What Causes Bad Breath in Children?

I’m often asked about what causes bad breath in children. Certainly the most common causes of oral odor such as eating onions, smoking, drinking alcohol and dental decay can’t apply to very young babies and toddlers. When children have bad breath there may be very different causes and these may be either oral or non-oral.

Oral Causes of Bad Breath in Children

Bacterial Build Up: In 85% of cases the cause of bad breath is oral. This means that the odor is located somewhere in the child’s mouth, most commonly the back of the tongue, between teeth or under gums. When the tongue is coated it’s usually a build up of bacteria, shed epithelial cells and blood cells. Cells which are being shed may become trapped in dental plaque and on the back of the tongue. When bacteria starts to decompose these cells, sulphur is produced and bad breath results.

Dental Problems: In very young children extensive dental decay is not commonly found and the usual causes of bad breath are dietary choices and poor oral hygiene such as irregular, poor quality brushing and failing to use dental floss.

Oral Fungal Infections: These days many children are placed on antibiotic therapy for bacterial infections of the respiratory tract. These antibiotics may destroy friendly oral bacteria and Candida infection (thrush) may result. Children who have suppressed immune systems due to chemotherapy or HIV infection may be more prone to oral fungal infections. These usually result in a sweet odor.

Non-Oral Causes of Bad Breath in Children

Systemic or Chronic Diseases: When discussing what causes bad breath we must not overlook chronic or systemic diseases. These include liver disease, tonsillitis, diabetes, trimethylaminuria, sinusitis, kidney problems and Helicobacter pylori infection.

Liver Diseases: Liver failure and cirrhosis can cause a sulphur smell. Trimethylaminuria is a metabolic liver disease that causes the urine, breath and perspiration to have a fishy odor.

Tonsillitis: Sometimes in chronic tonsillitis the tonsils develop deep crypts or crevices. Odor can result if small food particles become trapped. Tonsilloliths or tonsil calculi often form in these crypts. These are small, calcified clusters which are a very common cause of halitosis in children.

Post Nasal Drip, Dry Mouth and Sinusitis: Dry mouth in children may be due to a post nasal drip caused by allergic rhinitis and mouth breathing at night, dehydration, and a decrease in saliva, diabetes or in children with cancer - chemotherapy.

Diabetes: If a child has juvenile diabetes an acetone smell may become evident if there is ketoacidosis. This can be very serious and if your child’s breath smells like acetone (nail polish remover) you should contact your doctor immediately.

Kidney Problems: When the kidneys fail, uraemia is the result. This can cause the breath to smell like ammonia. This is a very clear indication that medical treatment should be sought and you should contact your doctor.

Helicobacter Pylori Infection: This is a gastric infection that causes inflammation in the stomach and may result in bad breath. The infection is treated with medication which resolves both the infection and the unpleasant odor.

Foreign Bodies: Children are notorious for their love of placing objects like toys and food into the nasal cavity. This is often, but not always noticed by the parent. Sometimes a foreign body that has not been noticed begins to cause an inflammatory response, discharge and odor.

When it comes to understanding what causes bad breath we must consider a multitude of origins to truly cure the problem.

To learn more about how to stop bad breath check out this article:
“Bad Breath Remedy & Tips”

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