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Oooh, That Smell

Halitosis? A Burlington doctor takes your (bad) breath away


Published January 17, 2001 at 3:36 p.m.

Illustration: Luke Eastman
  • Illustration: Luke Eastman

You’d think from the number of products available for cleaning and prettifying every body part that Americans would be acutely diligent about halitosis. Not so. In fact, most people with a breath problem are blissfully ignorant about it unless someone else tells them — we’re certainly, and often hideously, aware of other people’s breath. But for some reason, we find it easier to pronounce “I want a divorce” than “You have bad breath.”

All of us know at least one person we avoid because their breath would make dragons scurry back to the cave. If it’s a family member, especially one you regularly insult anyway, you can usually bring yourself to tell him or her. But if it’s a friend or, worse, a co-worker, forget it.

Why is it so difficult to tell someone they smell? It’s humiliating to civilized people, of course — nearly as much to the messenger as to the offender. “It’s an embarrassment issue,” confirms Dr. Lorne Lavine, “though I don’t see why you can’t say that to someone you care about.” But maybe at this point Lavine can utter “halitosis” as effortlessly as “toothbrush” — after all, he’s treated some 250 people for breath disorders since launching the Vermont Breath Centre six years ago. It’s part of his periodontal practice in South Burlington, in an office he shares with root canal specialist Dr. Ken Stavisky.

Interestingly, dental school avoids talking about breath nearly as much as the rest of us. It was “unheard of” when Lavine, who graduated in 1991, was in school. Even now, he notes. “You might get a day or two here and there,” but most schools still do not address the problem in their curricula. Considering it’s a medical condition, that seems puzzling — especially because bad breath turns out to be rather easily remedied.

But it wasn’t untilaround 1993, says Lavine, that research began to be published about breath disorders. The subject attracted him in part because, as a periodontist, he gets his share of patients with halitosis — most of whom don’t know it — and in part because he was looking for a way to expand his services.

“I was in a new practice and there’s lots of competition,” he explains. “I was looking for things I can do that are different.” As far as he knows, Lavine, now 38, is the only dentist offering breath treatment services in the state — he also has offices in Montpelier and Waitsfield. Nearly all his patients are referrals. Most are in their forties or fifties, he says, though he’s treated teens to octogenarians. And most are women — because, Lavine believes, women are more conscious of personal hygiene.

Without formal training available, Lavine took it upon himself to study, in dental journals and online, all the research on bad breath available. That’s how he learned about a measuring instrument called a halimeter — a box about the size of a CD player, with a narrow tube protruding from it. Put the tube in your mouth and the digital numbers on the side instantly start climbing. A measurement in the 100 to 180 or so range is normal, Lavine explains. Above that, you’ve got a problem.

The scale has four digits, so theoretically someone could have a reading of 9999, but Lavine says the highest he’s ever seen was around 1500. Considering the next highest was around 300, Mr. or Ms. 1500 must have been pretty heinous. “Typically people who come in here are in the 250-plus range,” Lavine notes. “After two to three weeks [of treatment], I expect to see 30- to 50-point drops.”

So what is the halimeter reading? Sulfuric gases in parts per billion. Volatile sulfur compounds are produced in the human mouth as a result of the deterioration of proteins. When the amino acids from proteins break down, gases are released; the two most common bad breath gases are hydrogen sulfide — the “rotten egg” smell — and methyl mercaptan.

But it’s not as if you just have free-form gas molecules floating around in your mouth; there’s also a collection of gunk on the back of the tongue — accumulated bacterial plaques and food that coats the tongue where your toothbrush can’t reach. Well, it could, but it would make you gag. Lavine likens the tongue to a shag carpet that collects all sorts of stuff, and some people’s carpets are simply thicker than others. “It’s genetic — one more thing we can blame on our parents,” he quips.

That’s where the tongue scraper comes in. Thanks to the capitalist marketplace, these scrapers come in a variety of materials and styles, but the one Lavine offers is a simple piece of serrated plastic made by Oolitt that goes for around $1.50 to $2. Make a loop with the strip and you’ve got a sort of comb that can be placed somewhere on the back of the tongue and gently pulled forward. Generally the first few such swipes will scoop little globs of a milky liquid from the tongue. The idea is to repeat the motion until the liquid looks like just spit.

It’s not possible to mechanically remove all this plaque, though. So the other part of the treatment is to brush the teeth well — for two to three minutes, not the 20 seconds most of us give it — floss, and swish around the mouth for another minute or so a rinse containing chlorine dioxide. Oxyfresh or Retardex are two examples — Lavine doesn’t push any single brand. But he does caution that the majority of commercial toothpastes and mouth rinses only masks odor temporarily, and some can exacerbate the problem in the long run. “Products that make things worse are any product with alcohol,” he says. Listerine and the like dry out the mouth and simply change from one odor to another — so read the labels.

Reducing the flow of saliva — which can also result from drinking alcoholic beverages and smoking, among other things — causes the tissues in the mouth to secrete plasma proteins that worsen bad breath over a period of time, according to the American Breath Specialists Web site (www. It helps to stay hydrated by drinking a lot of water every day. And, contrary to popular myth, odors from the stomach do not cause halitosis; the vast majority of bad breath conditions originate in the mouth — never mind garlic breath, which is powerful but temporary, and at least keeps away vampires.

Following Lavine’s recommended treatment twice a day is generally the answer to even the most horrific breath disorders. In some cases he also recommends an electric toothbrush or a Waterpik. Where mouth odor is a result of dental or other medical problems, such as a sinus infection, he refers patients to the appropriate practitioner. “Ninety-five percent of patients we’ve treated, we’ve treated successfully,” he says. Not surprisingly, Lavine’s approval rating is high — “practically every person comes back happy,” he says. “It’s a great satisfaction for me personally, and it’s always surprising to people how little it takes.”

Breath treatment is so simple, in fact, you’ve got to wonder why everyone doesn’t do it. Lavine attributes that to lack of information. And, he notes, it’s challenging for many people to change their habits. The good news is, even beastie breath isn’t as bad as “olfactory reference syndrome.” Patients who suffer from it believe they smell when they don’t. It’s part of larger syndrome, Lavine explains, called monosymptomatic hypochondriacal psychosis, in which the sufferer is convinced the source of his or her odor is intrinsic. Now, that would really stink.