THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts 538-1 and 538-2

Week: 538.1 Guest: Dr. Richard Miller, DDS Topic: Bad Breath..., Part One of Two Producer/Host: Steve Girard

NEMA: All of us have it in the morning...and then we reach for the toothpaste and mouthwash, and our breath is fresh again. But for many of us, bad breath, or halitosis, is a problem that persists during much of each day. We're with Dr. Richard Miller, a dentist from Alexandria, Virginia, who has tracked down the causes of bad breath, and written a booklet aimed at helping those with the problem. Dr. Miller, what led you into this area?

MILLER: I've been a general dentist for 23 years. I've been practicing in Alexandria, VA, and we do all kinds of dental procedures in a general would ask me what to do about their bad breath. And so, at that time, there wasn't enough collected information on it to be able to really treat this problem. The old adage that bad breath comes from the stomach was entirely false, but nobody had really realized that until we started looking in the research. So, about three years ago, we ran a search through the National Medical Library, and gathered a great deal of information from other speakers and medical journals, and put together a program that really works, professionally, in eliminating people's bad breath.

NEMA: Tell me about some of the ways that this problem has been treated over the years....are there other myths of strange treatments that people have tried in the past?

MILLER: Treatment for bad breath in the past has always been to cover up an offensive odor with a stronger, yet more pleasant odor. Back in ancient Egyptian scrolls, we found in some medical literature references to this, they would cover up with aromatic herbs like blueberry or myrrh. Hippocrates was the first one, and of course everyone knows him as the Father of Modern Medicine", but he was the first one to recognize that the gums might be contributing to a problem with the breath. As the research went on, and we started looking at recorded information in the National Medical Library, we find references to this back in the mid 1800's and again the treatment has simply always been to cover up the offensive odor with something more strong, but also more pleasant. In the past three or four years, however, compounds have been developed that destroy the bad breath molecules, the sulfur compounds, if you will, as well as research to tell us how to eliminate the problem and prevent it. And now, there are a number of scientific studies going on, some have already been reported, about things that people can do at home, and things their dentist can do to try to treat these problems.

NEMA: What were some of the things people used to believe caused bad breath?

MILLER: Up until the last few years, when the research information has been gathered and put together, people thought it was sinus problems, for instance, or sore throats, or things that they ate. While it's true that garlic and onions can stay on your breath for up to 72 hours, the chronic bad breath problems that people have are really caused by oral situations. Only about 10% are caused by medical problems, like stomach problems or like sinus problems. It's a very small percent.

NEMA: Dr. Richard Miller....we'll talk with him again on our next program as we talk about steps you and your dentist can take to systematically rid yourself of bad breath. I'm Steve Girard.

Transcripts:

Week: 538.2

Guest: Dr. Richard Miller, DDS

Topic: Getting rid of bad breath, Part Two.

Host/ Producer: Steve Girard

NEMA: We're with Dr. Richard Miller, a dentist who has done extensive research into what has become a rewarding area for him...finding the causes of, and eliminating bad breath. So, what do you tell dentists that tell you, Yes, I have plenty of patients who wonder if they have a breath problem"?

MILLER: Well, the first thing that a dentist needs to be able to do is a scientific diagnosis...not everybody who complains of bad breath really has bad breath. There are a number of people who do perceive they have a problem, either from a bad taste, or because someone has turned their is a scientific diagnosis. And we now have some instruments that are available to dentists that can help them make the diagnosis. Now, once the diagnosis is made, the treatment, again scientific, is to eliminate the sulfur compounds and the bacteria that produce them. And these bacteria come from three major areas: in between the teeth....things like faulty dental fillings, places where food gets trapped. Those are all places where the bacteria will create a component of bad breath. Second place is underneath the gums...people with gum disease have up to an eight time more propensity to have bad breath than those who don't have it. And the third likely place is the tongue, and the area of the tongue that we really look at is the back one third, where it goes almost down into the throat. These are places where people really can't keep clean very well, and where coatings accumulate year after year after year, and the bacteria live amongst those coatings, and again produce those sulfur compounds.

NEMA: So, for most of your patients, the occurrence of bad breath is mostly preventable?

MILLER: There's basically two classifications of people that I see in my office. One is the person who this problem is entirely preventable for, and the care of well enough, or it has progressed beyond a certain point...and the kind of person who has anatomical variations in their tongue where these coating cannot be eliminated. Most dentists yet though are not very aware of the fact that the tongue also needs to be cleaned. And brushing the tongue is something that we instruct all our patients on, and there are also instruments on the market, very inexpensive, that can remove the top coating off the tongue by scraping it or cleaning it....you can even do that with a tablespoon.

NEMA: I have seen mentions of a stomach condition, supposedly treated by antibiotics, that can cause bad breath...true?

MILLER: At this point in time, from an anatomical standpoint, unless someone has a problem with the valves in the esophagus, or the valves in the stomach, something like hiatal hernia, esophageal reflux....those are the only places, the only situations where an odor from the stomach can rise up through the mouth. There have been a couple of papers that have talked about ulcers caused by helical bactor pilori, which has been recognized now as the cause, I believe, of gastric ulcers...and people also having a bad breath associated with that.

NEMA: So, there you have it...or maybe you don't. But don't feel afraid to talk to your dentist about what you think may be morning breath that lasts all day. Our thanks to Dr. Miller, who has written a booklet available by mail by writing to:3604 Forest Drive, Alexandria, Virginia...22302. And the proceeds from your purchase of the $ 10.45 booklet goes to the Make-a-Wish Foundation. I'm Steve Girard.