Not only is bad breath a personally and socially frustrating problem, but it can also impact your professional life. Unless you live in a cave and limit your singing to Fafnir the Dragon (and you sing opposite the fearless Siegfried), halitosis can be a liability on the stage as well as off. Commercial solutions, ranging from mouthwashes to breath fresheners, really don’t address the underlying issue.
So, let’s look at some common causes and potential solutions that work. Warning: some of this is pretty disgusting, but is important. You have been warned.
One way to analyze bad breath is in terms of local causes and other sources that are more distant. Locally, the common culprits are the teeth, tongue, and tonsils. The mouth is generally full of bacteria, but these for the most part do not cause an infection—they are part of the normal microbiome that covers every surface of our body, inside and out. However, there may also be areas of localized infection that involve other bacteria, some of which produce pus. These must be sought out and removed.
The number one cause of bad breath is, arguably, the teeth and gums. If your teeth are carious and infected, you will probably know—they usually become sensitive and painful. However, if the infection involves the gums, you may not develop symptoms until much later. The pockets between the gums and the teeth are like miniature moats that can be filled with debris—bits of food and bacteria. As gingivitis progresses, the gums recede and more of the tooth becomes exposed. In other times, this was a common finding with age, giving rise to the expression “long in the tooth.”
Good dental and gingival care is the answer. Floss your teeth, several times a day if possible—I recommend after every meal—and brush using an electric toothbrush. A visit to the periodontist for accurate diagnosis and possible additional treatment should take care of dental-related halitosis.
Gentle brushing of the top of the tongue is also recommended, although this by itself is rarely cause for bad breath. More important are the tonsils. Chronic tonsillitis may not cause acute pain, but the pockets in the tonsils can become filled with a white debris containing bacteria and dead cells, which can produce bad breath. The solution here is to clean the white stuff out of your tonsils with a Q-tip or a water pick, if possible. If chronic recurrent tonsillitis continues, consider having them removed.
One purpose of good oral hygiene, apart from dislodging food particles, is to remove the biofilm. This is a matrix containing bacteria, debris, and mucoid proteins that covers the surface of the mucous membrane and is believed to be a source of infection. In the mouth, biofilm is best removed mechanically by brushing, flossing, and vigorous rinsing.
Another common source of halitosis-causing infection is the nose and sinuses. Chronic postnasal drip, especially if green or yellow, is a sign of infection. If the sinuses are infected, smelly mucus will drain into the nose and down the back of the throat. This can happen even in the absence of acute sinus symptoms such as pain, pressure, or tenderness. If mucus becomes stagnant in the nose, it can become thick and unpleasant. The many causes for such stagnation include a deviated septum and enlarged adenoids (in young people), as well as allergy and nasal infection.
If your nose is blocked and you are a mouth breather at night, this can also cause bad breath. This area is best addressed by an ENT examination, but before you focus on the nose as a halitosis source, be sure that the mouth and teeth are clean. You can then begin to address this area by aggressive saline nasal washes, using a Neti pot or NeilMed sinus rinse. Adding a bit of Alkalol brand nasal wash to the solution will freshen things up further.
Less commonly, bad breath comes from down below—stomach and lungs. Chronic low-grade lung infections, such as seen with COPD and bronchiectasis, frequently involve the accumulation of bad-smelling mucus. Since most singers don’t smoke (right?!), this is infrequent in the singing community but does occur, especially in older singers who smoked in the past. And, finally, consider problems in the stomach and esophagus. While reflux is common, it does not in itself cause bad breath unless you are refluxing material such as undigested food.
Another important category is what we put into our bodies. Obviously, strong-flavored and spicy food will affect the breath. It just goes with the territory—if your vice is kimchi, you will not smell like roses. Eating raw garlic as a health measure, drinking alcohol, smoking or chewing tobacco . . . and the list goes on. Keep in mind that the smell from such indulgences can last for many hours and just plan your dietary adventures around your social and professional schedule. In this regard, meat is worse than vegetables; routine flossing and brushing after your meal will minimize the impact.
A final, less common cause of halitosis is from metabolic abnormalities. When the body metabolizes certain materials, they can exude through the mucous membranes and affect your breath. If you are metabolizing fat and form ketones, this produces a characteristic breath. A ketotic smell is seen in diabetes, but can also occur in people on a strict “starvation” diet—you’re not burning carbohydrates, but are now metabolizing fat. Yet another example is in people with kidney failure. Urea backs up into the blood and is excreted through the mucous membrane, generating a smell of ammonia.
A couple of final words about mouthwashes. Based on what you have read above, you will realize that this is a superficial measure which will not really address any chronic infection. Furthermore, alcohol-containing mouthwashes can irritate and damage the mucous membrane, making it more vulnerable to bacteria. Despite those commercials, “tingly” is not equivalent to “clean.” While aggressive washing of the mouth using salt or baking soda is a good additive measure, avoid sugary and alcohol-containing commercial preparations. Old-fashioned breath fresheners, such as mint or clove, work just as well.
