Halitosis, Bad breath or Oral malodour
Halitosis has often been a common complain among the population from the time of recorded history. It is an unpleasant odour present in the exhaled breath emitted by conditions in the mouth, nasal cavities, sinuses, esophagus,lungs and stomach.
Bad breath is a social taboo and is often a cause for embarrassment and social anxiety. Pathological odour prevalence ranges from 45% to 55% whereas 99% have "Dragon breath" (morning breath) and worse ,it is often difficult to diagnose.
Etiology of Fetor oris
Halitosis has been derived from latin halitus and the greek suffix -osis and literally means "breath condition".
Considered as the 3rd most common problem seeking dental treatment ,it has both internal and external factors which include the consumption of certain foods like onion, garlic etc, alcohol consumption ,smoking tobacco , poor oral hygiene and certain medical conditions like lung diseases, sinus infections,gastric disorders etc.
Crash dieting,low carbohydrate diets and fasting are other causes of halitosis. They cause the body to break down fat, which produces chemicals called ketones that emit an acetone breath.
Certain medications can cause bad breath like the nitrates used in angina, some chemotherapy medications ,tranquilisers etc.
Saliva in the mouth has a buffering and anti-bacterial properties. Dry mouth or xerostomia caused due to reduced saliva or disorder of the salivary gland can increase the number of bacteria in the mouth as well as develop into other types of bacteria leading to bad breath .
Gastrointestinal disorders like bacterial infection of the stomach lining and small intestine have been linked with bad breath.
Oral conditions causing oral malodour
Certain foods and drinks leave thin films on the surface of the tongue and teeth. The tongue provides a suitable environment for the bacteria to attach, multiply and grow. Most odor-causing bacteria produce compounds that cause bad breath called volatile sulfur compounds (VSCs). These primary VSCs that cause bad breath are hydrogen sulfide and methyl mercaptan. Most of these odor-causing bacteria reside in the posterior area of the tongue.
Food between the teeth where the tip of toothbrush do not reach can build up and form calculus. If treatment isn't sought at this time, it can progress to gingivitis i.e. inflammation of the gingiva. As time progresses, more bacteria accumulate and penetrate into the internal surface of the gums and can reach the tip of the root leading to periodontitis. This build up of bacteria , dental caries ,dry socket and poor oral hygiene causes halitosis.
Fungal infections forming a coating on the tongue, cheek and floor of the mouth ,otherwise called as oral candidiasis or oral thrush.
Methods to detect halitosis
Detection of oral malodour include:
1) The Halimeter (also known as a portable sulfide gas monitor) is the most commonly used clinical diagnostic instrument utilized in this field. It measures the concentration of hydrogen sulfide in parts per billion (ppb) in mouth air. The Halimeter uses a patented electrochemical voltammetric sensor.
2) The BANA test detects anaerobic bacteria associated with bad breath and periodontal disease, specifically bacteroides forsythus, treponema denticola and porphyromonas gingivalis. Plaque and tongue coating samples are taken to determine whether a trypsin-like enzyme exists within these substances. If the enzyme is there, it reacts positively (i.e., turns blue) when mixed with synthetic peptide benzoyl-DL-arginine-naphthylamide (BANA), and is an indication that anaerobic bacteria is causing chronic halitosis and possible damage to teeth and gums.
3)Gas chromatography measures the molecular intensity of three volatile sulfur compounds:dimethyl sulfide, hydrogen sulfide and methyl mercaptan, the worst smelling of all the VSCs.
4)Digital bad breath detector capable of judging the intensity of the volatile sulphur compounds.
Remedy for combating halitosis
Fetor oris or the so called oral malodour is a dentist's nightmare.The treatment found so far has only been to mask the odour.
Solutions to resolve malodour include :
1) Regular brushing after every meal using a standard toothbrush with soft bristles especially after consumption of fish, meat, onion ,garlic etc.
2) Floss and use of tongue cleaner twice a day.
3) Use of alcohol free mouthwash helps in reducing bad breath
4) Stimulate your salivary flow - Prevent dry mouth with chewing gum, lozenges,or mints that are sugar free. Xylitol containing chewing gums not only prevent bad breath but also have anti-cavity properties.Others include green tea,oral probiotics like K12 and M18 , zinc gluconate etc.
5) Eat fibrous fruits and vegetables- Apples help in keeping mouth moist.
6) Quit smoking and drinking of alcoholic products.
7)Drink plenty of water- 8 -10 glasses of water helps.
8) Clean your dentures atleast once a day.
9) It is important to meet up with your dentist or physician to get a proper diagnosis. Be sure to be open and honest to the physician performing the examination so that he/she may fully understand all the health problems you are experiencing and find out the underlying cause.
10) Breath freshner/ mouth spray.
There is no treatment. The treatment depends on what is causing the problem.Halitosis or oral malodour is a condition which can be masked with regular maintenance of oral hygiene, timely physician intervention, avoiding/reducing consumption of onion,garlic etc .
Gentle but effective tongue cleaning may also be required.The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue.
People with sinusitis should be treated with nasal spray and antibiotics against the sulphur producing anaerobic bacteria.Meet your dentist /physician to find the cause of halitosis and to find the best treatment for you.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2016 Stephy Varghese Thazhone
Sharon on June 07, 2016:
sujeesh koshy on May 18, 2016:
Great information. It would help some people be aware of this.