Children can develop bad breath for the same reasons that adults do. If bad breath is a problem, the child's dental hygiene routine may need a boost. Regular brushing of the teeth is good, but it is often not enough. In some cases, additional factors are at work, and a more detailed investigation is necessary to identify and treat them.
Oral Causes
Garden-variety halitosis in children arises when certain bacteria, called gram-negative anaerobes, act on plaque and debris that collect in the mouth, Dr. Daniel Ravel, a pediatric dentist in Fayetteville, North Carolina, writes on his practice's website. Factors that increase the likelihood or severity of bad breath include dry mouth, postnasal drip, sinusitis and dental problems. Food and debris sometimes accumulate in crypts in the tonsils and cause a foul odor. The worst halitosis, Ravel writes, occurs when dying oral epithelial cells become lodged in the crevices at the back of the tongue.
Non-Oral Causes
The origin of bad breath can lie outside the oral cavity. For example, several types of medicine, including antihistamines, bronchodilators, antispasmodics, antipsychotics and antidepressants, can cause a dry mouth that leads to halitosis, Revel writes. A course of antibiotics can also lead to bad breath via a temporary imbalance of oral bacteria. Uncontrolled diabetes can, over time, cause ketoacidosis and resultant changes in mouth odor, causing the breath to have an acetone smell.
Diagnosis
A doctor or dentist evaluating a child for potential halitosis first takes a detailed medical history, including notes on the current or past use of any medications, Ravel writes. The next step is a thorough clinical examination, including a check for gum disease, salivary gland problems, mouth sores, dental decay, faulty tooth restorations and issues with orthodontic appliances. Finally, the health professional will evaluate the odor of the mouth by the "organoleptic technique," or essentially the smell test, or with a device called a portable sulfide monitoring unit, or Halimeter.
Treatment
Gently cleaning the tongue, particularly the middle third of it, can disrupt the coating of bacteria and debris that may be the main source of the problem, Ravel writes. Flossing is also key, but children younger than 8 years old generally need help from an adult. If the bad breath is because of a dry mouth, the child should drink plenty of sugar-free fluids; the dentist may also recommend chewing sugar-free gum. The restoration of teeth damaged by cavities can solve some cases of bad breath, as can the treatment of gum disease through improved oral or hygiene or, in more severe cases, medications and surgery.
Warning
Small children sometimes put objects in their nose, and one can become stuck without the parents knowing about it. Bad breath can be a clue that something is there, Dr. Vincent Iannelli, a pediatrician, writes on the website Keep Kids Healthy. Such a "nasal foreign body" can become infected and requires medical attention. Another potential hint is a greenish discharge from one nostril.
