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Ask Dr. Sears: Stinky Breath

Q. Recently my daughter placed my toothbrush in her mouth in an attempt to learn how to brush her own teeth. Now I have noticed that her breath is more unpleasant than usual. Could my daughter be harboring some of my germs in her mouth? Is there anything I can do to correct this situation?

A. There are many things going on inside a child's mouth that can contribute to stinky breath. Sometimes it's just a temporary and insignificant annoyance. Other times halitosis can be a clue of some underlying medical problem that needs addressing. Consider these possibilities:

Chronic sinus infection.

In my pediatric practice, chronic sinus infections are one of the most common, but hidden, causes of bad breath. Fluid collects in the sinuses and nasal passages and drips down the back of the throat and settles on the back of the tongue. The mouth's resident bacteria feed off of this mucus drainage and decompose it, releasing odorous gases. Signs of a sinus infection are frequent colds or colds that seem to linger, yellow drainage from the eyes, snotty nose, a tired child and frequent cough. If you suspect chronic sinus infection, "steam clean" your child (with a facial steamer or by sitting in the bathroom while running a hot shower) and "hose the nose" by spritzing a few drops of saltwater into each nostril several time a day. Have your doctor check your child out for possible sinus infection.

Large tonsils.

If your child's tonsils are large, food—as well as oral and nasal secretions—can collect in the deep pits of the tonsils. As these collections decompose, they'll give off odors. Either have your doctor check this out or shine a flashlight at the back of your child's throat to see if you see large tonsils with debris collecting in the pits.

Dental problems.

A fetid odor may come from decomposing food trapped in the crevices between teeth or some decaying teeth. Be sure to brush your child's teeth well and try to floss if your child is old enough. Have your child brush with a pleasant toothpaste and rinse and swish water around the mouth to help wash out all the extra secretions.

Foreign body stuck in the nose.

Another cause of bad breath is a decomposing piece of food—such as a pea, seed or even a piece of toy!—stuck in the child's nose. A foreign body putrefies and releases an odor. A clue to this cause is a foul-smelling discharge coming from only one nostril where the object is stuck. If you suspect this as a cause, your doctor can easily remove the stinky cause.

Dry mouth.

When the mouth is dry, the natural rinsing action of saliva goes down. This lets bacteria grow in the mouth and release smelly gases. Fight this by encouraging your child to drink three or four glasses of water a day.

A stinky tongue.

Bacteria and secretions often collect on the back of the tongue. Try to scrape the back of your child's tongue with a plastic spoon or toothbrush as much as your child will accept without gagging. Or try a plastic tongue scraper, available at most pharmacies.

Gastroesophageal reflux.

Another hidden cause of bad breath is the regurgitation of stomach acids up into the throat, similar to what adults would call "heartburn." If you notice an acid-smelling breath, it's likely your child needs treatment for this. Other clues are: "colicky" behavior, spitting-up frequently, restless sleeping, throaty noises and abdominal discomfort after eating. You can ease mild reflux by offering your child smaller, more frequent feedings. Also, keep her upright and quiet for at least a half hour after eating.

It might not sound pleasant, but it's time to put your sensitive nose to work and do some detective work. Do a sniff test to try to tell whether it's an acid smell or the putrefying bacteria and a clue that your child needs treatment, is an acid-smelling breath from or debris coming from the sinuses, teeth or tonsils. Hope the above remedies help!