Bad breath (Halitosis)
Bad breath is a problem few can admit and even fewer will point
out. It's especially difficult to detect since a person can't
smell his or her own breath. Bad breath (medically termed
halitosis) is a common problem faced by a large number of people
these days. The problem can turn out to be quite depressing and
embarrassing at times to the afflicted person as well as the
people around. Treatment of bad breath should be aimed at
eliminating the root cause of the problem rather than adopting
camouflaging measures such as mouth fresheners, mouthwashes etc.
Causes may be local or systemic. The local causes related to
halitosis include wearing dentures or partial dentures, faulty
dental fillings, drifted, moved or extruded teeth, gingivitis,
gum or tooth abscesses, oral cancer and xerostomia or dry mouth.
The human being has over 400 species of different types of
bacteria in the mouth of which about fourteen of them, mainly
anaerobic bacteria, cause bad breath by releasing sulfur odors.
Halitosis is caused by volatile sulfur compounds (VSC mainly
hydrogen sulfide and methyl mercaptan), which are released by
the break down of proteins by bacteria. These sulfur compounds
are odorous and lousy tasting. Bad breath mostly comes from the
back of the tongue, not the stomach or teeth. Most of the odor
contributing to bad-breath is produced by anaerobic bacteria,
which grow on the back of the tongue. Tongue cleaning reduces
mouth odor by 75 percent. The anaerobic bacteria have beneficial
effects also as they aid in digestion by breaking down proteins.
Persons suffering from badbreath due to oral causes are found to
have abnormally high numbers of anaerobic bacteria in the oral
cavity. An agent called halimeter is used by some of the
specialists which aids in measuring the concentration of
sulphide molecules in breath of patients which in turn gives
an assessment about the degree of badbreath the patient has.
Systemic medical conditions contribute to a significant
percentage of halitosis cases. Diseases afflicting the nose,
sinuses, throat, lungs and the gastrointestinal system the
body parts which are anatomically linked to the mouth are also
found to contribute to halitosis. Eg. conditions like sinusitis,
pharyngitis, common cold, bronchitis and asthma, tonsillitis,
indigestion and acidity, constipation, etc. are found to cause
bad breath. Persons suffering from colds and sinusitis often
have postnasal drips of mucus which is rich in protein.
Breakdown of the proteins by anaerobes cause release of VSCs
causing the bad breath. Medical conditions such as diabetes,
renal failure, liver dysfunction, hormonal imbalance etc. are
also found to cause halitosis.
Food and tobacco are contributing factors to halitosis but are
not a primary cause. Very spicy foods, such as onions and garlic
(they contain sulfur compounds called mercaptans), and coffee
may be detected on a person's breath for up to 72 hours after
digestion. Onions, for example, are absorbed by the stomach and
the odor is then excreted through the lungs. Studies even have
shown that garlic rubbed on the soles of the feet can show up on
the breath. There are 4 categories of food which are found to
increase the problem of badbreath by causing an increase in
sulfide production by bacteria drying agents (cigarettes,
alcohol), dense protein foods (diary foods, meat and fish)
sugars and acids (coffee, fruit juices such as those of citrus,
orange, tomato, grapes, pineapple etc.) all these stimulate
growth of anaerobic bacteria.
Even stress, dieting, snoring, age and hormonal changes can have
an effect on your breath.
Morning breath - Saliva is the key ingredient in your
mouth that helps keep the odor under control because it helps
wash away food particles and bacteria, the primary cause of bad
breath. When you sleep, however, salivary glands slow down the
production of saliva allowing the bacteria to grow inside the
mouth. To alleviate "morning mouth," brush your teeth and eat a
morning meal. Morning mouth also is associated with hunger or
fasting. Those who skip breakfast, beware because the odor may
reappear even if you've brushed your teeth. Remaining still for
long hours with restricted movement of the tongue and jaws such
as while traveling long distances, slows down salivary
production and will also be associated with bad breath due to
the reasons mentioned above.
Proper tooth brushing twice a day and flossing will help to
maintain good oral hygiene thereby aiding in reducing bad
breath. Tongue cleaning is also an essential part of oral
hygiene measures. Dentists recommend using a tongue scraper as
part of a daily dental hygiene routine that includes brushing
and flossing. This can definitely help control bad breath.
Persons using removable dentures are advised to remove them at
night and clean them. They may be worn in the morning after
Drier your mouth, the worse your badbreath gets. Drink more
it helps in arresting activity and growth of anaerobic
bacteria. Seven of the top ten prescription medications cause
dry mouth thereby resulting in halitosis. Eg. antidepressants,
antihypertensives, antianginal drugs, some antacids and
Chewing sugar-free gum also may help control the odor. If you
have dentures or a removable appliance, such as a retainer or
mouthguard, clean the appliance thoroughly before placing it
back in your mouth. Before you use mouth rinses, deodorizing
sprays or tablets, talk with your dentist because these products
only mask the odor temporarily, and some products work better
Mouthfreshners and other related items
Very often they are only short-term solutions. Most of the
products work for an hour or two and after that the bad breath
returns with increased severity. Many of them kill the bacteria
to help decrease odor, besides generating a pleasant odor which
also helps mask bad-breath. A common ingredient in breath
freshener products is alcohol, which dries out the mouth, making
the bacteria grow faster. Eg. Listerine pocket packs, Trioral
Visit your dentist regularly because checkups will help detect
any physical problems. Checkups also help get rid of the plaque
and bacteria that build up on your teeth. If you think that you
suffer from bad breath, your dentist can help determine its
source. He or she may ask you to schedule a separate appointment
to find the source of the odor. Or, if your dentist believes
that the problem is caused from a systemic source (internal),
such as an infection, he or she may refer you to your family
physician or a specialist to help remedy the cause of the
Tongue cleaning important aspects
The total bacteria count on the dorsum of the tongue can
be reduced as much as 50 percent after one day of tongue
scraping in comparison to one week of tongue brushing to achieve
the same results.
Tongue scraping significantly reduces dental plaque by 33
percent without causing any deleterious tissue changes in the
Tongue scraping is especially important for heavy
smokers, mouth breathers, or those who do not use their dentures
due to unduly coated tongues.
Tongue scraping reduces a source of halitosis, root
caries, and improves taste acuity and interest in different
varieties of food in the elderly.
The toothbrush is designed specifically to remove plaque
from teeth. It is not designed to clean the tongue's
histological structure effectively.
Daily hygiene of the tongue is an important part of total
mouth care, in addition to brushing and flossing.
Dr. Prasanth Pillai K.S.,
Dental, Oral and Maxillofacial
DRYMOUTH / XEROSTOMIA
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