Bad Breath

Dr. Greene's Answer

Most kids would go out of their way to avoid eating garlic or onions, yet it is not unusual for a child to wake up with very bad breath. Throughout the day, a child’s saliva, swished by the mouth muscles, washes away unwanted debris. As soon as a child falls asleep, saliva production plummets, and bad muscles relax. The longer a child sleeps, the higher the bacterial count in the mouth rises, resulting in “morning breath.”

Common Causes of Bad Breath

In children, smelly breath that persists throughout the day is most often the result of mouth-breathing, which dries out the mouth and allows the bacteria to grow. Children who consistently breathe through their mouths might have colds, sinus infections, allergies, or enlarged tonsils or adenoids blocking the nasal passages, so a visit to the pediatrician is in order. Thumbsucking or sucking on a blanket can also dry out the mouth. Tonsillar stones, collections of food and bacteria that get stuck in the crevices of the tonsils, can also cause bad breath.

Treating Bad Breath

To improve most cases of bad breath, the goal is to decrease mouth bacteria and increase saliva. The better your daughter’s toothbrushing technique, the smaller number of bacteria will be present. Make after-meal brushing a habit. Use a timer to help her brush for at least two minutes. Be sure she brushes her tongue. You might also try a rotary electric toothbrush. I do not recommend mouthwashes or fluoride rinses in young children, since they tend to swallow them. Breath mints may mask the problem, but don’t get at the source. As your daughter gets older, sugarless sour candy or sugarless chewing gum can get the saliva flowing and get those mouth muscles moving.

The American Dental Association (ADA) also recommends flossing at least once a day and increasing fluid intake. Some studies involving adult subjects suggest that commercially available tongue scrapers/cleaners may be slightly more effective than using a toothbrush to clean the tongue  However, studies using tongue scrapers/cleaners still need to be performed in children.

If the problem persists, she should see her doctor. Bad breath in children that doesn’t respond to the above measures should be investigated.

Uncommon Causes of Bad Breath

Here is a list of some very uncommon, but telltale, odors (mostly from Mace, Goodman, Centerwall, et al: The child with an unusual odor. Clinical Pediatrics 15:57-62, 1976). Take a whiff:

• Acetone – diabetes or acetone, alcohol, phenol, or salicylate ingestion
• Ammonia – some types of urinary tract infections, or kidney failure
• Asparagus – eating asparagus (very unusual in children;>))
• Bitter almonds – cyanide poisoning
• Cat’s urine – odor of cats syndrome (beta-methyl-crotonyl-CoA-carboxylase deficiency)
• Celery – Oasthouse urine disease
• Dead fish – stale fish syndrome (trimethylamine oxidase deficiency)
• Fresh-baked bread – typhoid fever
• Foul – tonsillitis, sinusitis, gingivitis, tonsill stones, lung abscess, or dental cavities (some of these are actually quite common)
• Garlic – arsenic, phosphorus, organic phosphate insecticides, or thallium poisoning
• Horse-like (also described as mouse-like or musty) – phenylketonuria
• Rancid butter – odor of rancid butter syndrome (hypermethionemia and hypertyrosinemia)
• Raw liver – liver failure
• Sweaty socks – odor of sweaty feet syndrome (Isovalryl CoA dehydrogenase deficiency)
• Sweaty socks – odor of sweaty feet syndrome II (Green acyldehydrogenase deficiency)
• Violets – turpentine poisoning

Three-year-olds often stuff items in their noses, and then forget about them. When my son Kevin was three, he put five peas up his nose before anyone found out! Watch for the combination of smelly breath and a smelly, yellow nasal discharge — especially from one nostril. You and I might not think of stuffing peas up our noses, but three-year-olds think outside the box!

References:

J Am Dent Assoc, Effectiveness of mechanical tongue cleaning on oral levels of volatile sulfur compounds. 2001 Sept., Vol 132, No 9, 1263-1267 — Page last visited Oct. 11, 2019

Gen Dent. A Cochrane systematic review finds tongue scrapers have short-term efficacy in controlling halitosis., 2006 Sep-Oct;54(5):352-9; 360, 367-8 — Page last visited Oct. 11, 2019

Clinical Pediatrics The child with an unusual odor. A clinical resumé. 15:57-62, 1976 — Page last visited Oct. 11, 2019