Bad breath, or Halitosis, can be bothersome not only to the person suffering from it, but also to others around them. It can lead to awkward social situations and have a negative psychosocial impact. Is there a way to fight it?
Bad breath or halitosis is a symptom where an unpleasant odor comes from the mouth due to a lack of oral hygiene. Food particles can accumulate between the teeth, gum tissue, and on the tongue when the mouth is not kept clean.
More than 90% of cases of halitosis are caused by the presence of bacteria in the oral cavity. Humid conditions in the oral cavity provide an ideal environment for the growth of anaerobic bacteria in the mouth. These bacteria degrade organic substrates such as glucose, protein, and peptides present in food residue and produce chemical compounds that have a strong and unpleasant odor 11.
A dry mouth can also trigger bad breath. Saliva present in the mouth usually helps in washing food particles away. But in a dry mouth, the cleaning of food particles from the mouth is not optimal. Bacteria degrade the food, plaques are formed, and ultimately, lead to bad breath.
The type of food you eat can also trigger bad breath. Foods with strong odors, for instance, onions and garlic, can cause unpleasant odors in your mouth. Chemicals contained in these foods will be absorbed into the bloodstream to the lungs. It will be exhaled through the breath and mouth. Tobacco, alcohol, and betel are also known to cause bad breath.
Diets high in sugar and protein have also been linked to bad breath 8. Volatile compounds such as sulfur, nitrogen, amines, alcohol compounds, ketones, and short-chain fatty acids have also been shown to trigger bad breath 4, 12.
Some pathological conditions can also give rise to halitosis. These conditions can be categorized into oral conditions and non-oral conditions. Among oral conditions, oral infections, dental caries, gum disease, and canker sores are associated with bad breath1. In addition to poor oral hygiene and food intake, bad breath can also be triggered by certain health conditions or non-oral causes.
The presence of infections in the lungs, throat, nose, chronic bronchitis, chronic sinusitis, and digestive system disorders can be associated with bad breath6. Other pathological conditions such as liver disease or failure, kidney failure, endocrine system disorders, diabetic ketoacidosis, and menstruation can also cause bad breath2.
The most common preventative measure is to maintain good oral hygiene. Brushing your teeth regularly twice a day can help reduce plaque buildup on the teeth. It reduces food debris in the mouth and ultimately, reduces the risk of developing periodontal disorders leading to halitosis and dental caries.
A few years ago, the American Dental Association (ADA) issued a recommendation to brush your teeth using toothpaste that contains fluoride to keep your teeth clean1. You can also use self-care products to prevent bad odors from coming from your mouth. Bad breath prevention products such as mouthwash, mint gum, and dental spray can reduce bad breath by creating pleasant odors.
The compounds such as zinc salts and chlorine dioxide in mouthwash will prevent the evaporation of bad odors in your mouth. Mint chewing gum can also reduce bad breath by increasing salivary secretion so that the cleaning of food debris is more optimal. These approaches have proven effective for bad breath caused by pungent foods or smoking. These preventative measures can help in maintaining fresh breath and to relieve bad breath to some extent 3, 9.
Management of halitosis
To treat bad breath, an accurate diagnosis of the underlying disease or causative factor is important. Visit your healthcare provider and/or dentist to get accurate information about the cause of bad breath you are experiencing. Some underlying diseases can be serious and hence, halitosis should not be neglected.
The diagnosis of halitosis may include a physical exam and other tests. For instance, gas chromatography is a test used to diagnose bad breath. The patient closes their mouth and after 30 seconds air samples are collected using a gas syringe. These samples are later analyzed using the gas chromatography method. Although this test is objective and reliable, it may take a few hours to analyze the sample2. Other tests such as sulfide monitoring and salivary incubation tests may be done if necessary.
Dental treatment is needed when the severity of bad breath increases and cannot be prevented through self-care products. A dentist may first do an oral exam and ask several questions related to history, lifestyle, habits, etc. This detailed exam must be performed to increase the success of the treatment.
Early periodontal treatments such as scaling can be implemented to reduce the severity of inflammation caused by a bacterial infection in the exposed oral cavity. Antiseptic mouthwash may be used during periodontal treatment procedures to help reduce the number of bacteria in the teeth and mouth 5, 7.
To increase the success of periodontal treatment, proper brushing, and cleaning of the lining of the tongue are recommended. Patients need to follow these instructions properly and regularly. A study showed that the act of cleaning the tongue can effectively reduce the volatile sulfur compounds that have a strong smell 10. Restoration of the exposed tooth enamel structure can be done to prevent the accumulation of bacteria.
Treatment of dental cavities can also be done to treat bad breath by preventing the emergence of bacterial reservoirs. Furthermore, there is a need for holistic treatment to overcome bad breath caused by other diseases such as respiratory, liver, kidney, endocrine, hematology, and gastrointestinal disorders. Therefore, there is a need for further consultation with a healthcare provider to determine the best treatment 2.
In most cases, halitosis can be treated effectively with timely interventions, and its recurrence can be prevented. Do not let bad breath interfere with your social life. Get closer with confidence.
- ADA, 'Bad Breath: Causes and Tips for Controlling It', The Journal of the American Dental Association, 143 (2012), 1053.
- B. U. Aylıkcı, and H. Colak, 'Halitosis: From Diagnosis to Management', J Nat Sci Biol Med, 4 (2013), 14-23.
- Z. Fedorowicz, H. Aljufairi, M. Nasser, T. L. Outhouse, and V. Pedrazzi, 'Mouthrinses for the Treatment of Halitosis', Cochrane Database Syst Rev (2008), Cd006701.
- S. Goldberg, A. Kozlovsky, D. Gordon, I. Gelernter, A. Sintov, and M. Rosenberg, 'Cadaverine as a Putative Component of Oral Malodor', J Dent Res, 73 (1994), 1168-72.
- C. Kara, A. Tezel, and R. Orbak, 'Effect of Oral Hygiene Instruction and Scaling on Oral Malodour in a Population of Turkish Children with Gingival Inflammation', Int J Paediatr Dent, 16 (2006), 399-404.
- S. Kinberg, M. Stein, N. Zion, and R. Shaoul, 'The Gastrointestinal Aspects of Halitosis', Can J Gastroenterol, 24 (2010), 552-6.
- P. R. Klokkevold, 'Oral Malodor: A Periodontal Perspective', J Calif Dent Assoc, 25 (1997), 153-9.
- P. P. Lee, W. Y. Mak, and P. Newsome, 'The Aetiology and Treatment of Oral Halitosis: An Update', Hong Kong Med J, 10 (2004), 414-8.
- C. K. Rösing, S. C. Gomes, D. G. Bassani, and R. V. Oppermann, 'Effect of Chewing Gums on the Production of Volatile Sulfur Compounds (Vsc) in Vivo', Acta Odontol Latinoam, 22 (2009), 11-4.
- R. Seemann, A. Kison, M. Bizhang, and S. Zimmer, 'Effectiveness of Mechanical Tongue Cleaning on Oral Levels of Volatile Sulfur Compounds', J Am Dent Assoc, 132 (2001), 1263-7; quiz 318.
- K. L. Tyrrell, D. M. Citron, Y. A. Warren, S. Nachnani, and E. J. Goldstein, 'Anaerobic Bacteria Cultured from the Tongue Dorsum of Subjects with Oral Malodor', Anaerobe, 9 (2003), 243-6.
- S. van den Velde, M. Quirynen, P. van Hee, and D. van Steenberghe, 'Halitosis Associated Volatiles in Breath of Healthy Subjects', J Chromatogr B Analyt Technol Biomed Life Sci, 853 (2007), 54-61.