Dear Dr Garner,
I am almost ready for Christmas except for one embarrassing problem. No matter how much I brush my teeth, my breath does not smell so sweet. I notice people turning away from me when I talk. I have tried numerous remedies and am at a loss to figure this out. The problem has been there for at least a year.
Bad Breath in Buschwick

Dear Bad Breath,
I am sorry to hear about your problem.
Bad Breath is known medically as halitosis and can be the result of poor dental habits. It also can be a sign of other health problems. Certain foods may make it worse as well as other unhealthy habits.
All foods that enter you mouth, are digested and enter the blood stream and eventually get back to your lungs where you breathe it out. If you eat foods with a strong odor, such as garlic or onions, brushing and flossing and even mouthwash will merely cover it up for a while. The odor will not go away completely.
I realize that you brush your teeth frequently, but flossing is also very important. The food particles can remain in your mouth, which promotes bacterial growth between the teeth. This causes bad breath.
Smoking or chewing tobacco products can also cause bad breath.
The persistence of bad breath can be a sign serious gum disease, which is caused by buildup of plaque. Gum disease has been shown to be associated with heart disease, as the bacteria in the gums can damage the heart blood vessels as well.
Dry mouth can also causes bad breath. The saliva helps to clean and moisten the mouth. If you have dry mouth, there is not enough saliva to clean out the particles in the mouth. If you sleep with your mouth open, it will make the mouth even drier, Some medications like antihistamines also cause dry mouth.
Dentures that aren’t cleaned regularly or don’t fit properly can harbor odor-causing bacteria and food particle’s
Chronic lung infections can produce foul-smelling breath.
Cancer, and kidney and liver problems can cause bad breath that smells “fishy.”
People with poorly controlled diabetes may have a fruity odor to their breath.
People with reflux of the stomach acid may have bad breath.
Sinus infections are a frequent culprit as well.
People on a diet may develop an unpleasant odor of their breath.
In summary, bad breath may be much more than annoying. It might be a sign that there is a serious underlying medical problem. I definitely believe you need to see your doctor for a general check up as well as a dentist to determine if you have any problems with your teeth or gums. Before you go to your doctor and dentist, keep a little diary and answer the following questions:
1. When did you first begin to experience symptoms?
2. Are your symptoms occasional or continuous?
3. How often do you brush your teeth or clean your dentures.
4. Do you have any suspicions as to what is causing the bad breath?
5. Do you have allergies or sinus problems?
6. Do you snore?
7. Do you breathe through your mouth?
8. What medications do you take?
9. What kinds of food do you eat?
10. Do you floss at least once a day?

The above will help you to be a partner in addressing this problem with your doctors.
In the meantime, the following may provide you with relief, while you wait for you appointment.
1. brush your teeth after you eat. (At least 2-3minutes)
2. Floss at least once a day
3. Brush your tongue- (this helps to remove dead cells, bacteria and food debris.
4. If you use wear dentures, make sure to clean them well.
5. Drink plenty of water(it may help to dilute strong odors)
6. Chew fresh parsley or suck on a sugarless mint.
I hope this brings you some relief, but remember- it is critical that you see your doctor and dentist to make sure there is no underlying medical problem.
I do hope you have sweet breath for Christmas.

*Reprinted with permission of The Tablet