research found volatile sulfur compounds (hydrogen sulfide, dimethyl sulfide, methyl mercaptan) which are generated by anaerobic bacteria are a principal malodor in chronic halitosis. The device to measure volatile sulfur compounds in a clinical setting is the Halimeter®.

Contributing factors of halitosis are:

1. Oral or dental disease - tooth decay, gum disease, odontogenic infection and mucous membrane disorders, dry mouth (Xerostomia). Food impacted inside infected gums and becomes fermented by bacteria and generates foul odor.  

2. Poor oral hygiene or improper practice of oral hygiene. Proper brushing should include: the cheeks, palate, and tongue; flossing, and use of a tongue scraper after each meal helps remove bacteria, plaque, and food particles.

3. Dentures can harbor bacteria; bacteria consume foods that trap underneath the denture and produce volatile sulfur compounds that cause bad breath.  It is important to clean the dentures using a toothbrush thoroughly after each meal, which include removing and replacing denture adhesive. Every night soaks the dentures in a denture cleaning solution for at least 30 minutes to an hour.

Some common home-made cleaning solutions for dentures that don't have metal parts are:

• 10% Clorox bleaching agent (1 part of Clorox to 10 parts of water)
• 50% vinegar (equal part of vinegar and water)
• Mixture of baking soda (1 teaspoon of baking soda to 8 ounces of water)

if you have a soft liner underneath the dentures, ask your dentist for the best cleaning solution that is suitable for the soft liner.

4. Tonsilitis, tonsil stones

5. Upper respiratory tract infection or inflammation (sinusitis,  rhinitis). The common one is a sinus infection, the drainage of infection to the back of the throat yields foul odor when exhale.

6. Lower respiratory disease (emphysema, lung disease, bronchitis)

7. Digestive tract disease (gastroesophageal reflux disease - GERD, dyspepsia, peptic ulcer, Crohn's disease, ulcerative colitis).

GERD is a condition caused by an inadequate seal between esophagus and stomach due to the loose sphincter, causing food and digestive acid to regurgitate to the mouth. Foods that may change the integrity of the sphincter are spicy foods, sour food, alcohol, and coffee.  Some people may be affected by different types of food other than what mention here.  If you suspect that you have halitosis, you should keep tract of foods you eat, ask close friends or relative about letting you know if they smell bad breath right after you finish eating a particular food.

In the Journal of Medical Microbiology, a report found H.pyroli indirectly causes halitosis to some people, and the association of H.pyroli to gum disease, dyspepsia, acid reflux, peptic ulcer, and cancers.  Therefore; eradication of H.pyroli will resolve the bad breath problem and other serious condition as well.

8. Tobacco and alcohol users

9. Foods, e.g., garlic, onion, coffee, tea can be detected on an individual's breath for up to 2-3 days after consuming.  Halitosis caused by foods will resolve on its own after the foods being digested and being completely absorbed or excreted.

10. In low carbs diet, carbohydrates are not available as a source of energy.  The body uses fats and proteins as its source of energy.  As the body burns fat and proteins, releasing by-products that cause halitosis.

11. Low acid stomach, low enzymes; food cannot digest properly, leads to food fermentation inside the digestive tract, and foul odor occurs.

12. Liver and gall bladder stones; limit amount of bile to the stomach, caused improper digestion, leads to food fermentation

13. Constipation is an indirect cause of halitosis.  Food remains in the colon for a long period can cause fermentation, and create halitosis

14. In diabetic patients, the body uses fat instead of sugars as a fuel source because the body has no insulin or not enough insulin.  By-products of broken down the fat called ketones that generate a fruity odor to the breath.

15. Prolong vomiting: Breath smells like feces, especially when there is a bowel obstruction. It may also occur temporarily if a person has a tube (nasogastric tube) placed through the nose or mouth into the stomach to drain the stomach contents in place.

16. In individuals with chronic kidney failure; the breath may have an ammonia-like odor (also described as urine-like or "fishy")

Some Remedies for bad breath

1. Cavities
Remedy: Have the cavities filled. Brush with sea salt powder or sodium perborate three times a day. Floss after each meal.

2. Gum disease
Remedy: Have deep cleaning, rinse your mouth with Chlorhexidine or Hydrogen peroxide

3. Acidic body
Remedy:

• Take 1/2 teaspoon of baking soda plus 1/2 teaspoon of citric acid twice a day. 
• Have plenty of sleep for the body to restore the bicarbonate levels

4. Low stomach acid
Remedy:

• Add 1/4 teaspoon of sea salt per liter of drinking water
• Take betaine HCl to restore the stomach acids
  Caution: Must test for low stomach acid by the physician before taking betaineHCL.

5. Constipation
Remedy: Eat more high fiber foods. Avoid milk, sugar, all white flour snack or food, vegetable oils, margarine, and canola oils, instead use coconut oil, eat millet, whole wheat.

6. Improper blood sugar level or high blood sugar.
Remedy:

• Take 9 mg. of the biotin per day plus one teaspoon of granulated lecithin to help the body get rid of excess fats and reduce the blood sugar. 
• Or take Vitamin D3 or D4
  Avoid all vegetable oils, fried foods, soft drinks, starchy foods, and replace with coconut oil

7. Eating late at night
The digestive system doesn't work well during the late evening.  Stop eating late at night.

8. An imbalance of bacteria in the mouth
Remedy: a natural tree resin called mastic gum, has been shown to help improve to a healthy mouth environment by reducing acidity and promoting microbial homeostasis

9. Use tongue scraper to clean the top of your tongue every morning

10.  Use BreathRx Anti-Bacterial Mouth Rinse (33oz Bottle)
Ingredients of BreathRx:

• Active; Cetylpyridinium Chloride
• Inactive;
  
  • Citric Acid
  • Cocamidopropyl Betaine
  • FD&C Blue 1 
  • Hydrogenated Starch Hydrolysate
  • Mint Flavor, PEG-40
  • Hydrogenated Castor Oil
  • Poloxamer 407
  • Propylene Glycol
  • Sodium Saccharin
  • Sorbitol, water
  • Xylitol
  • Zinc Gluconate)

11. Use Dr. Katz TheraBreath Oral Rinse and Dr. Katz TheraBreath Oxygenating Toothpaste

12. Gum disease (periodontal disease, gingivitis) is the most common cause of bad breath.

Remedy:  Use probiotic.

• Have your teeth cleaned at the dental office and maintain it with water pik. 
• Rinse with probiotic mixture before bedtime or apply probiotic paste around the gum
  
  To make the probiotic mouth rinse; Pour the content in 2 capsules of probiotic into 1/2 cup of water and mix well. Before bedtime, gargle the mixture and keep it in the mouth for at least 5 minutes or more before emptying.  Do not rinse the mouth afterward.
   
• For bleeding gums; make the probiotic paste by mixing the content in 2 capsules of the probiotic with water until it becomes a thick paste.  Use Q-tip or finger to apply to the area between the tooth and gums that bleed. 

13.  Abscess;  bad breath can come from a collection of pus.
Remedy: have the root canal done on the tooth or have the tooth extracted.

14. Impacted wisdom teeth; food trap underneath the gum tissue can cause bad breath.  Have wisdom teeth removed.

15. Tobacco users need to stop smoking

16. Spicy foods - stop eating food that left unpleasant odor in the mouth such as garlic and other spices

17. Acid reflux
Remedy: Use prescription drugs such as Prilosec or Prevacid

18. Systemic disease - consult your physician if you have a lung infection, sinusitis and throat infection, bowel obstruction and Other systemic diseases include acute renal failure, esophageal cancer, gastric carcinoma, atrophic rhinitis.

Temporary removing bad breath:

1. Hydrogen peroxide mouthwash can be used to remove the halitosis in many people.

Instruction for mixing Hydrogen Peroxide Mouthwash:

a. Mix equal parts of 3% Hydrogen peroxide and water and gargled for about 2-3 minutes to kill bacteria and have a fresh breath.  Rinse and gargle with water thoroughly afterward.

b. If the problem continues, repeat (a) once a week or maybe once a month.

c. If bad breath accompanied by body odor:

• Add probiotics to the regimen.  Bad breath comes from bad bacteria in the gut. Adding good bacteria into the gut improves Halitosis condition
• Take Dolomite tablet. Dolomite is a naturally occurring mineral (Calcium Magnesium Carbonate) in chlorophyll.  Dr. Pierre Delbet, M.D discovered how to remove body odor by modification of the intestinal flora using Dolomite.

2. Chew on parsley, fennel and caraway seeds. 

3. Rinse and gargle with parsley and cloves mixture; add many sprigs of coarsely chopped parsley and few whole cloves in boiled water, occasionally stir, let cool and strain the water for mouthwash.

Oil Pulling

Oil pulling is an ancient Ayurvedic technique for detoxing that had been re-discovered by Dr. F. Karach, M.D.  He presented a paper before the All-Ukrainian Association. The attendants include the oncologists and bacteriologists from the Academy of Science of the USSR. Dr. Karach explained an unusual simple healing process using cold-pressed oils.

The appealing factor of this healing method is its simplicity. It consists of swishing cold pressed oil such as sesame oil and sunflower seed oil in the mouth. The healing process is accomplished by the human organism on its own.  The body itself gets rid of the toxic waste without disturbing the healthy microflora.  Dr. Karach suggested organic, cold pressed sunflower oil or sesame oil which were the oil prescribed in Ayurveda texts for oil pulling. Some people use other oils such as organic cold press olive oil or coconut oil with some success.

Oil pulling if practice daily, may help relieve tooth pain, bad breath and stop gum bleeding due to gum disease.  In some cases, it will help whiten the teeth.

It is critical to practice oil pulling three times a day before meals on an empty stomach.  Daily practice can heal acute diseases in two to four days.  In chronic illness, the healing time may be up to one year or more depending on the condition of ailment, age, habits, state of general health of the person.

Method:

1. In the morning before breakfast after brushing teeth, use a tongue scraper to remove the coating from your tongue, put one tablespoon of Sunflower or Sesame Oil in the mouth but do not swallow it. Switch the oil back and forth between all of your teeth and sides to sides across your gums. Let the oil hit the cheeks and soft palate everywhere over and over for 20 minutes. This practice is essential for the oil pulling to work. If swishing less than 20 minutes, it may not work. If swishing longer than 20 minutes, you run the risk of reabsorbing the bacteria and toxins back into your body.

Use organic, unrefined, cold pressed oil Sunflower or Sesame Oil as the first choice.

This process makes oil thoroughly mixed with saliva. Do not swallow the oil. In the end, oil should turn from clear and thick to a thin, white and milky consistency. If the oil is still yellow after spit out, re-do the process with new oil.

2. Rinse, gargle, and wash out the oil. Brush teeth and use tongue scraper thoroughly.

3. Drink plenty of water.

Stomach considered empty in this status:

1. In the morning before drinking or eating, 
2. One hour after drinking liquids like water, tea or coffee
3. Four hours after meals

What not to do:

Do not gargle or swallow the oil. Taking a little will not harm you, but repeatedly swallowing the oil after you've swished with it means you will be ingesting thing that you're trying to remove. If you swallow inadvertently, undigested oil will be excreted.

What problems arise during oil pulling?

1. Oil does not become watery as expected.  This situation caused by inadequate salivation and dry mouth.
Solution: Drink few glasses of water, take a 30-40 minutes walk and do oil pulling again.

2. The nose becomes blocked during oil pulling.
Solution: Clean and blow your nose before starting oil pulling. Slowly blow out the nose to clear while holding the oil in the mouth. Repeat if necessary while continuing with the oil pulling.

3. Sneezing or coughing while doing oil pulling.
Solution: Practice oil pulling slowly in a relaxed state. Stop as sensation to sneeze is felt. You can sneeze or cough while holding oil in the mouth.

4. Phlegm comes into the mouth, making pulling inconvenient.
Solution: Spit and do pulling with fresh oil again.

Many people report improvement or cure from these conditions:

• Mgraine headaches
• Bronchitis
• Tooth problems
• Arterio thrombosis
• Chronic blood disorders such as leukemia
• Arthritis and related illnesses
• Neuro physiological paralysis
• Eczema
• Gastro enteritis
• Peritonitis
• Heart disease
• Kidney disease
• Meningitis

Reference:

• HV Amith, Anil V Ankola, L Nagesh. Effect of Oil Pulling on Plaque and Gingivitis. Journal of Oral Health & Community Dentistry: 2007 ;1(1):Pages 12-18 http://www.johcd.org/pdf/Effect_of_Oil_Pulling_on_Plaque_and_Gingivitis....
   
• S Asokan, J Rathan, MS Muthu, PV Rathna, P Emmadi, Raghuraman, Chamundeswari. Effect of oil pulling on Streptococcus mutans count in plaque and saliva using Dentocult SM Strip mutans test: a randomized, controlled, triple-blind study. Journal of the Indian Society of Pedodontics & Preventive Dentistry. 26(1):12-7, 2008 Mar. < http://www.jisppd.com/article.asp?issn=0970-4388;year=2008;volume=26;iss... >
   
• TD Anand, C Pothiraj, RM Gopinath, et al. Effect of oil-pulling on dental caries causing bacteria. African Journal of Microbiology Research, Vol 2:3 pp 63-66, MAR 2008. < TD Anand, C Pothiraj, RM Gopinath, et al. Effect of oil-pulling on dental caries causing bacteria>