What is Bad breath?

Bad breath:

The term halitosis also known as foetor oris(stench of mouth) or bad breath is used to describe noticeably unpleasant odour exhaled in breathing. What ever the source it arises from it, it has a direct and significant impact on an individual both personally and socially. It has been estimated that halitosis is the third (3rd)most common/frequent rea- son for seeking dental care after common dental problems of dental decay and periodontal disease. The term HALITOSIS, a combination of Latin word Halitus meaning breath and Greek suffix Osis,often used to describe a medical condition. Another term that re- quires some attention is HALITOPHOBIA or (delusion halitosis) in which patients have a very strong and highly exaggerated concern of having a bad breath.

Causes:

The bad breath can occur due to eating certain foods (garlic,onion,meat,fish,cheese) or obesity,smoking and alcohol consumption and also due to certain drugs,accumulation of heavy metals, infections and even stress.

The main reasons for halitosis includes the following local as well as systemic factors including,

Tongue:

The most common location for mouth related halitosis is tongue,bacteria present on the surface of tongue produces malodourous compounds and fatty acids and also by colonies of anaerobic bacteria utilizing food remnants,dead epithelial cells on the posterior dorsum of tongue producing bad breath since these colonies are undisturbed,relatively dry and poorly cleaned. Post-nasal drip caused by rhinitis, sinusitis and allergy is also a known factor to cause bad breath.

Mouth:

The mouth harbours more then 600 different types of bacteria in the average mouth and several dozens of these produces high level of foul odour which are produced due to the breakdown of proteins into amino acids which is followed by further breakdown of certain amino acids to produce VSC(volatile sulphur com- pounds)the foul gases including hydrogen sulphide,allyl methyl sulphide, dimethyl sulphide and methyl mercaptan.

Gum Disease:

The periodontal disease also contributes to bad breath through the sub gingival plaque deposits. Nose: The nose can contribute to bad breath due to either the sinus infections or foreign bodies.

Tonsils:

The tonsils also contributes to around 3-5 % of cases of bad breath and some times due to the formation of tonsilloliths producing a extremely foul smell.

Oesophagus:

The patients suffering from G.E.R.D. (gastro esophagul reflux disease) causing the reflux of acid into oral cavity as well as stricture or due to improper working of esophageal valve called cardia.

Stomach:

The stomach is one of the most uncommon source of bad breath, however when involved, is due to the allyl methyl sulphide (found in Garlic) since it does not get metabolised in the digestive tract.

The systemic diseases include:

1.Metabolic dysfunctions.

2.Diabettis mellitus.

3.Carcinoma

4.Renal failure and infections

5.Lower respiratory track infections(bronchial & lung infection)

6.Liver failure

Diagnosis:

1.Self diagnosis

2.Professional diagnosis through halimeter or Gas chromatography,B.A.N.A. (benzoyl-DL-arginine-naphthylamide) test and beta galactosidase test.

Complications:

Hydrogen Sulfide can cause jaw bone resorption as well as inflammation of the tongue. Recent publications also suggest the bacteria responsible for bad breath to increase resistance to Insulin.

Signs & symptoms, prevention & treatment of bad breath.

Signs & Symptoms

Bad breath. Taste changes. Coated tongue.

Prevention

Check your food intake. Brush regularly not only teeth but also the sides of the tongue and the hard palate (please do not try to brush too far backwards on tongue or palate as it may cause gagging or vomiting). Drink lots of water.

Treatment

Treat the underlying cause if bad breath is due to any disease or infection. Maintenance of proper oral hygiene including daily tongue cleaning, brushing, flossing and regular visit to dentist or hygienist for professional cleaning. Gargling, especially just before bedtime with an effective mouthwash or normal saline rinses (4-5 times a day). Mouthwashes can only temporarily mask the odour but are not permanent cure. Chewing gums cause increase in saliva formation. Avoiding or minimizing the use of foods known to produce bad breath. Healthy breakfast with rough foods that helps clean the posterior surface of tongue.