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Combating Bad Breath

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Bad breath is a common condition, which usually originates in the mouth itself, and thus falls under the responsibility of the dental practitioner. In individuals with a healthy periodontium and good oral hygiene, bad breath usually comes from the posterior tongue dorsum, and can be treated by regular deep tongue cleaning. Nasal problems are an important secondary cause of bad breath, and are easy to detect by comparing the odour existing in the mouth and the nose.

Numerous other medical conditions can lead to bad breath, but are found very infrequently, as compared to the odour of oral and nasal etiologies. Contrary to popular belief, the gastrointestinal tract is rarely, if ever, responsible for chronic bad breath. Because people have trouble assessing their own oral malodour, many individuals develop greatly exaggerated concerns of suffering from bad breath ("halitophobia"), while millions of others remain ignorant of their own oral odours. In most cases, good professional oral care combined with a daily regimen of oral hygiene including inter dental cleaning, deep tongue cleaning and optional use of an efficacious mouth rinse, will lead to improvement.

Halitosis and its management are fast becoming a part of dental practice. One of the strong reasons to render this treatment service in a dental practice is the power of this concept as a marketing tool. Management of halitosis is an excellent way of attracting new patients, especially those who are not regular users of dental services.

Fear of pain is a major factor preventing people from seeking dental treatment. Since the management of halitosis is often viewed a "non dental" procedure by the public, it does not carry the psychological impact of other dental treatments. The idea of getting freedom from bad breath can be a strong motivator for the acceptance of dental treatment, particularly for periodontal disease, a major source of halitosis.

Update April2008:
Solobacterium moorei is the organism largely responsible for chronic bad breath, or halitosis, biologists reported Saturday at the annual meeting of the American Association for Dental Research in Dallas. For full news release click here

Causes of Halitosis

  1. Odour causing foods: Whatever food one consumes, affects the air exhaled and some of them like garlic and onion contribute to objectionable breath odour. After getting absorbed into the blood stream the food is transferred to the lungs, where it is expelled. The odour stops when the body eliminates it fully. Infrequent eating can also cause unpleasant breath.
  2. Lack of Oral hygiene: If brushing and flossing is not done regularly, or if dentures are not cleaned properly, the food particles remain, collecting bacteria and causing bad breath. This appears to be due to the breakdown of proteins by a variety of bacteria. Several of the breakdown products are foul smelling gases. The posterior part of tongue is also an important source of bad breath. The postnasal drip can get stuck on the tongue, which is then broken down by bacteria on the tongue surface.
  3. Dry Mouth (Xerostomia): Saliva is necessary to cleanse the mouth and remove particles that may cause odour. Dry mouth can be the result of continuous breathing through the mouth, salivary gland problems or various medications.
  4. Tobacco products cause bad breath, stain teeth, reduce one’s ability to taste foods and irritate gum tissues, increasing the likelihood for periodontal disease.
  5. Periodontal Disease: Persistent bad breath or a bad taste in the mouth is one of the warning signs of periodontal disease.
  6. Sinus and respiratory infections: If bad breath appears suddenly in a child, it can mean the onset of a throat infection, bad breath will cease with the cure of throat infections.

The Tongue, teeth and gums are common sources of oral malodour, particularly subgingival and proximal areas. Margins, overhangs, leaky crowns, and periodontal pockets are prime sites for anaerobic bacterial activity leading to putrefaction.

When in doubt concerning the oral etiology of the odour, the patient may be instructed to rinse and gargle for a week with a potent antibacterial mouthrinse (e.g., chlorhexidine-containing mouthrinses which have been shown in several studies to reduce odour levels significantly (p<0.001) for long periods following use). If malodour is significantly reduced, then an oral origin may be inferred.

It is known that Volatile Sulphur Compounds (VSCs) are responsible for the bad odour, and 80-90% of these comes from oral sources. VSCs are produced by bacteria and cellular degradation and include hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Since oral odour can originate from sources other than the oral cavity, thorough examination and history are required for correct diagnosis.

It is now possible to quantify the level of VSCs. Halimeter- a gas analysis sensor, similar to breath analyser in design can detect and measure the level of VSCs. This provides an indication of the severity of the problem, its primary source and helps to monitor improvement.

The VSCs can be neutralized with a product containing a stabilized form of chlorine dioxide. Mouth rinses, tooth pastes and gels which contain this ingredient are pleasant for the patient to use and non-irritating to oral tissues. Combining their usage with other standard oral hygiene procedures, and promoting the use of tongue scrapers will effectively manage the worst of problems.

There is growing evidence that VSCs increase the permeability of the periodontal membrane to bacteria, and may play a role in its destruction process. Decreased levels of VSCs will show the opposite effect i.e. decreased permeability. It will often be a pleasant finding that you treat the patient for a primary complaint of halitosis, and you see a significant improvement in the periodontal condition.

Halitosis is a very prevalent problem. It may simply be embarrassment to some, but it may also be the sign of potentially serious problems in others. After a professional cleaning and checkup if the patient thinks he has constant bad breath, ask him to keep a log of the foods he eats and to make a list of medications he takes. Referral to a physician may be necessary to rule out systemic involvement.

Halitophobia, or the fear of bad breath is believed to exist in about 15% people. These persons beleive they have bad breath but in reality they do not have it. It can cause unnecessary pshycological problems for those affected.

Advice to People with Bad breath

  1. Brush teeth after breakfast and dinner and get a professional cleaning done.
  2. Floss the teeth to remove the food particles from interdental areas.
  3. Clean the tongue by brushing or using tongue scraper.
  4. Drink plenty of liquids.
  5. Chew sugar free gum for a minute or two to stimulate saliva flow especially if mouth feels dry.
  6. Rinse mouth with water every time you drink or eat especially milk products and fish or meat.
  7. Denture wearers may soak denture in antiseptic overnight.
  8. Use a suitable mouthwash, or even better wash frequently with water.
  9. Eat fresh fibrous vegetables such as carrots.
Frequently asked Questions about Bad Breath

Reference:

  1. Brit. Dent. Assoc. News release Sept 1996
  2. J. of Periodont. Res. 27:233-238,1992
  3. JADA 127:475-482, 1996.

4. Internet.


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