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

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.

Treatment

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 morning brushing.

Drier your mouth, the worse your badbreath gets. Drink more water… 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 antihistaminics.

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 than others.

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 breath rinse.


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 problem.

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.

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 Surgeon

Email  drprasanth@pramodclinic.com

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