What causes bad breath in children and how to avoid it?

Bad breath in young children is not a trivial problem. If the origin is oral, it may be a minor problem such as poor oral hygiene, but if restoring a correct brushing technique does not solve it, it could be that this infantile halitosis is the consequence of an oral disease or even a systemic one. If you have noticed that your child does not have good breath, we recommend that you pay attention.

What you should know about bad breath in children

1. What is and what causes bad breath in children?
2. How can oral halitosis in children be prevented?
3. How is children’s oral halitosis treated?

1. What is and what causes bad breath in children?

Halitosis is a bad smell or bad breath in the mouth. In children, this problem can present itself in two ways: it can be transitory, which corresponds to a bad smell in the morning and is due to a decrease in the amount of saliva during sleep and prolonged fasting, or to the consumption of certain foods. But it can also be persistent, and in this case, depending on its origin, it can be oral or extraoral (responsible for 15% of cases):

1.1. Oral halitosis.

• Inadequate oral hygiene. An incorrect brushing technique, the omission of areas such as the tongue or the interdental space, or poor oral hygiene in terms of time and number of times can lead to an accumulation of bacterial plaque. This plaque is the result of the proliferation of bacteria in the oral cavity which, together with other decomposing food, can lead to bad breath. The problem is when the tissues begin to be affected.
• Periodontal diseases. Although proper oral hygiene sometimes does not lead to noticeable halitosis, one of the consequences is the onset of periodontal disease. Gingivitis, a first stage of periodontal disease, is usually associated with halitosis as a symptom, along with inflammation of the gums. If left untreated, this disease can lead to periodontitis, which can even cause the loss of baby teeth in young children.
• This is another oral disease resulting from poor brushing and the accumulation of bacterial plaque and calculus or tartar formation. If this infection occurs, it is very likely that the child’s breath will be affected and the integrity of the tooth, which could be lost, as well as that of the rest of the tissues and teeth in the oral area, could be endangered.
• Use of orthodontics. Some orthodontic appliances such as braces tend to make oral hygiene very difficult for young children. Since it is somewhat more complicated and they need to be patient, they tend to be less thorough. This not only increases the presence of food remains in the oral cavity which, during their decomposition, cause bad odour, but also increases the formation of bacterial plaque which, as we have already mentioned, has a series of important consequences for health, halitosis being one symptom of them.
• Xerostomia or dry mouth. Saliva is fundamental in the digestion process, it is the first step in the decomposition of food and allows bad odours to be eliminated. However, the oral breathing of some children can increase oral dryness, decreasing the amount of saliva and the capacity to initiate the process of food digestion.

1.2. Extraoral halitosis.

• Infectious processes: pharyngitis, catarrh and tonsillitis, sinusitis, rhinitis, etc.
• Problems of the digestive system. Infection in the stomach, gastritis, reflux, inflammatory diseases or intestinal obstruction, some strains of the stomach bacteria Helicobacter pylori can cause bad breath in children.
• Intolerances: e.g. lactose intolerance.
• Systemic diseases. Diabetes, kidney, liver or lung diseases.
• ENT problems: hypertrophy of the adenoids or tonsils.

2. How to prevent oral halitosis in children?

• On the one hand, avoid foods with a lot of condiments, spices, rich in fats, or foods such as garlic or raw onions. On the other hand, increase water intake to avoid xerostomia, for which it is also important to breathe through the nose.
• Carry out proper oral hygiene, for which parental supervision is recommended, as well as taking special care when wearing orthodontics. It is important not to omit brushing the tongue or using floss, floss or an interdental brush and to use mouthwash. Instilling a good oral hygiene routine from an early age is essential for the dental development of children and the maintenance of healthy teeth and gums, for which it is ideal to lead by example:
• Regular visits to the paediatric dentist who can assess the actual state of oral health and determine whether any preventive treatment is necessary, or if there is any oral disease that has halitosis as a symptom:

Depending on whether the halitosis or bad mouth odour is caused by the accumulation of bacterial plaque due to poor oral hygiene, or whether it is the result of an illness, the approach will be different. In each case, the aim is to treat the source of the problem.

• Professional oral cleanings. These cleanings are the ones that guarantee the good health of teeth and gums by efficiently removing all the accumulated bacterial plaque to prevent caries and periodontal diseases.
• Treatment of childhood caries. In the event that this bacterial plaque has affected the teeth, it is essential to carry out treatment to eliminate this infection and protect the teeth. Preventive measures can also be taken against caries after professional cleaning.
• Treatment of periodontitis. To alleviate the effects of periodontal disease, treatment may be necessary to eliminate the abscesses that have formed under the periodontium, eliminating the infection that causes this halitosis.

If, after correcting the aforementioned habits and having a check-up with the paediatric dentist, the problem is ruled out, it is advisable to visit the paediatrician to rule out some of the extra-oral diseases mentioned at the beginning. Although it is less prevalent in children, it is important to rule out the existence of non-oral diseases.