Hi I am new at posting. I been on pd dialysis for 5 years and ever since I been suffering from cronic bad breath. I tried antibiotics and all kinds of mouth washes to no avail. I visit my dentist every 6 months. PLEASE HELP!!

Hi, DD. You say you are 5 years on pd, but I am guessing from your question that you are new to the web. RenalWEB is a great place to start looking for answers, and I would also recommend the American Association of Kidney Patients (http://www.aakp.org).

Here's a quote from AAKP nutrition page:

"Urea is a waste product that comes from eating protein. Healthy kidneys get rid of urea in the urine. Sick kidneys do not rid get of enough urea in the urine. Urea builds up in your blood. Blood urea nitrogen (BUN) should be between 5 and 25 mg/dl. Eventually, people with kidney disease may have a bitter taste in the mouth. Urea will accumulate in your saliva, which can cause a bad taste and bad breath."

Maybe you are not getting enough clearance and you are tasting the urea left behind? Maybe something in your diet? Search nutrition sites especially, because it doesn't sound like a dental problem or any kind of infection or inflammation.

The best help is SELF HELP, you just need to get yourself pointed in the right directions. (http://www.aakp.org)

Yes I have had bad breath since my transplant failed and I also noticed that when I was younger and was losing my original kidneys.

It is something associated with renal failure but I don't notice it so much. It is my mom who points it out and gets frustrating because I do all I can and have never even have had a cavity ever in my life and I am alredy 32! There is only so much you can do. Sad to say, but you might just have to accept it. I did.

quote:

Originally posted by dd:
Hi I am new at posting. I been on pd dialysis for 5 years and ever since I been suffering from cronic bad breath. I tried antibiotics and all kinds of mouth washes to no avail. I visit my dentist every 6 months. PLEASE HELP!!

As Dave replied, insufficient urea clearance is the most likely cause of bad breath in a renal patient.

Though this post is a long one, it may help to some extent. I regret to say that I do not have the source of the following article with me and hence cannot give due credit.

This article is written for the general public. Do keep in mind your dietary and fluid restrictions!

Warm Regards,

S.Bhagwat

Bad Breath
Causes

There are a number of causes of bad breath, foremost among them being bacteria in the mouth, stomach and intestinal disturbances, bowel sluggishness, sinus or throat infections, and tobacco and alcohol use.

• Alcohol consumption causes digestive problems which leads to bad breath. In addition, alcohol dries out the mouth, which reduces saliva production. See below for more information.

• Stress is another cause which may not be readily apparent when you are looking for reasons for bad breath. Stress affects the digestive system. An insufficient supply of digestive enzymes may be another cause.

• Other sources of bad breath are in the nose and the nasopharynx, the area above the base of your tongue.

• Dieting may be a cause of bad breath.

• Since dehydration leads to constipation and digestive problems, it is very beneficial to drink 6-8 eight ounce glasses of water a day. Juice, coffee, tea, colas, etc. don't count!

• Bad breath may emanate from the back of the throat due to sinus or tonsil infections resulting in excess bacteria. See Sinus Problems in our Ailments section for more information. If you have sinus or throat problems you may well have some form of allergy. See Allergies in our Ailments section for more information.

• Bad breath may also be the sign of potentially more serious medical conditions such as diabetes, duodenal ulcers, gastroesophageal reflux, hypoglycemia, kidney or liver malfunction, and respiratory disorders.

• The foods eaten also are a potential cause of halitosis. Certain foods, such as garlic, onions and certain spices are frequently cited as cause for a person's bad breath. Both vegetarians and those who eat large quantities of meat may develop bad breath due, in part, to the digestive process. Digestion begins in the mouth. Saliva has enzymes which begin the digestion process, and the type of food eaten can affect the food chemistry of the mouth. Saliva will also pick up odors from food within several hours after it has been eaten. Odors are strongest from carbohydrates - sugars, starches and cellulose, less strong from proteins, and nonexistent from fats. Bacteria in the mouth react with the decaying food and drink residue and can be the source of the foul odor.

• A milk intolerance often is the cause of bad breath. Eliminate all dairy products and see if they are the culprit.

• The stomach also is an area that causes bad breath problems for many people. Poor digestion, constipation, or bowel disorders may create gas which exits the mouth. Not enough hydrochloric acid in the stomach may cause poor digestion, so undigested food will pass into the intestines, putrefy and give off foul gas which rises up and causes bad breath. This problem is quite common with older people whose body does not produce enough hydrochloric acid naturally to aid the digestion process.

Another common digestive problem is due to the imbalance of good and bad bacteria in the gut. Food won't be digested properly and the result can be acid reflux, yeast overgrowth, or fermentation. One of the byproducts of this problem is bad breath. To correct this imbalance, use a probiotic.

• Diarrhea caused by intestinal parasites is the third leading cause of illness. If you have a number of the following symptoms: gas, diarrhea, chronic constipation, bloating, fatigue, skin rashes, nail biting, mood swings, insomnia, dry skin, brittle hair, hair loss, weight gain, bad breath, and muscle cramping, you should be tested for parasites.

• Dental problems, especially periodontal disease and tooth abscesses, are often the cause of bad breath. These infected areas harbor large quantities of bacteria from the infection and foods eaten which have been allowed to putrefy. Other dental sources are gaps between teeth or crooked teeth, both areas where food can be left to decay. Vitamin deficiencies, especially vitamin C and niacin, are the cause of some gum diseases, so follow the supplementation recommendations listed below. Don't chew gum or eat candy, as the sugar can leave a residue that promotes rapid bacterial growth. Each person's body chemistry is different, so what works for somebody may have no effect on somebody else, all due to that person's chemistry. See our gingivitis/periodontal section for more information on dental problems.
Changes to Make

Ridding yourself of bad breath may be a several step process. By following a step-by-step program you may find the cause of bad breath and be able to eliminate the problem. Try this program over several weeks and see what works for you.
Oral Hygiene

Practicing good oral hygiene is always important, so start here. There are three areas of concern in the mouth: the tongue, teeth, and gums. Brushing your teeth, flossing, and cleaning your gums, followed by rinsing thoroughly, will help minimize the problem by removing the buildup of bacteria. The tongue may be loaded with decaying food particles and bacteria that cause bad breath. Brushing or scraping your tongue first thing in the morning and before bed will help eliminate the problem here. See our Product. By removing the buildup of decayed material, a major breeding ground for bacteria, you will reduce your plaque as well. The plaque leads to periodontal disease, which, in turn, can lead to heart disease. So this oral hygiene step is very important to your overall health!

• Get your teeth cleaned and any cavities filled. Plaque and cavities are a great breeding ground for the bacteria that cause bad breath.

• Another way to improve your oral hygiene is to use a water pik after breakfast. Put an ounce of hydrogen peroxide in the water.

• Try brushing your gums and tongue with some powdered cloves or myrrh.

• Brush your tongue twice a day with a toothbrush soaked in chlorhexidine (an antibacterial agent).

• Swish water around in your mouth after each meal or snack. This will reduce the food particles or drink residue (primarily sugar) that may lead to your bad breath.

• Although mouthwashes will solve some of the immediate problems, you must get at the root of the cause. Mouthwashes in general are only a temporary mask for the problem, and their effects last only half an hour or so. Gargle with an antiseptic mouthwash. Try to find a mouthwash that has as little alcohol as possible, as the alcohol will make the problem worse! Also, frequent use of a mouthwash with more than 25% alcohol has been linked to an increased incidence of oral cancer. For a non-alcoholic mouthwash, use a mixture of 50% hydrogen peroxide (3% solution) and 50% water, and swish it around for 30 seconds and expectorate.

Your saliva is important in the fight against bad breath as it suppresses bacteria that cause it. Anything that reduces the saliva output, such as alcohol, antianxiety drugs, smoking, stress, and medications such as decongestants and diuretics, allows the microorganisms to proliferate.
Dietary

Eliminating certain types of foods, such as high-fat foods, meat, sugar, exotic spices, and dairy products is the next step in pin-pointing the cause of bad breath. The types of food you eat may be one of the reasons for your bad breath. Acidic foods, for instance, create an environment for bacterial growth. High-fat and high-protein foods may not digest well and give off gas. Some people have a hard time metabolizing meat and dairy products, with the result being bad breath.

Sugary foods are a problem as the bacteria in the back of the throat feed off the sugar.

Garlic, onions and exotic spices (such as curry) are common sources of problems for many people. As these foods are digested certain compounds are transmitted from the blood through the lungs and exhaled for up to 24 hours.

Cheeses, such as blue, Camembert and Roquefort, fish, especially canned tuna and anchovies, and spicy deli meats are often the culprits.

Beverages such as coffee and tea are other possible sources of bad breath. They are both very acidic. Cut back on these and see what happens.

Eat more fruits, especially kiwi, papaya and pineapple, which contain digestive enzymes. Vegetables are very important, too, especially leafy green ones. See Digestion/Intestinal Health in our Ailments section for more tips and products that will help the digestive process.

Supplements

Vitamin B A deficiency of B vitamins may be the cause of your bad breath, so try taking 50 mg of niacinimide with each meal, plus a high potency B complex tablet and 50 mg of B6 once a day.

Vitamin C in divided daily doses of 1,000 to 6,000 mg will help rid the body of excess mucus and toxins that may be the cause of bad breath.

Zinc A deficiency in zinc may be another cause; take 30 to 60 mg per day. Don't take more than 15 mg. of zinc for more than a week or ten days without medical supervision as high levels of zinc can interfere with the absorption of copper.
Digestive system

Another step to take is to improve your whole digestive system. By changing your digestion you may well eliminate the cause of your bad breath. A high-fiber diet emphasizing whole grains and fruits and vegetables is essential for optimum digestion. Stay away from high-fat foods. Eating yogurt or acidophilus will help balance your stomach by adding beneficial bacteria which will improve digestion.

There may be three causes of improper functioning of your digestive system.

• First, your system may be lacking in enzymes necessary for proper digestion. This is especially prevalent in older people. To remedy this problem take 2-4 tablets of digestive enzymes with each meal.

• An imbalance of good and bad bacteria in your gut, as mentioned above. Take a probiotic supplement that contains good bacteria like acidophilus and bifidus.

• A second problem may be the lack of enough hydrochloric acid, the production of which declines with age. To remedy this, take a tablespoon of apple cider vinegar before each meal. Another way to get the necessary hydrochloric acid is to take 10 grains of betaine or pepsin tablets before each meal to aid digestion.

Detoxification of your bowels is another important step to take as many health problems are caused by poor bowel functions. See our Detoxification and Digestion/Intestinal Health sections in our Ailments section for more information and products. For instance, constipation may be the cause of your bad breath. Putrefied food may be stuck in your intestines and give off noxious gas. See our Constipation section for a detailed list of remedies and tips on solving the problem, as well as the sections mentioned above. Many people who are constipated don't drink enough water. For optimum health, drink eight 8 ounce glasses of water a day.

Another important thing to do is eat plenty of fiber. Eating several servings of yogurt with live cultures will help regain a balanced intestinal flora and get the bowel to function the way it should. This will help the constipation problem and get your intestines working properly. Or, you may not realize specifically that you have a bowel problem, so it is important to cleanse the bowel to eliminate this as a possible source. If you have a tendency to over eat your stomach's digestive enzymes may not be able to complete the digestion process and gas may be emanating from the intestines.

In some cases a deficiency of vitamin B6 is the cause. Since B6 is not plentiful in foods, this deficiency occurs frequently.
Remedies
Folk

Apple cider vinegar Take a tablespoon of apple cider vinegar just before each meal. You may want to take it in a glass of water. This will aid your digestion.

Baking soda Brushing your teeth with baking soda (or a paste made with hydrogen peroxide) will help reduce the acidity in your mouth and make a less-friendly environment for the bacteria to grow.

Charcoal Take 5 gm. daily of activated charcoal to cleanse the stomach and intestines. Charcoal absorbs toxins and is a natural purifier.

Hydrogen peroxide The sinuses can become infected and cause bad breath. If this is your problem, the best treatment is using hydrogen peroxide (H2O2). Use the drugstore variety, which is three percent, dilute it 50% with water and put five to ten drops in each nostril and sniff vigorously. It may burn a little. Do this twice daily and see if it helps. If it doesn't, your sinuses are not the problem.

Water, salt Gargling with salt water will help clean out bacteria, mucus and food particles on your tonsils or the back of your throat that may be causing your bad breath.
Herbal

Alfalfa tablets may help eliminate bad breath.

Anise Chew anise, cardamom, dill or fennel seeds to help mask odors. Anise, the licorice-flavored seed, kills the bacteria that cause odor.

Chlorophyll Try liquid or chlorophyll tablets which you can buy at your pharmacy. Chlorophyll has a deodorizing effect and is used in a number of products for that purpose. See our Product.

Cloves Cloves are a powerful antiseptic. Make a tea by putting 3 whole or 1/4 teaspoon ground cloves in 2 cups of hot water, and steep for 20 minutes, stirring occasionally. Pour through a fine strainer and use as a mouthwash or gargle twice a day.

Fennel Fennel is another useful herb and can be used in several ways. Slowly chew the leaves and allow the saliva to build up in your mouth. Or, mix the contents of a fennel capsule with baking soda, make into a paste, and brush your teeth, gums and tongue with it. The fluid extract of fennel can be rubbed on your gums and tongue.

Filberts Chew some filberts (hazelnuts) slowly as they will absorb the bad breath.

Herbs Chewing mint, parsley, basil, rosemary, thyme and wintergreen will help mitigate bad breath.

Lemon Suck a lemon wedge sprinkled with salt to stop onion or garlic breath.

Myrrh Dissolving a pea-sized piece of myrrh in your mouth before bed or sucking a small piece of cinnamon bark during the day may help relieve the problem.

• It can be made into a tea. To make the tea add 2 sprigs of coarsely chopped parsley, 3 whole spice cloves, 1 teaspoon of powdered myrrh, and 1/4 teaspoon powdered goldenseal to 1 pint of boiling water. Steep. Stir occasionally while cooling, then strain and use as a mouthwash.

Parsley & mint Chewing parsley or mint leaves has been a remedy used for thousands of years. These herbs are especially good if garlic and onions are the source of your bad breath. Parsley is very high in chlorophyll. Chew a few parsley sprigs dipped in vinegar for immediate relief. If you swallow the leaves after chewing them they will be digested and continue to provide breath freshness for quite a while. These plants seem to reduce the production of intestinal gas by promoting better digestion.

• Natural gum made with spearmint or peppermint essential oils will also be helpful. These oils kill odor- causing bacteria, and the chewing action stimulates the production of saliva which helps combat bad breath.

Sage Chew sage. It contains essential oils with antibacterial properties that help neutralize one of the causes of bad breath.

Spirulina is a very good source of chlorophyll and can be purchased either in capsule or loose form. Start with 500 mg three times a day.

Tea Another tea may be made by steeping 2 sprigs of coarsely chopped parsley, 3 whole cloves, 1 teaspoon of powdered myrrh and 1/4 teaspoon powdered goldenseal in 1 pint of boiling water. Stir occasionally while cooling, strain, and use as a mouthwash. Can also be used for a sore throat. Alfalfa is rich in chlorophyll. Drink alfalfa tea several times a day to keep your breath fresh. To make the tea, put two teaspoons of dried leaves in a cup of boiling water and steep for 10-20 minutes. You may also find alfalfa tablets at an herb or health food store.

• Peppermint or fenugreek are other good herbs to use in a tea to sooth the stomach. They are exhaled through the lungs and help sweeten the breath.

Tea tree oil Tea tree oil, derived from the leaves of the native Australian Melaleuca alternifolia tree, contain antiseptic compounds that make it a powerful disinfectant. Try using a toothpaste containing tea tree oil, or put a few drops of tea tree oil on your toothbrush alone, or with your regular toothpaste. It has a strong aromatic flavor.

Read online/Free Download of "It's Your Life - A Practical Handbook for Chronic Ailments" and "The Caregiver's Manual" at:
http://www.stormpages.com/sbhagwat/

quote:

Since dehydration leads to constipation and digestive problems, it is very beneficial to drink 6-8 eight ounce glasses of water a day. Juice, coffee, tea, colas, etc. don't count!

This statement hardly applies to many Dialysis patients. I only wish I could drink that much water daily! Many of us have little or no output at all.

Sorry, I guess that I neglected to read the comment that stated that the remedies for bad breath were intended for the general public and that dialysis patients for keep their diets and fluid restrictions in mind.

was that long post in reply to mine? The reason I ask is because most of that stuff is common sense. And it may mislead patients to believe that it is their own damned fault that they have bad breath as if they have bad higene or what ever.

So that is why I decided to say this:

My dentist could vouch for me on this. I am 32 years old and have never had a cavity a day in my entire life. I have never needed to be drilled or get fillings or any of those other things I have only heard about.

So what does this mean? It means that there is nothing you can do about it. Face it. If you have E.S.R.D. (End Stange Renal Disease) you WILL have bad breath. Why? Because you have waste products in your blood!

My mother, a hair dresser, even noticed things doctors will NOT notice. But a hairdresser would because their hands can notice things others wouldn't. My hair is not as smooth as some one who is healthy. It has the tiniest bumps along each hair. (I have tried to feel them and can't) Why? Because the hair is only as healthy as the body it grows from. And dialysis patients have bad blood from kidneys not cleaning it.

But what about dialysis you ask? Well dialysis canNOT do as well of a job as real KIDNEYS can. As simple as that.

Is there ANYTHING I can do for bad breath? Well there are things you can do. But to talk about preventing bad breath as a dialysis patient is totally rediculous! I just wanted to say that much!

actually the post before the long one is the best answer I see so far here:

quote:

Originally posted by Dave M:
Hi, DD. You say you are 5 years on pd, but I am guessing from your question that you are new to the web. RenalWEB is a great place to start looking for answers, and I would also recommend the American Association of Kidney Patients (http://www.aakp.org).

Here's a quote from AAKP nutrition page:

"Urea is a waste product that comes from eating protein. Healthy kidneys get rid of urea in the urine. Sick kidneys do not rid get of enough urea in the urine. Urea builds up in your blood. Blood urea nitrogen (BUN) should be between 5 and 25 mg/dl. Eventually, people with kidney disease may have a bitter taste in the mouth. Urea will accumulate in your saliva, which can cause a bad taste and bad breath."

Maybe you are not getting enough clearance and you are tasting the urea left behind? Maybe something in your diet? Search nutrition sites especially, because it doesn't sound like a dental problem or any kind of infection or inflammation.

The best help is SELF HELP, you just need to get yourself pointed in the right directions. (http://www.aakp.org)

Also check the side effects of your meds, some of them can cause bad breath and maybe your doctor can put you on a different pill to stop it. This might not be the cause, but is worth a check. :>

quote:

Originally posted by Jeckel:
Also check the side effects of your meds, some of them can cause bad breath and maybe your doctor can put you on a different pill to stop it. This might not be the cause, but is worth a check. :>

good idea

Gastric problems can also cause bad breath! If you have acid reflux and bad breath it's certainly something to consider; a trip to the GI doctor might be in order also. Lin.

I know that isn't the problem with me. I think it is just that all dialysis patients have bad breath. Is this true? I think it is because of the urea.

I think a lot of people in general have bad breath; dialysis pts. are no exception but if they are getting adequate clearance rates urea is certainly not the problem, and I would be looking elsewhere, and too making a trip to the dentist to make sure dental problems aren't the cause. Lin.