Dr. Jeff Holt, a pediatric dentist at Kids Dental in Plano & Carrollton, discusses a common question from parents about bad breath in children.
Bad Breath in Children – Halitosis
Bad breath, also called halitosis, in children is a common oral disease that is often the result of poor dental hygiene but can also occur due to other medical conditions, and therefore, should be professionally evaluated to determine its cause. It is not surprising that consuming particularly strong flavored foods produces bad breath, however, when your child’s breath smells bad for no such obvious reason, parents have a genuine cause for concern.
Causes of Bad Breath in Children
One of the main reasons that young children or toddlers have bad breath stems from inadequate oral hygiene. Many children, when learning how to take care of their teeth, fail to brush them properly or thoroughly.
Poorly brushed teeth can lead to:
- Food debris left in mouth
- Thriving environment for bacteria
- Tartar and plaque build-up
- Cavity formation
- Dental abscess
- Gingivitis (gum disease)
These repercussions of poorly maintained teeth involve the presence of bacteria, which can produce foul smelling breath, as well as painful dental problems when allowed to remain in the mouth.
Another primary cause of bad breath in kids is mouth breathing. Breathing through the mouth can promote:
- Growth of anaerobic bacteria (bacteria which do not require oxygen to grow)
- Reduced saliva flow
- Excessive mucus in the throat
These conditions are conducive for bacteria to thrive and produce volatile sulfur compounds (VSCs), which are unpleasant smelling gaseous compounds which smell similar to decayed meat or rotten eggs. The tongue, gum line, and throat can all harbor these bacteria to create bad breath in kids. A white, pasty tongue is characteristic of a bacterial build-up.
In toddlers, it is not uncommon for mouth breathing to be a result of a foreign object lodged in one of the nasal passages, thus leading to bad breath. If you notice your toddler suddenly has bad breath and is mouth breathing, contact your pediatrician to check for nasal passage obstruction.
Other contributors to oral bacterial growth include:
- Dry mouth (xerostomia)
- Saliva stagnation
- High protein diet (anaerobic bacteria feed on protein and sugars)
- Increased pH levels in the mouth
- High blood glucose (symptom of childhood diabetes)
- Fungal infection, such as thrush
- Post-nasal drip
- Dental infection
Medical Conditions that Contribute to Bad Breath in Children
Certain illnesses and medications can also contribute to a child’s bad breath. Some medicines break down in such a way within the body that chemicals are released, producing odorous breath.
Medical conditions which can contribute to unusual or foul-smelling breath in kids include:
- Tonsillitis: Chronic or recurring tonsillitis can be accompanied by tonsil stones, calcified debris comprised of bacteria, mucus, and food particles, which become embedded in the crevices around the tonsils. Tonsil stones produce an extremely foul odor, especially if opened or crushed, but can be easily removed with a toothbrush. Enlarged adenoids can also be a contributor to mouth breathing and result in bad breath in children.
- Seasonal allergies and sinus infections: Congestion can lead to mouth breathing and thus bad breath. Post-nasal drip secretions can feed bacteria which produce VSCs that cause bad breath as well.
- Gastroesophageal reflux disease (GERD): Children with GERD often regurgitate food which can cause oral health problems.
- Liver problems: When the liver is not functioning properly, the unprocessed bile that accumulates in the body can produce breath that smells like fish or rotten eggs.
- Diabetes: Bad breath (especially acetone or fruity smelling) in a diabetic child can be a sign of high levels of ketones in the blood (ketoacidosis).
- Kidney problems: A child with an underlying kidney issue may have foul smelling breath resembling urine.
Treating and Preventing Bad Breath in Children
Because a majority of halitosis cases in children are a result of improper dental hygiene, helping your child with his or her oral care routine will often reverse the bad breath problem.
Tips for preventing bad breath in kids:
- Supervise and/or help your child brush teeth thoroughly at least twice per day (three times if possible). Floss once a day to remove food particles that can cause odor.
- Be sure your child uses a soft-bristled toothbrush and brushes the back portion of the tongue (dorsum) to remove bacteria.
- Feed your child a fibrous breakfast to stimulate saliva flow and reduce microbial levels in the mouth.
- Drink water frequently to avoid dry mouth. Rinsing with water can remove bacteria when brushing is not possible.
- Give your child sugarless gum containing xylitol. Xylitol dental benefits include stimulating saliva flow which helps keep teeth clean.
- Replace your child’s toothbrush every 3 months to keep brushing effective.
- Visit your pediatric dentist regularly. Dental cavities and other dental problems such as gum disease cause much less discomfort when detected early.
- Keep hands clean, especially if your child has a thumb sucking habit. Sterilize pacifiers and any other items your child may put in his/her mouth.
While an age appropriate mouth wash can be helpful in treating bad breath, children should not use mouth washes that contain:
- Alcohol: Can damage or dry out oral tissue
- Saccharin or sugar substitutes: Provide no oral health benefits
- Sodium lauryl sulfate: Foaming agent that can contribute to canker sores
If your child has bad breath, do not simply mask the odor with mints or gum, as there may be an underlying medical issue that needs to be addressed. Kids Dental recommends consulting your pediatric dentist for an evaluation of your child’s oral health.