Bad Breath

Overview

Deterioration of oral health may result from various factors. According to the statistical reports by the World Health Organization (WHO) nearly 60-90% children and about 100% of the adult population suffer from oral disorders. In the majority of the cases, oral and dental diseases are primarily manifested as “bad breath”. Epidemiological studies by The American Academy of Periodontists suggest that nearly 85% of the bad breath cases reported till date originates from the mouth or the oral cavity. This survey also established that about 10-30% of the population in any country suffers from persistent bad breath condition. It causes social embarrassment. In certain cases, bad breath may be an indicator of some major dental or gastrointestinal disorder. Hence the diagnosis of bad breath is necessary to ensure proper treatment.

Definition of bad breath

Bad breath or “halitosis” is defined as the unpleasant odor generated from the mouth while exhaling. It may arise due to diseases of the gum, teeth, nasopharynx, larynx or gastrointestinal tract. Bacterial infections are the prime contributors of malodorous breath. Dietary habits and hygiene conditions also account for halitosis. Bad breath may affect people belonging to any age group or gender. Maintenance of proper health and hygiene conditions is necessary to control oral problems.

What causes bad breath?

The most common causes of halitosis are explained below-

• Mouth problems: Bacteria present in the mouth may interact with food particles trapped in between the teeth or behind the gums. This causes decay and foul odor. Bacteria present at the back of the tongue interact with dead skin cells (mucous cells) and generate bad breath. Presence of excess mucous or drying up of saliva can equally contribute to bad breath.
• Gum diseases: Gingivitis or gum problems can cause a receding gumline due to erosion caused by bacterial agents. This can cause unpleasant breath generating from the infected mucosal tissues.
• Tongue problems: Extremely rough surface of the tongue, the build-up of plaque and formation of pus-filled blisters on the tongue can lead to foul breath.
• Nose problems: Malodour may generate from the nose due to nasopharyngeal infections like sinusitis or nasal sepsis. Excess mucous accumulated within the nose during cold and flu or pneumonia can lead to similar conditions.
• Tonsil problems: Tonsilitis, laryngitis or other problems of the tonsil can lead to bad breath due to inflammation of the tonsil.
• Existing diseases: Patients of a few systemic diseases like gastrointestinal disorders, liver diseases, metabolic disorders, trimethylaminuria (“fish odor syndrome”), kidney infections, respiratory tract infections or gastroesophageal reflux diseases can experience bad breath condition.
• Dental decay: Dental disorders such as dental caries, periodontal diseases, impacted teeth, dental cavities or malocclusion can develop bad odour in breath due to bacterial decomposition.
• Morning breath: People usually experience bad breath in the morning due to bacterial decomposition of residual food in the mouth. In general, during sleeping, secretion of saliva is less, which causes drying up of the mouth. Also, some people have the habit of mouth-breathing during sleep, that dries up the saliva. Again, a few people experience regurgitation of gastric juice in the morning due to indigestion. All these factors can lead to bad breath in the morning.
• Substance abuse: Excessive intake of alcohol and tobacco can cause severe damage to the teeth, liver, and lungs, causing halitosis due to degenerated tissues.
• Diet: Diet containing high quantities of onion or garlic can generate a temporary malodor. Low-carbohydrate diets lead to the generation of “ketone” as the end-product of metabolism. This leads to a pungent odor. A regular diet abundant in proteins, especially animal protein, beans or dairy products may also cause smelly breath.
• Oral hygiene: Poor oral hygiene practices like- not brushing the teeth properly in the morning or not cleaning the tongue frequently can cause bad breath.
• Medications: A few medications like anti-histamines, diuretics or anti-depressants cause drying up of the mouth and saliva. Again, some medications cause the production of extremely thick and sticky saliva. Both the cases may lead to malodor.
• Dehydration: Dehydration resulting from less intake of fluids, consumption of certain dehydrating agents (alcohol or certain medications), existing medical conditions or exposure to extremely dry climatic conditions can lead to odorous breath.
• Dentures: Wearing unclean or poor-fitting dentures can lead to improper cleaning of teeth and cause bacterial decomposition. This can generate foul-smelling breath.

What are the symptoms of bad breath?

The common signs and symptoms of halitosis are as follows-

• Generation of unpleasant odor while exhaling
• Feeling of dryness within mouth and throat
• Frequent use of mouth fresheners or mouthwashes to eliminate bad odor
• Hesitation in interacting with people without covering the mouth
• Presence of bad taste in mouth (especially while eating)

Types of bad breath

Halitosis is broadly categorized into the following types-

• Transient bad breath: This type of bad breath usually stays for a short duration. It arises temporarily due to conditions like drying up of saliva after sleep or having foods like onions or garlic. Transient bad breath usually goes away after brushing.
• Persistent bad breath: These types of bad breaths usually exist for a prolonged period. They may arise due to some serious dental disorders or certain systemic diseases that are not easily cured.

Diagnosis

The following tests are usually recommended by dentists-

• Dental probe (to check for dental caries)
• Dental radiograph
• A complete examination of larynx and nasopharynx
• A full examination of the gastrointestinal tract
• Total examination of the respiratory tract
• Blood tests (Complete Blood Count and ESR)

Treatment and prevention

Treatment 

• Mouth rinse and toothpaste may be prescribed to those who have severe plaque formation on their teeth. These mouth rinses are prescribed to help kill off the bacteria.
• At times, patients are recommended to meet gum specialists to help remove the bacteria that have formed in gum pockets. Damaged teeth are also removed as they contain the most number of bacteria.

Prevention

• Brush your teeth after a meal.
• Floss at least once a day.
• Avoid having a dry mouth.
• Visit the dentist regularly.
• Avoid foods that can cause bad breath.
• Change your toothbrush regularly.
• Make sure that you clean your denture and dental appliances regularly.
• Do not forget to clean your tongue.

References