Q I have an uncomfortable and somewhat personal question. My father-in-law is in his late 80s and has bad breath. It is difficult to sit next to him at dinners. I don’t feel comfortable discussing this with him. Is bad breath a normal function of aging and is there some way to approach the topic delicately?
A Dear L.J.: It seems that age makes us more likely to have bad breath, commonly called halitosis. Let’s begin by understanding some of the reasons.
The mouth is considered a tiny ecosystem where good bacteria that need oxygen coexist with the bacteria that don’t need oxygen called anaerobic bacteria. These anaerobic bacteria lurk in places in our mouth where oxygen is not easily reached such as between the teeth or under the gum line. These same bacteria excrete sulfur compounds that are odorous — like rotten eggs — and are often described as “stinky.”
Regardless of age, one significant cause is the lack of oral hygiene. That means not brushing or flossing, or doing it poorly. Without good oral care, food can be trapped between the teeth and are then broken down by the “bad” bacteria, causing halitosis. These bacteria also hide in the back of the tongue where mushroom shaped papillae trap food particles.
Another common cause is dry mouth, which often is age-related. As we get older, the salivary glands produce less saliva, a natural mouth cleanser. A dry mouth with little saliva allows these anaerobic colonies to grow quickly.
Saliva is the hero of the day. It contains immune cells that wash away the bad bacteria and food debris that nourishes them. Saliva contains powerful immunoglobulins, or antibodies. “In their absence, anaerobes will grow,” says Allan C. Jones, a SouthBay dentist.
“Bad breath is more complicated than it seems,” Jones adds. Lack of oral hygiene is a cause. Yet he sees older patients who brush and floss — and still have bad breath. These patients may suffer from the most underdiagnosed cause — a sinus infection. Additional causes are plaque that accumulates on the tongue and high blood sugar among those with diabetes.
Add to the list strongly flavored foods and beverages such as onions, coffee and alcohol as well as smoking, infections and some medications and chewable chemotherapies.
To treat halitosis, Jones suggests improving oral hygiene. If this doesn’t work, he advises visiting an ear, nose and throat specialist to rule out a sinus infection.
Now let’s get a little more personal. How can you discuss this with your father-in-law?
Patricia Napier-Fitzpatrick, founder of the Etiquette School of New York, suggests two approaches as noted by CNN journalist Danielle Dellorto.
First, if your father-in-law is not too sensitive, find a private setting to chat and be direct. You might begin by telling him there is something you think he would want to know and that you are unsure if he is aware of the problem.
If your father-in-law is very sensitive, you might bring up the issue by carrying some mints, taking one for yourself and then offering him one. If he does not accept you might say, “Perhaps you should,” or a similar comment.
Here are some tips regardless of age: Some suggest drinking more water, but Jones says it is unlikely more water will cure bad breath. More effective might be chewing sugar-free gum, which increases saliva production, and eating crisp fruits and vegetables such as celery and apples. Chewing them also produces saliva and the firm texture helps rub away the bacteria.
Note that most people with halitosis are not aware of it because the brain becomes used to one’s own personal scent. That may be the case with your father-in-law.
L.J., thank you for asking about this sensitive issue that often is more prevalent among older adults. Hopefully your father-in-law will appreciate that you care enough about him to bring the problem to his attention.