Don't neglect bad breath in children

Everyone suffers from bad breath at some point in life. Persistent bad breath in children may be a symptom of a serious underlying problem. Read on to find out more.

By Dr Kavitha Ramar

Don't neglect bad breath in children


Scientifically termed halitosis, bad breath originates from bacteria. Apart from being a social problem for the sufferer, it could also indicate problems relating to the tongue, gums, stomach, lungs, liver, blood or hormones. A thorough investigation into the cause of the condition by a dental expert will help in early treatment and correction.

What causes bad breath?

In the vast majority of cases, bad breath in kids is caused by the breakdown of food particles that remain in the crevices of the mouth. This debris is turned into sulphur gases like hydrogen sulphide or methyl mercaptan by protein-eating bacteria. These gases produce a foul odour.

While food collection accounts for 90% of the cases of bad breath, coated tongue (fungal disease), sinusitis, throat infections, gastric problems, urinary problems and uncontrolled diabetes are responsible for 9% of them. In 1% of the cases, the cause of halitosis is diet or drugs.

While food accumulation in the mouth can be easily detected and corrected by simple gum cleaning treatments or restoration of the teeth, the other causes of persistent bad breath problems need to be investigated thoroughly.

Why does food accumulation occur in the mouth?

The single biggest reason is poor oral hygiene or inadequate brushing. Secondly, food can accumulate in cavities, broken teeth, broken fillings, improperly fitted crowns, braces, etc., which are breeding grounds for bacteria, leading to bad breath.

When food accumulation is left unattended for a few weeks, it builds up as plaque and later forms a hard coating over the teeth called calculus. Calculus in children can be yellow or sometimes even green in colour. It harbours all the odour-causing bacteria. It slowly infects the gums and causes bleeding gums. If it is untreated, it can infect the bones that surround the teeth, causing the teeth to lose their support structures and start wobbling.

Diet, bad breath and oral hygiene

It is normal for breath to smell of recently consumed food for a few hours. If the food is sticky, like caramel, jaggery, sugar syrup, etc., it may stick to the teeth surfaces and will not be washed away by saliva. Moreover, when food lacks the fibre needed for chewing and cleansing the mouth, food accumulation increases. Food containing simple sugars, like glucose (glucose-rich biscuits, simple carbohydrates, baked and pastry items with icing, etc.) can be easily used by bacteria to produce smelly sulphur compounds. Making sure children rinse their mouth after sugary treats is the most essential among bad breath remedies.

Children rarely complain of dental pain but will adapt to it by not chewing on the side that aches. This results in the build-up of calculus in the region that is not used, resulting in bad breath, gum disease and more decay or the spread of decay. This situation needs to be identified quickly and remedied, so that the normal chewing pattern is restored.

Another important factor in halitosis is the flow of saliva. Saliva performs many essential roles in the oral cavity. One of them is to suppress the growth and proliferation of bacteria which cause bad breath. The intensity of sulphur compounds is increased by the reduction in the flow of saliva.

Why does saliva flow reduce?

Salivary flow may be affected for many reasons, such as certain medications (e.g. anti-epilepsy drugs, ADHD drugs), salivary gland diseases (e.g. diabetes, Sjogren's Syndrome), chemotherapy, or radiotherapy.

Inhalers that contain low doses of steroids, used to treat children with wheezing or asthma, can cause bad breath too, if not used properly. Since steroids can also increase the chances of tooth decay, children using the devices should be trained to use them with a spacer and to rinse the mouth after every use.

There are several clinical conditions too that can cause changes in salivation patterns. One such condition is mouth breathing. Mouth breathing causes surface drying of the mucosa, among other things. If diagnosed and treated early, side effects of mouth breathing can be prevented.

Dry mouth, which leads to bad breath, could also be caused by some food and drugs. Over-use of medicated mouthwash could result in a build-up of fungus, again resulting in bad breath.

Treatment of bad breath

Since food accumulation in the mouth is the most common cause of halitosis, removing the causes of food accumulation will dramatically alleviate the problem. Treatment of the gums and removal of plaque are the first steps in this, followed by strict adherence to oral hygiene. A check-up once in six months can prevent recurrence.

Whatever its cause, bad breath can affect children psychologically and emotionally because of the social exclusion they face due to it. They may consequently become prone to anxiety. Also, recent studies indicate that the nitrites produced by oral bacteria cause headaches and other systemic problems.

If your child suffers from persistent bad breath, don’t ignore the problem. Escalate it immediately to a dental health professional, who will be able to identify the cause and facilitate prompt treatment and correction to avoid bad breath.


Dr. Kavitha Ramar is a Consultant Pediatric Dentist and Unit Head at Apollo White Dental, Tambaram Clinic, Chennai.