Patty Zeitz's father nicknamed her "buffalo breath." Her brother warned visitors: "Don't go into Patty's room. There's a green cloud over her bed."
Along with an estimated 25 million Americans, Ms. Zeitz was the victim of chronic halitosis, or bad breath. "It was hell," says the 24-year-old Philadelphia resident. "The first time my date kissed me was usually the last time."
These days, Ms. Zeitz breathes easily. The nation's first halitosis clinic, opened in Philadelphia in 1993, cured her bad breath, she says. And with that clinic's success, bad-breath centers are sprouting all over the country. Last month, 10 dentists in the Baltimore area brought the concept to Maryland, opening what they call the Great Breath Centers.
Dr. Harold S. Marks, owner of Family Dental Associates in Eldersburg, assembled the group. He says recent research into the causes of halitosis, the development of a device -- the halimeter -- for measuring bad breath, and the availability of deodorizing toothpastes and mouth rinses have made it "an easily treatable condition."
"Patients are always asking their dentists and physicians: 'What can I do about this breath?' " Dr. Marks says. "In the past they've been told: 'Just brush and floss, and everything will be OK.' But now we know that's simply not the case."
Bad breath is usually caused by bacteria on the back of the tongue. This produces sulfur compounds that release foul-smelling gases. The amount of bacteria varies from person to person, and some saliva cleanse tongues better than others. In most cases, Dr. Marks says, reduce and deodorize the bacteria, and you've wiped out offensive breath.
Though simple, that's a fairly recent discovery. Research
focusing on bacteria as the culprit did not commence until the late 1970s, says Dr. Jon L. Richter, who runs the Philadelphia clinic. Most dentists who treat halitosis now agree on the cause, he says. It's the remedy that's in dispute.
The Baltimore-area dentists prescribe products manufactured by Oxyfresh USA of Spokane, Wash., whose motto is: "The peace of min
d product line." Oxyfresh makes toothpaste, rinse and mints as well as vitamins, shampoo and pet products -- including one to eliminate dogs' bad breath.
Dr. Richter says Oxyfresh products "really don't perform a lot better than water." He promotes a rinse he developed called ProFresh.
Dr. Marks responds mildly: "If you get 10 doctors in a room, you might get 10 different opinions. Our group felt this product [Oxyfresh] was effective. Just eat a sandwich with onion on it, and then use the toothpaste and mouth rinse. The odor of onion in your mouth is gone."
ADA takes no stance
The American Dental Association (ADA) endorses neither product. Its spokesman, Dr. Richard H. Price of Newton, Mass., says the ADA takes no stance on breath clinics because it considers bad breath a social, not a medical problem.
"Certain odors are not as offensive to some people as they are to others," Dr. Price says. "For example, many Europeans think we Americans shower too much."
Despite the ADA's indifference, Dr. Price, as a practicing dentist and a showering American, has reason to be interested. Dr. Price has, in his own words, "a breath problem."
He visited Dr. Richter in Philadelphia and embraced the regimen, including scraping bacteria from the tongue and then swishing with ProFresh. Dr. Price later experimented with commercial mouthwashes and decided they worked just as well.
"It works for me," he says. "And that's what I tell my patients: 'Try this first. If this doesn't work, then try the clinics.' "
Dr. Price tells his patients to buy a tongue cleaner at the drugstore or simply to use a teaspoon turned upside down. Scrape your tongue morning and night as far back as you can stand it -- "even farther back than you can stand it," he says. "You'll eventually get over the gagging sensation." Also, watch your diet and make sure your mouth is healthy and clean. That should take care of most breath problems, he says.
"You know, we make a lot of jokes about bad breath," Dr. Price adds. "But some people are actually paralyzed by what they perceive as their own breath problem."
Dr. Richter says he has treated patients who were unable to work, had left marriages, lived in isolation and even threatened to commit suicide because of bad breath. "There's a very strong psychological component to this," he says. "I'd say 80 percent of my halitosis patients have an exaggerated opinion of how bad their breath odor is."
'Brainwashed by TV'
Dr. Mark Shulman, whose office in Towson includes one of the Great Breath Centers, says the patients he has seen so far fit that mold.
"They are extremely concerned and anxious about everything -- about how they look, how they smell," he says. "They're all real self-conscious. . . . We've all been brainwashed by TV: Don't smell -- it's a big thing."
Dr. Shulman and his cohorts first make sure a patient's bad breath is not the result of tooth or gum disease or a medical condition, such as diabetes, lung cancer or a sinus infection. Then they bring on the halimeter. A straw inserted into the mouth and then into the nostrils gently sucks air into the device, which measures sulfur compounds in parts per billion. A reading of 150 or higher is cause for concern; 300 or higher might cause one to step backward.
Dr. Manny Shaw, president and founder of Interscan Corp. in Chatsworth, Calif., invented the halimeter. It's a modified version of a toxic-gas monitor used in industry. He has sold nearly 1,000 in the past few years to dentists opening breath clinics, he says.
"They're beginning to pop up like dandelions," Dr. Shaw says. "The halimeter gives them a way of actually putting a number on breath, instead of just smelling it and saying, 'Phew, that's bad.' " It also lets patients follow the progress of their treatment, he says.
Just how are the treatments -- which cost $100 to $125 each -- progressing for the hundreds who've called the 10 Great Breath Centers? Dr. Marks says very well, but he declines to ask patients to be interviewed, citing doctor-patient confidentiality. Does Dr. Shulman have any patients who might talk about their breath?
"Absolutely not," Dr. Shulman says. "They won't even call me until the end of the day, and then they'll say, 'Don't call me at work.' I have to see them on a day when nobody else is here, when it's just them and the chair."
'It changed my life'
But Patty Zeitz, formerly "buffalo breath," talks about her treatment with the zeal of a lottery winner. "It changed my life," she says. "It was like a miracle or something."
She says her parents told her she always had bad breath. "It was something I thought about morning to night," Ms. Zeitz says. "I always felt like I was dirty. I always felt gross. I mean, everybody told me my breath smelled like, well, crap."
She chewed gum and sucked mints constantly -- until she saw a news report about Dr. Richter's breath center nearly a year ago. His treatment last year cost her $400, she says, "but I would have paid a million."
Brushing, rinsing and scraping her tongue worked, Ms. Zeitz says. Her husband, Al Filemyr, confirms that. The 30-year-old mechanic says his wife's breath "sometimes was pretty nasty. You didn't want to have a conversation with her for more than five or 10 minutes. Now there's no smell at all."
Ms. Zeitz chewed gum to make conversation tolerable. But the gum rotted her teeth, and her dental bills have reached $3,000 so far, she says.
She and Mr. Filemyr were married April 1 after dating several years. "I don't know how he put up with me," Ms. Zeitz says. "I know I wouldn't have wanted to kiss me."
She says her greatest fear, before visiting the breath clinic, was having to kiss people in the receiving line at her wedding. "I was afraid people would say: 'The bride is beautiful, but she has bad breath.' "