Bad Breath - Causes and Treatment of Halitosis

Why do I need to write this article?

In the last, nearly 25 years of seeing clinical patients I have observed Halitosis or bad breath is the third most frequent reason for patients seeking dental aid, following tooth decay and gum disease.

Recently this area has witnessed growing technology and communications, particularly an enormous increase in advertisements for bad breath remedies on television, the internet, and in magazines.

This, in turn, has raised the levels of information and misinformation about bad breath among the patients.

Lack of knowledge on how to prevent halitosis allows for its occurrence thus limiting the patient’s quality of life. As social relationships are one of the pillars of quality of life, -halitosis needs to be considered a factor of negative interference in our day-to-day social interactions.

Who can have bad breath?

No one appears to be immune to having bad breath at one time or another. In nearly 2 decades of clinical practice, we at Smileesence - the Specialist Dental Centre have found Bad breath can be an indication of-

A problem with your digestion,
An initial or progressed gum disease.
Indication of an allergy,
An acidic metabolic system,
Low immunity or
Most often ---- an inadequate oral hygiene

Impact on you

Most people have some element of transient unpleasant oral odour at some time or other during their lifetime and it is seen that most patients tend to avoid addressing the issue or hide it, till the time someone (usually their family members) points out the fetid odour.

In the last 2 decades of dealing with so many patients, we at Smileesence have found that patients only come to the clinic when the smell has turned severe or longstanding, with the patient's feelings.

A decrease in self-confidence
and a marked decrease in his/her social interactions.
Personal discomfort
Social disagreements among colleagues and friends.

In some instances, it is only when the patient hears the idiom “Please don't breathe until you have reached a desert.” Finally leads the patients to approach our center.

Incidence and occurrence of bad breath

10-30 percent of population
Approximately 50% of middle-aged and older individuals emit socially unacceptable breadth
The reported incidence ratio between female and male patients with oral malodour is almost the same; no gender-based differences.

However, it has been observed that women seek treatment more often than men.

A brief interesting history of our ancestor’s bad breadth

You may be surprised to read this little historical note-

References have been found citing bad breadth, in papyrus manuscripts dating back to1550 BC
During the early days of Christianity, it was presumed that sins produced a more or less bad smell hence the person may be having the devil's supreme malignant odor (smell like sulfur).
A treatise in Islamic literature in the year 850 talked about dentistry, referring to the treatment of fetid breath, and recommended the use of siwak when breath had changed or at any time when getting out of bed.
The Hindus consider the mouth as the body's entry door and, therefore, insist that it be kept clean, mainly before prayers. The ritual is not limited to teeth brushing but includes scraping the tongue with a special instrument and using mouthwash.
Buddhist monks in Japan also recommended teeth brushing and tongue scraping before the first morning prayers.

What factors cause Bad Breadth?

It has been observed, that most bad breath causes can be broadly grouped into four main reasons-

Oral diseases (90% the cause due to mouth diseases)
Nasopharyngeal diseases.
Bacterial decomposition of food particles,
Decomposition of used cells, blood, and some chemical components of saliva in your mouth.

Bugs in your mouth cause bad breath.

There are many. Let’s name a few-

Prevotella (Bacteroides) melanogenic,
Treponema denticola,
Porphyrgingivalis,
Porphyromonas endodontalis,
Prevotellaintermedia,
Bacteroides loescheii,
Enterobacteriaceae,
Tannerella forsythensis (Bacteroides forsythias),
Centipedaperiodontii,
Eikenella corrodens,
Fusobacterium nucleatumvincenti,
Fusobacterium nucleatum, and
Fusobacterium periodontium..........................should I go on??........

Local sources of mouth odors..... Are

The tongue
The gum sulcus
Food particles on and between the teeth,
Coated tongue
Dehydration states,
Caries,
Artificial dentures,
Smoker's breath,
Healing surgical or extraction wounds.

Common causes of halitosis...

Local Causes

A. Oral disease

Food impaction
Acute gum disease
Pericoronitis (flap like gum over your last molar)
Dry socket (unhealed tooth socket after extraction)
Xerostomia (dry mouth/ less saliva in mouth)
Oral ulceration
Oral malignancy

B. Respiratory disease

Foreign body
Sinusitis
Tonsillitis
Malignancy Bronchiectasis (lung disease)

C. Volatile foodstuffs

Garlic
Onions
Spiced foods

Systemic (body) Causes

Acute febrile long-standing illness
Respiratory tract infection
Helicobacter pylori infection (a dirty bug)
Pharyngo-oesophageal diverticulum
Gastro-oesophageal reflux disease (you’re burping)
Pyloric stenosis
Duodenal obstruction (your intestines)
Hepatic failure (your liver)
Renal failure (your kidneys)
Diabetic ketoacidosis
Leukaemias
Hypermethioninaemia Menstruation (menstrual breath)

How you can be certain that you have bad breath?

Smelling the exhaled air of the mouth and nose and comparing the two.
Spoon test
Dental floss and then check for odour,
saliva odour test.

Some effective home methods to reduce the bad odour are-

Start with your teeth…do Effective teeth cleaning, including thorough brushing and interdental flossing.
If oral hygiene is already good and still oral malodour persists, then check your tongue and do tongue cleaning also.
It has been observed that some Chewing gum can be used but they seem to lead to only a temporary reduction in oral malodour.
Try mouthwashes…they may be effective in a few cases but again may be a transient reduction…Try using.

A. Triclosan containing mouthwashes and toothpaste.

B. Chlorhexidine gluconate containing mouthwashes.

C. A mouthwash containing a combination of chlorhexidine/cetylpyridinium chloride and zinc lactate.

However, please remember when you use mouthwashes for too long it may give rise to a burning sensation of the oral mucosa if used too frequently, and may even cause (reversible) staining of the teeth. So use judicially.

If even after the above the bad odour does not decrease or goes for a short time and comes back again, we recommend seeing our team of specialists at Smilessence – The Specialist Dental Centre.

Conclusion

The relation between mouth odors and social aspects has always been a source of concern in our society while it has been observed that we all, in the attempt to hide the bad odour have since time immemorial used a plethora of chemicals and substances that often turn out to be more harmful.

It is always better to get experts advice on the first instance of bad odour-

To keep your breath smelling minty-fresh remember to.