Halitosis otherwise known as "bad breath" may be described as an unpleasant odour coming from the breath that is exhaled through the mouth or nose.
Bad breath is a social taboo and as a result sometimes psychological or social problems can develop for example social anxiety, depression, reluctance to speak and being withdrawn.
Most of the time the unpleasant odor may be caused by conditions inside the mouth example:
Odors released by bacteria present below the gum line and on the back of the tongue.
Sores inside the mouth
About 10% of the time halitosis may be caused by conditions outside of the mouth for example.
Disorders in the nasal cavity
Other times halitosis may be a symptom of a serious underlying medical condition for example:
Kidney disease or failure
Halitosis can be categorized by the character of the odour into three groups.
1. Sulfurous or fecal
Commonly caused by volatile sulfur compounds most notably methyl mercapton,hydrogen sulfide,and dimethyl sulfide.
2. Fruity or Sweet
Caused by acetone present in diabetes
3. Urine like or Ammoniacal
Caused by ammonia,dimethyl amine and trimethyl amine that is present in Trimethyl aminuria and uremia.
Causes of intra oral halitosis/malodour
Open cavities inside the mouth that causes food impaction and stagnation(food debris lodged inside the cavity for days,weeks or even longer)
Recent dental extraction sockets filled with blood clot which provide a habitat for bacterial growth.
Interdental food packing or food getting pushed between the teeth and debris being trapped resulting in bacterial growth and release of toxins by bacteria.
Poor cleaning of acrylic dentures, failure to remove the dentures at nights and causing the growth of yeast and bacterial retention occupied by a typical smell.
Oral ulcerations or sores
Menstrual cycle causing an increase in volatile sulfur compounds
Eating volatile food items for example onion, garlic,duriam, cabbage, cauliflower, radddish which leave malodourous residues int the mouth subjected to bacteria and volatile sulfur compounds being released.
Medication which causes xerostomia dry mouth) causing increased microbial growth in the mouth.
In The Nose
Air exiting the nostrils has a pungent odor that is different from the odor of the mouth. Commonly caused by sinus infections or foreign bodies lodged in the nose.
In The Tonsils
Putrefaction from the tonsils is considered a minor cause of bad breath. Small bits of calcified matter in the tonsillarcrypts called tonsilloliths (tonsil stones) that smell extremely foul when released causing halitosis.
In The Esophagus
The lower esophageal sphincter which is the valve between the stomach and the esophagus may not close properly due to a hiatal hernia or GERD (gastro esophageal desease) allowing acid to enter the esophagus and gases to escape to the mouth.
A zenker's diverticulum may also result in halitosis due to aging food retained in the esophagus.
In The Stomach
In Belching, reflux or a continuous flow of gas or putrid substances from the stomach.
Fetor Hepaticus ( bad breath caused by chronic liver failure)
Bronchial and Lung Infections
Renal Infections or failure
Trimethylaminuria(fish odour syndrome)
Metabolic conditions resulting in elevated blood dimethyl sulfide.
Detecting Bad Breath/ Halitosis
Due to Acclimatization it is difficult to detect ones own breath odor.
Ask someone preferably a trusted confidant to smell your breath.
Lick the back of the wrist , let the saliva dry for a few minutes then smell the back of the wrist.
Lightly scrape the back of the tongue with a disposable spoon then smell the drying residue.
Wear a disposable face mask covering your nose and mouth then speak while wearing it and smell.
Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on the tongue swabs are now available.
Proffessional Diagnosis of Halitosis
Halimeter- a portable sulfide monitor used to test levels of sulfur emissions in the air of the mouth.
Gas Chromatography- digitally measures molecular levels of hydrogen sulfide, methyl mercapton and dimethyl sulfides.
BANA Test- A test to find the salivary levels of an enzyme showing the presence of certain halitosis related bacteria.
B-galactosidase- Testing salivary levels of this enzyme were found to be correlated with oral malodour.
Organoleptic measurement is a subjective sensory test score based on the examiners perception of a patients breath odor by the use of a HaliSens
An Instrument test is an objective way to measure the volatile sulfur compounds known to be the principal components of halitosis.
Treatment For Halitosis
Gently cleaning the tongue at least twice daily.
Eating a healthy breakfast containing rough foods with the ability to clean the back of the tongue.
Chewing sugar free gum increasing the flow of saliva.
Rinsing with an antibacterial mouthwash frequently.
Good oral hygiene which includes, brushing the teeth at least twice daily and after meals if braces are being worn and flossing after meals.
Probiotic treatments for example K1 for streptococus salivarius.
Medical check ups and treating underlying medical conditions.
Consult an (ENT) Ear Nose and Throat specialist.
Get a professional dental cleaning at least twice yearly
Drink water frequently.
Maintaining a balanced diet.
Do not skip meals
Monitor hormonal changes.
Avoid eating late at nights.
Remove decayed teeth.
Treat open cavities.
Not every toothpaste will give you fresh smelling breath, find the one that works for you.
Avoid smoking and too much alcohol drinking.
Remember to remove dentures at nights and clean them properly.
Treat mouth sores and oral infections.
Treat sinus infections
Avoid consuming too much garlic or onions.
If braces are being worn, clean them after meals, use waterpik and seek professional dental cleaning every 3 months.
Tina Dooley RDH firstname.lastname@example.org