“10 Years
– And I Still Have Bad Breath” –

Alvin H. Danenberg, DDS Nutritional Periodontist
September 26, 2016 [printfriendly]

many causes of bad-breathEmily scheduled a telephone consultation with me the other day. Her problem has distressed her for years, and she was clearly frustrated.


She explained to me that she had been trying to prevent bad breath for over 10 years! She described how her coworkers would shy away from her. Only her closest friends would tell her that she had bad breath. She went to her medical doctor years ago to try to figure out what was going on – only to be rebuked. Her MD poo-pooed the whole idea and said her bad breath was not caused by a medical problem.


Then Emily went to her dentist who examined her mouth and suggested more frequent cleaning appointments with the dental hygienist. That made sense to Emily, but after repeated cleanings, there was no difference. Confused, Emily began to research other solutions for her problem.


During her unsuccessful efforts to find the answers, she did begin to eat a more nutritionally balanced diet. Emily felt better and had more energy, but she still had bad breath. She finally discovered me online and sought my opinions.


First, I explained the obvious causes of bad breath, which she already knew and investigated. Then I explained some underlying medical issues, which could be the cause and which needed to be ruled out by a medical doctor. Her previous medical doctor never suggested these steps. I gave Emily some names of medical doctors who also practiced functional medicine in her local area and who could perform a thorough medical exam incorporating functional testing. Finally, I made some recommendations for her to try right away. Here is a summary of my discussion with Emily:



Obvious Causes

First of all, look for the most obvious causes. In Emily’s case, she already did that. But, as a review, here they are.


Most bad breath comes from gum infections, decaying food particles in the mouth, or from foods you have eaten that produce strong odors as they are digested. To take care of gum infection or decaying food particles, you must clean your mouth correctly and efficiently. HERE.


There is very little you can do if you eat foods that create odors. As these foods are being digested, they produce gases, which can pass through the lungs and are exhaled as bad breath. You might be able to reduce these odors if the foods are cooked rather than eaten raw. Also, eating green leafy vegetables either during or after the offending foods may help neutralize some odoriferous foods like onions and garlic.


Since Emily had addressed these causes with no change in her bad breath, I then delved into the causes that may not be so obvious.



Not-So-Obvious Causes

  • Specific prescription medications and various nutritional supplements can create unique and unpleasant odors. To remove these odors, you would need to stop taking those medications or supplements.
  • Dry mouth or reduced saliva flow could cause bad breath. HERE. Dry mouth may be a result of taking certain medications or may be a result of a disease in, or damage to, the salivary glands. HERE. Bad breath also could be a result of psychological stress, which often could reduce salivary flow. HERE. A simple solution would be to have bottled water available to drink as frequently as necessary.
  • The tonsils that are located on the sides of the throat just past the tongue can lodge calcified bacteria, which are known as tonsil stones. They may look like small, white nodules that can harbor significant odor. If you gargled with warm salt water, you might be able to dislodge them. If not, a dentist or an “ear, nose, and throat specialist” could do that for you.
  • If bad breath is still a problem, definitely make a nutrient-dense, anti-inflammatory diet part of your lifestyle. HERE. Nutrient-dense foods and anti-inflammatory foods will help keep bad bacteria in check and will support a healthy immune system – all of which support pleasant breath.


Many of the causes I have described up to this point are under your control. The following are trickier and will require a healthcare professional.


Specific diseases need to be ruled out by a physician who may need to perform some medical tests. Infections and lesions in the sinuses, stomach, lungs, intestinal tract, pancreas, liver, and kidneys are potential problem areas. Also, if foods are not digested properly and completely, their remaining particles could become putrid and create strong odors.


Functional medicine testing could shed some light on the source of bad breath. HERE. Your doctor may want to order a stool test. Also, testing for SIBO (small intestinal bacterial overgrowth) through breath analysis may be helpful. These tests could pinpoint overgrowth of bacteria, yeast, or parasites in the digestive tract. If unhealthy levels of these microbes are discovered, your doctor may suggest botanical or prescription medicines to eliminate them. If inadequate digestion were diagnosed, various supplements like digestive enzymes and Betaine HCl might be recommended. In addition, fiber (from vegetables and fruits) and good bacteria (from fermented foods) would be beneficial.



Final Thoughts

Bad breath affects everyone at times. But, it is pathologic for bad breath to last for a long time. There is always a cause. Getting to the cause may be tricky. I have summarized my suggestions to understand and resolve this problem once and for all.


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Can Gut Problems Cause Gum Problems?

      Alvin H. Danenberg, DDS     February 5, 2016   [printfriendly]

Gut Problems and Gum ProblemsYes!


But, my next statement may be even more important: Bad things may be going on in your gut without causing obvious gut symptoms. Yet, those bad things still could be causing your gum problems.


Let me explain.


The tube that extends for about 30 feet from your mouth to your anus is called the digestive tract or gastrointestinal tract. Anything that goes on in any part of that tube may affect everything else in that tube. If you had unhealthy changes in your gut, they definitely could affect your mouth.


What could affect the gut?


The foods you eat could change the bacteria populations in your gut, which could damage your gut lining. Also, some foods could put holes in the lining of your gut. Then, undigested food particles and bacteria particles could leak from your gut into your blood system and cause various inflammatory reactions. All this could affect other areas in your body.


Changes in the bacteria in your gut and changes in the lining of your gut also could cause changes in the tissues in your mouth. You could develop ulcers in your mouth; you could have unhealthy increases of bad bacteria around your gums; you could develop serious damage in the bone that holds your teeth in place in your jaw. Gut issues could cause all these mouth issues. However, as I mentioned, you may not have obvious gut pain or other gut symptoms.


Are there tests that can suggest what is happening in the gut?


Some functional medicine tests could help determine if you are sensitive to specific foods that could be the culprits. Other tests could help determine if there is an abundance of bad bacteria or other microbes living in your gut. Additional tests could identify if your gut lining is damaged and causing leakage into your bloodstream. These tests might help your dentist or other practitioner get to the bottom of your mouth problems.


Although proper oral hygiene is very important to help your mouth stay healthy, there may be other causes. Not-so-obvious causes may start in your gut but later affect your mouth. Probably, up to this point, no one has addressed those possibilities.


If you suffer from these problems, a dentist that understands functional medicine might be able to help.


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Functional Medicine & Dental Health:
Is There Something To It?

      Alvin H. Danenberg, DDS     February 2, 2016   [printfriendly]

Have you heard the term “functional medicine” floating around the Internet? Do you know what it means?


Functional Medicine & Dental HealthMany traditional medical practitioners do not embrace the concepts of functional medicine, but I do. Let me explain how functional medicine could actually benefit your dental health.


I am a traditionally educated periodontist and have been in practice for almost 42 years. Three years ago I began extensive functional-medicine training and subsequently earned the designation of Certified Functional Medicine Practitioner. I have found incorporating the concepts of functional medicine with my traditional practice of treating gum disease can enhance the treatment I offer my patients.


So, what is Functional Medicine? Functional medicine is the science of looking deeper and deeper for the causes of disease and not just managing the symptoms of disease. Everything starts on the cellular level. Since there are 10 trillion human cells, there is a lot going on. Cells communicate with one another. A breakdown in that communication for whatever reasons can lead to improper function down the line – in the mouth and in the entire body.


In my experience with patients over the years, most have wanted to know the cause of their gum problems. The obvious causes are dental plaque, poor oral hygiene, and unhealthy biting forces on the teeth. These play an important role in the progression of gum disease. However, in certain situations, there may be more to gum disease than these obvious causes.


For example, some patients brush and floss daily, but still have bleeding gums. Others may see their dentist every six months, but they still are loosing their teeth. What’s going on here? Could there be deeper problems that have not been identified?


Functional medicine helps me look deeper into the not-so-obvious causes and mechanisms involved with gum diseases, which also may be causing other chronic diseases.


I believe that every patient is an individual and does not just fit into a group statistic. Each person has unique cellular qualities that respond to different things in different ways. My job is to find the individual differences that are causing disease and to help my patients become healthier. Specific functional medicine tests may take me a step closer to learning what is going on for that individual.


Since the mouth is just the beginning of the digestive tract that ends at the anus, anything that affects one part of this tube could affect other parts. Various tests can be performed using blood, saliva, urine, stool, and breath to help put the pieces of the puzzle together. Damage to the gut lining, overgrowth of bad bacteria and other microbes, and toxic chemicals interfering with the functions of cells can all be studied by using specific functional testing. If damage to some of the cells could be traced back to specific offenders, and if those offenders could be removed or corrected, then other cells might heal. Improving the health of individual cells could improve the health of tissues and organ systems. The mouth as well as the entire body could benefit from discovering the underlying causes.


In future articles, I will describe several of the most reliable functional medicine tests that could be considered.


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I’m A Periodontist:
What Makes Me Different?

      Alvin H. Danenberg, DDS          January 5, 2016


What makes me different? functional medicine

I am a periodontist (a dentist specializing in gum disease) and have been in practice for almost 42 years. I have been trained traditionally, and therefore I would be considered a conventional periodontist.


However, for the last 6 years I have abandoned the conventional surgical procedures of treating advanced gum disease and have embraced the LANAP® Protocol (Laser Assisted New Attachment Procedure). This laser treatment kills specific bacteria that cause periodontitis and assists the patient in growing new bone around diseased teeth. The procedure does not require scalpels or sutures, and the patient returns to his or her normal schedule the next day.


In addition, I also have been trained in functional medicine and awarded the designation of Certified Functional Medicine Practitioner. That means I not only treat the signs and symptoms of gum diseases. I also actively seek the core causes of these diseases to improve cellular function that could turn these diseases around. Many of these causes are related to our species’ specific nutritional and lifestyle requirements, which have evolved over the last 2.5 million years.


With my training in functional medicine, I view the mouth as interconnected to the whole body. I appreciate that anything affecting an individual cell will ultimately affect the entire body. I recognize that underlying issues can trigger numerous and diverse manifestations of disease. Science now is demonstrating the benefits of functional medicine. These include addressing basic causes of disease on a cellular level and finding the right tools at the right time for each individual to improve health and prevent future disease.


I see my patients as unique individuals who are experiencing common but advancing periodontal diseases. My goal is to explore each patient’s unique nutritional and lifestyle issues that may be compromising her or his oral health and overall health.


In this way, I am different than most periodontists. I combine periodontal treatment, functional medicine concepts, and ancestral nutrition and lifestyle requirements to treat my patients. I offer my patients a health-oriented, patient-centered, holistic approach to periodontal treatment.


While I am a gum specialist, my approach is more diverse than that of most others in my profession.

What Did You Say I Have?

        Alvin H. Danenberg, DDS       November 8, 2015


evolution r“What did you say I have? I brush my teeth everyday and floss when I can. Now you say I have gum disease that is eating away at my jawbone! How did this happen to me?”


You are not alone!


A study published in 2010 demonstrated that 93.9% of adults in the United States had some form of gingivitis, which is inflammation of the gum tissues surrounding the teeth.


Another study published in 2012 by The Centers for Disease Control and Prevention stated that 47% of the US adult population has periodontitis (the advanced stage of gum disease that eats away at the jawbone). If you were over 65 years old, the prevalence of this advanced infection jumped to 70%. Wow!


Advanced gum disease typically does not hurt. The earlier stage of this disease, which is gingivitis, usually produces bleeding gums. But, if gingivitis progresses to the more advanced stage of periodontitis, the bleeding generally stops as the infection moves deeper under the gums to begin destroying the jawbone.


If left untreated, periodontitis will cause teeth to get loose. Teeth will become sore and painful to the touch. Chewing will become uncomfortable. Infection that is around the tooth root could be pushed into the blood system, affecting other areas of the body. These gum infections could also become severe in the mouth resulting in much swelling, bleeding, and odor. Once the structure of the jawbone is significantly destroyed, the only option would be to extract the teeth involved. In addition to mouth problems, gum disease has been associated with many other bodily conditions such as diabetes, pre-term and low-weight babies, heart disease, and many more.


There are many causes. The most common is bacteria that get under the gums around the teeth that thrive off of the sugars and refined carbohydrates we eat abundantly everyday. Another cause is the lack of efficient oral hygiene, which includes effective tooth and gum cleaning habits. Additional causes are the health of our digestive system, the nutrients that are in our foods, our stress level, and our genetic predisposition. Frequently, habits like gritting or grinding your teeth, even if you are not aware of this habit, could weaken the jawbone and result in further destruction.


You cannot change your genetics, but you can change the quality of foods you eat and your lifestyle, and you can learn to properly clean around your teeth and gums.


Those who read my blogs may know that I am a periodontist (gum specialist) with 41 years experience in treating patients with advanced gum disease. I also am licensed in the laser gum treatment called LANAP® (Laser Assisted New Attachment Procedure), which is patient-friendly and involves no cutting with scalpels and no stitches. I have found this to be the best way to treat advanced gum disease. In addition, I am a Certified Functional Medicine Practitioner using this background to guide patients to a healthier diet and lifestyle. Some of my patients decide to complete a 3-Day Food Journal, which allows me to evaluate their eating and lifestyle habits and then to recommend healthier food and lifestyle choices.


I offer my patients a Lifestyle Repair Plan, in which I recommend an anti-inflammatory diet, selecting from a host of nutrient-dense foods. These are the foods that have a great deal of nutrients packed into each calorie. My Plan also incorporates changes in lifestyle that are critical for overall health. Included are concepts of health maintenance like Oral Care, Restorative Sleep, Efficient Exercise, and Stress Reduction – concepts that I have summarized into simple and doable steps.


My goal for my patients is to treat their active gum infections, teach them methods to maintain a healthy mouth, and assist them with eating and lifestyle changes that could lead not only to a healthier mouth for the rest of their lives but also to a healthier body.

What Is This Thing Called “Functional Medicine”?

evolution rMany of us have come to know that much of medicine today is concerned with treating the symptoms of disease. Thousands of names have been created to label these disease entities along with their symptoms. And thousands of medicines have been developed to treat their individual symptoms. And then there are medicines to treat the side effects of other medicines. It is often a frustrating battle.

Is there another paradigm? Is there a way to identify why cells in our body function poorly? Is there a process to rectify the breakdown in communication between cells so healing could occur? Is there a science that treats the underlying causes, and not just the symptoms, of disease?

Yes! The science is called Functional Medicine. Functional Medicine looks for the cause of cellular miscommunication.

All disease starts with cellular inflammation. When the source of cellular inflammation is determined and addressed, then the various manifestations from cellular damage might begin a repair process throughout the body.

Let me be specific. Periodontal disease is a manifestation of inflammation around the gum margin, but this disease did not start with just plaque around the teeth. This inflammation has a much more complicated beginning.

When we eat certain harmful “foods”, the good bacteria in our gut become altered. Also these harmful food products weaken our gut lining, which is only one cell layer thick. This protective lining is the primary physical barrier that separates the outside world from our inner self. Bacterial byproducts and undigested proteins accumulating in our gut are able to leak into our blood. This portal to our blood system allows a vicious chain of events to occur, affecting our bodily functions. Now a host of degenerative diseases have a chance to simmer and develop over many years. Along with these changes, the bacteria in our mouths become more virulent, which can initiate gum disease.

By applying the concepts of Functional Medicine, we can begin to heal our gut, which begins a healing process for our mouths as well as the rest of our body. This thing called Functional Medicine is changing the way traditional medicine is practiced.