HALITOSIS – BAD BREATH

OVERVIEW:

Halitosis is a frequent or persistent unpleasant odour of breath, bad or sour smelling breath. Bad breath can be acute (short term) or chronic (long term) depending on the cause.

It is pertinent to know that about 85% of halitosis result from oral conditions. A variety of systemic and extra-oral conditions account for the remainder.

However, it is mainly caused by sulphur-producing bacteria that normally live within the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSCs) are released from the back of the tongue and throat.  Halitosis is not an infectious but it could be a symptom of infection.

The tongue is the major site for the production of the VSCs particularly the dorso-posterior site (back of the tongue), followed by the subgingival plaque The odour is caused by bacteria from the decay of food particles, other debris in the mouth, and poor oral hygiene.. These bacteria also inhabit the throat and the tonsils.

The activities of these bacteria in the mouth is enhanced by smoking, hormonal changes, uncontrolled diabetes mellitus, high protein diet, certain medication and alcohol. 

CAUSES OF HALITOSIS

Physiologic – usually temporary, mostly due to transient reduction in salivary flow which allows accumulation of oral bacteria e.g early morning breath, after sleep, fever, dehydration etc.

•Carious cavities – allow food packing.

•Stagnation areas and food impaction, pericoronal flaps.

•Bleeding into the oral cavity secondary to surgery,

•Poor oral hygiene.

•Gingival or periodontal disease.

•Decreased salivary flow e.g. parotid disease, sjogren’s syndrome, salivary stagnation and increased salivary pH.

•Necrotic oral cancer.

•Improper cleaning of dentures and other prosthesis.

•Oral infections or abscesses.

•Sinus or pulmonary infection e.g. bronchiectasis, aerobic lung abscess, nasopharyngeal cancer.

•Diabetes e.g. diabetic ketoacidosis.

•Acid and bile reflux from the stomach.

•Liver failure (mousy or faintly sulphurous odour)

•Renal failure (fishy odour)

•Post nasal discharge as in chronic sinusitis.

•Smoking which starves the mouth of oxygen.

•Hormonal factors; such as menstrual cycle or pregnancy.

•Foods e.g. garlic, onions, cauliflower.

•disorders of metabolism (foul, fishy odour that comes and goes and may be difficult to diagnose)

•Fasting (when the body is not provided with fuel in the form of food, fat and protein will begin to be broken down; the result is bad odour from the waste products of this metabolism).

•Dry mouth – caused by medicines, alcohol, stress or a medical condition.

•Food high in protein, sugar or acid.

• Reflux oesophagitis, GIT cancers, ulcers.

TYPES OF HALITOSIS

1. True halitosis – this is when the cause is known.
2. Delusional halitosis

The phrase delusional halitosis is somewhat self-explanatory. Delusional means something that is only in your mind, and halitosis means bad breath. So then, what is it? It refers to the thought or fear that you have bad breath when in reality you don’t.

•This disorder affects approximately 1% of the population or less, so it is not a common disorder, however, it’s thought that the majority of patients that seek treatment for halitosis have this disorder- in other words, they believe that they have a problem when they really don’t.

•Delusional halitosis can become a full-blown phobia and can begin to interfere with one’s job or life in general. Some who have this phobia avoid work and any other social situation in general. They may lose their job and have difficulties with intimate physical relationships. They avoid any social situation that brings them into close contact with others.

•Olfactory Reference Syndrome (ORS) is an overly excessive concern for one’s body odours, and delusional halitosis may fall under this category. Counsel patient and refer to a psychiatrist

SYMPTOMS OF HALITOSIS

•A white coating on the tongue.

•Dry mouth and teeth.

•Post nasal drip, or mucous.

•Morning bad breath and a burning tongue.

•Thick saliva and a constant need to clear your throat.

•Constant sour, bitter metallic taste.

•Having halitosis can have a major impact on a person; loss of confidence and self-esteem.

TREATMENT

 The treatment depends on what is causing the problem.

•Good oral hygiene, including brushing, tongue scrapping and flossing is very important.

•Some mouthwashes and toothpastes are effective in fighting halitosis e.g oxygenating mouthwashes such as hydrogen peroxide and Chlorine dioxide gel(oxyfresh) destroy sulphur containing compounds by oxidizing sulphur bonds

•Periodontal disease and /or cavities should be treated and repaired.

•Oral infections must be eliminated or impacted teeth may need to be removed.

• People with chronic sinusitis may find the regular use of a saline nasal spray helpful.

• A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help.

• Psychogenic halitosis may require psychiatric consultation.

PREVENTION OF HALITOSIS

•Brush your teeth and rinse your mouth thoroughly after every meal to remove food particles from the mouth.

•When you are brushing your teeth, also brush your tongue. The tongue is covered with papillae that can trap bacteria.

•Chew sugarless gum or suck on sugarless lozenges to increase the flow of saliva.

•If your mouth is dry, drink plenty of water..

•Avoid breath mints and mouthwashes that contain alcohol. They dry the oral mucosa causing more halitosis and mask the odour temporarily

•Snacking on vegetables such as raw celery or carrots can keep plaque from forming. Avoid alcohol and caffeine consumption, which can dry the mouth

•Quit smoking. Tar and nicotine can build up on the surface of the teeth, tongue and cheeks. It can also dry the mouth and inhibit saliva flow.

•Chlorophyll is a natural breath freshener and is found in leafy green vegetables like parsley.

•A few drops of peppermint or tea tree oil can be applied to the tongue or toothbrush to help freshen the breath.

•Baking soda has a long history of being used to maintain good oral.

• A mixture of 50% hydrogen peroxide and 50% water can be swooshed around in the mouth and used as a mouthwash.

•Avoid stress and seek out ways to relax and resolve stressful conditions in your life.