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Quick reference medical handouts used by Pediatric offices

Bad Breath in Children

Bad Breath

Children, particularly teens, can be very hard on their peers who have bad breath. Although rarely an indi­cator of medical problems, it can be very bothersome and difficult to treat.

Bad breath comes in two varieties – “morning bad breath” and “chronic bad breath.” Just about every­one awakens with morning bad breath. The bacterial concentration in anyone’s mouth is the highest when awakening. The long period of not eating, drinking, or even salivating much lets the bacteria build up. Brushing the teeth and eating breakfast brings down the number of bacteria and lessens or eliminates the bad breath.

Chronic bad breath occurs when there’s a persistent heavy concentration of bacteria in your child’s mouth. The odors can come from five places: the back of the tongue, degrading food particles trapped between the teeth, from the stomach, occasionally from the tonsils, and periodontitis.

The bacteria that cause bad breath are classified as anaerobes – bacteria that don’t need oxygen to survive and are actually killed when exposed to oxygen. You may wonder how bacteria in the mouth, a place where there’s lots of oxygen, can survive if oxygen kills them. Although the larger environment in the mouth is ex­posed to oxygen, there are many microenvironments that are free of oxygen. Bacteria, being so small, find many areas with no oxygen and survive just fine.

The first area where these odor-producing bacteria live is the back of the tongue. The bacteria that live here produce malodorous sulfite chemicals. There are two ways to attack these bacteria. The first is teach your child to brush the back of his tongue at least twice a day. If this doesn’t work, gargling twice a day with a hydrogen peroxide solution (half hydrogen peroxide, half water) should do the trick.

The second place odor-producing problem is food particles caught between the teeth. The putrification of these food particles, particularly meat, by anaerobic bacteria results in bad breath. The treatment is straightforward – remove those particles of food. Flossing is the best way. Brushing will also help.

The third source of bad oral odor is the stomach. This is usually caused by eating spicy foods (something few children do) or digestive problems (again something not common in children). If you believe this is the cause of

your child’s problem, then food avoidance may work. If not, then he should be evaluated by his doctor.

Children with tonsils can develop food lithes (literally food stones). About 25% of people with tonsils have this problem. Food accumulates in the folds and crevices of the tonsils. Bacteria build an outer protein layer to the gathered food, resulting in what looks like little white stones. The bacteria produce the foul odor. The food lithes eventually pop out and are either swallowed or spit out.

The last cause is periodontitis – infection of the gums. A child with this problems has gums that are red, swollen, tender, and may bleed easily. Periodontitis requires a visit to the dentist. Sometimes antibiotics are sufficient to treat it. More severe cases need other treatments.

Adapted from The Secret Life of Germs: Observations and Lessons From A Microbe Hunter by Philip M. Tierno, Jr. Ph.D.. Originally appeared in the excellent parenting newsletter Pediatrics for Parents and posted 11-01-04 on


As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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