Bad Breath (Halitosis)

Definition

Bad breath (halitosis) is an embarrassing condition where an unpleasant odor emanates from the mouth. Intake of certain food, poorly maintained dental (oral) health, smoking, alcoholism and certain medical conditions can cause bad breath. Bad breath is among the top three conditions for visiting the dentist’s office (others are tooth decay and periodontal problems). Maintenance of oral hygiene and treatment of associated medical problems are the mainstay of managing bad breath.


Symptoms

The odor of bad breath depends upon the underlying cause like “

  • Fetor hepaticus: smell of fecal matter in breath in chronic liver failure cases.
  • Fish odor (malodor) syndrome (trimethylaminuria): it is metabolic disorder where there is increased trimethyamine excreted via urine, sweat and breath. Usually women are more commonly affected than males (mostly during menstruation, menopause).

Most people suffering with halitosis cannot detect the offensive odor. It therefore is difficult for a person to test for bad breath on his own so help of other family members should be sought. About one out of four patients visiting the dentist’s office for bad breath actually have no bad breath (delusional halitosis). Bad breath can cause anxiety, embarrassment and even affect a person’s interpersonal relationships.

Causes

Bad breath can occur due to various causes and the offensive odor may not always originate from the mouth.

  • Mouth (most common site): At least 600 different types of bacteria naturally occur in the mouth. Odors are mainly produced by them due to break down of proteins which ultimately produce foul gas. Dry mouth is one of the most common causes of bad breath (like after waking up, morning breath).
  • Tongue: The tongue is the main cause of bad breath originating from the mouth. There are naturally occurring bacteria on back of the tongue which are not disturbed by mouth cleansing. Apart from this the upper portion of the tongue harbors odor producing bacteria which thrive under the influence of food particles coating the tongue.
  • Gum and teeth : Gum disease like gingivitis or periodontal disease can produce bad breath. Other part of the mouth like faulty dental work, unclean artificial teeth, food impact in between the teeth.
  • Throat : Infection of the tonsils can often produce bad breath.
  • Nose: The nasal cavity is an important site for the production of offensive odors.
  • Esophagus : Gastroesophageal reflux disease (GERD) is a common yet under diagnosed cause of bad breath.
  • Various medical ailments like liver disease, kidney disease, diabetes mellitus and lung infections,
  • Cigarette smoking and alcohol misuse are common lifestyle cases of bad breath.
  • Certain foods, like consuming garlic or onion, are major dietary causes of halitosis.

Treatment

Maintenance of proper oral hygiene by brushing twice daily using a fluoride toothpaste, tongue brushing, flossing and the use of mouth rinses are the best ways to treat bad breath. Even if the source of the offensive odor is not from the mouth, these measures will help reduce the intensity of the odor.  Dry mouth favors bacterial growth therefore the use of sugar free chewing gum is recommended.

Dietary and lifestyle modification may be helpful depending on the cause of halitosis. Other measures to treat bad breath depend on the underlying causes. In these instances bad breath is just one symptom of the disease. Therefore by treating the core medical problem appropriately, the symptom of bad breath may ease or even resolve completely.

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