Combating Bad Breath
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
- 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.
- 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.
- 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.
- Tobacco products cause bad breath, stain teeth, reduce one’s ability to taste foods
and irritate gum tissues, increasing the likelihood for periodontal disease.
- Periodontal Disease: Persistent bad breath or a bad taste in the mouth is one of the
warning signs of periodontal disease.
- 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
- Brush teeth after breakfast and dinner and get a professional cleaning done.
- Floss the teeth to remove the food particles from interdental areas.
- Clean the tongue by brushing or using tongue scraper.
- Drink plenty of liquids.
- Chew sugar free gum for a minute or two to stimulate saliva flow especially if
mouth feels dry.
- Rinse mouth with water every time you drink or eat especially milk products and fish or
meat.
- Denture wearers may soak denture in antiseptic overnight.
- Use a suitable mouthwash, or even better wash frequently with water.
- Eat fresh fibrous vegetables such as carrots.
Frequently asked Questions about Bad Breath
Reference:
- Brit. Dent. Assoc. News release Sept 1996
- J. of Periodont. Res. 27:233-238,1992
- JADA 127:475-482, 1996.
4. Internet.
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