Bad Breath

Bad breath is a common condition caused mainly due to bacteria and other medical reasons, which results in a foul smell from the oral cavity (mouth) while talking or exhaling air. It has been observed that the intensity of the bad breath differs during different timings of the day. For example, in the morning your breath may smell foul but the smell may fade away by the evening. Researchers claim that there are several factors which are directly responsible for oral malodor such as stress, fasting, eating certain foods (garlic, onion, meat, fish, and cheese) aid to bad breath. Additionally, smoking and alcohol consumption have also been found to be responsible for causing unpleasant odours and bad breath. Typically, our morning breath contains odour normally because the mouth is dry and inactive during the night allowing the growth and actions of microorganisms. But oral malodor is a chronic condition which needs dental attention followed by treatment. 

The symptom of oral malodor is a distinctive bad smell itself. Smells can be of various origins such as of rotten meat, decayed food or of any unpleasant odour. They are usually felt while a person is inhaling or exhaling air. A person in close proximity can feel the same while your talking, sneezing or coughing. 

When to see a doctor?

Medically bad breath can be typically characterised into two types

Physiological bad breath

The causes of physiological bad breath can be because of our day to day lifestyle. For example like our eating habits, poor oral hygiene, alcohol and tobacco consumption. Research suggests that usually physiological type bad breath is not associated with any underlying medical reasons they can be prevented and cured with a change of lifestyle and eating habits.

Pathological bad breath

The causes of pathological bad breath may be due to certain microorganisms or underlying medical conditions. Doctors recommend investigations and instant commencement of treatments.

It can further be sub-classified into two categories as follows-

• Oral: This category includes diseases the oral cavity that is the mouth, teeth, gums, tongue, buccal mucosa, cheeks, palate etc
• Extraoral or systemic: This category includes the diseases of the entire human body like nose, liver, lungs, stomach, etc.

Bad breath medically can further be classified into two more categories-

• Pseudo halitosis: This is a typical kind mostly in this case the bad breath or the foul breath is not perceived or detected by others, although it has been observed that the patient persistently complains about it and searches a cure from doctors for curbing it. Studies are suggestive that this condition improves by counselling and by keeping oral hygiene.
• Halitophobia: This is a very interesting condition often connected with human psychology, where it is believed that the person assumes or perceives foul smells even after the treatment from genuine halitosis or false halitosis the patients constantly believes that he/she still suffering from oral malodor or bad breath.

Doctors claim that 90% of all bad breath originates from the oral cavity (mouth), whereas, the remaining 10% responsible is systemic, underlying or normal causes. Oral bad breath is commonly the result of microbial putrefaction (decomposition) of food debris, cells, saliva and blood within the oral cavity. This is with special reference to the breakdown of proteins into peptides and amino acids which take place in the presence of a thiol group.

Bad Breath could be a result of a number of causes. We are listing known common reasons for bad breath.

Causes of physiologic bad breath

• Certain medicines
• Growing age
• Poor oral hygiene
• Fasting or starvation
• Tobacco consumption
• Alcohol consumption
• Foods like onion, garlic, etc.

Causes of pathologic bad breath

Pathological factors which mainly contribute are Periodontal infection foul odour from dental biofilm that is present beneath the gums, it is formed as a result of the accumulation of food debris and microorganisms. Specific diseases like acute necrotizing ulcerative gingivitis (ANUG) and pericoronitis

• Tongue with microorganisms
• Inflammation of mouth.
• Reduced salivary flow
• Faulty restoration retaining food debris and bacteria
• Unclean dentures
• Systemic and extraoral factor includes -Nasal infections like running nose, sinusitis, tumours and foreign bodies
• Disease of the gastrointestinal tract(GIT) like a hernia, cancer, GERD ( gastroesophageal reflux disorder ).
• Pulmonary infections like bronchitis, pneumonia, tuberculosis, and carcinomas. Certain hormonal changes that occur during pregnancy, menopause, menstruation and ovulation.
• Systemic diseases like diabetes mellitus, hepatic failure, renal failure, uremia, blood disorders, rheumatologic disease, dehydration, fever, vomiting, and liver cirrhosis 

As it is always said, “ prevention is better than cure ”. Please start taking care if you find visible signs of plaque formation and sense of mild odour from your mouth. You can prevent from having oral malodor by taking the following precautions:

• brush your teeth twice daily, this will protect your oral cavity (mouth) from no of bacteria and other pathogens (Germs).
• use chlorhexidine mouth rinse with a dentist guidance twice daily after brushing.
• get your teeth clean that is scaling and polishing procedure by ultrasonic scalers and air polishing by a professional dentist so that your subgingival (beneath the gum level) microorganisms (germs) activity can be reduced to the maximum.
• don't smoke, or consume tobacco products, alcohol and other harmful substances.
• make dietary changes if you consume a lot of sugar, onion, garlic, fish, meat, cheese, etc in your normal diets.
• get a whole body check-up by a doctor.

How to diagnose bad breath?

One can self-diagnose bad breath without having to go to a dentist, however, u may need to consult a dentist if the signs and symptoms persist more than 4 to 5 days. Your dentist will physically check your gums and review your oral hygiene, medical and family history. In addition to this, the dentist will also check with you for any ongoing medicines or medicines you have taken previously. A dentist may also physically examine the following to rule out other underlying medical conditions.

Clinical examination by your dentist may include the following-

• Intraoral Examination.                              
• Your dentist might check for tongue coating.
• Evidence of mouth breathing (to check whether the person is regularly breathing from the mouth). 
• Xerostomia ( lack of saliva secretion ) or dry mucosa.
• Other oral causes like faulty fillings, broken dentures if any, etc.    

Your dentist might also go for a complete periodontal examination which might include-

General personal care, state of oral hygiene, brushing habits and brushing techniques Gingival Probing and Periodontal status Evidence of negligence in past history of dental hygiene care.

Investigations

Your dentist may recommend you some test to investigate the severity and the type of infection. These test may include the following-

• Subjective organoleptic method. This test has been used as a benchmark for bad breath measurement.
• Gas chromatography in order to assess the bad breath, a portable industrial monitor has been developed these machines are specifically designed to digitally measure
• Halimeters– These machines measure the level of sulfide gas found in a person's breath.
• Bana test- (benzoyl-d,l-arginine-naphthylamide) -Some of the bacteria like P. gingivalis, T. denticola, and B. forsythus produce waste products which result and contributing for causing bad breath. These bacterias in question have the characteristics of being able to produce an enzyme that breaks down the compound BANA. When a sample of patient saliva with bad breath containing these bacteria is placed within the BANA testing compound they caused it to break down as a result of this breakdown the test compound changes its colour indicating a positive reaction.
• Chemiluminescence this test involves mixing a sample of saliva containing VSC”S with the mercury. This Inturn causes a reaction in which produces fluorescence this test is highly sensitive and can measure low levels of bad breath as well.

Treatment of bad breath is a step by step problem-solving procedure. Before starting the treatment of bad breath a dentist must take care to determine the source of bad breath. The simplest way to distinguish mouth and non-mouth origin bad breath is to compare the smell from mouth and nose. If the origin is nasal or due to any other medical causes they must be referred to a concerned specialist doctor.

The bad breath generated from the mouth often requires a dental treatment. There are no standard and protocols for the treatment of bad breath, however, the possible protocol contains the basic elements including standard dental and periodontal treatment.

 Bad breath can be treated as follows;

• A reduction of microorganisms (germs) by improving oral hygiene and periodontal health to a basic dental care, If necessarily incorporation of advanced hygiene methods like oral irrigation , sonic and ultrasonic toothbrushes.
• If  bad breath persists inspite of maintaining proper oral hygiene, brushing your tongue is advisable.
• 0.2% chlorhexidine mouthwash for example Listerine can be used to decrease the germ load in the mouth. However there long-term effect remains to be determined and it might lead to tooth staining.
• Another treatment strategy for treating bad breath is the conversion of VSC’S using various metal ions zinc is the most common ion used in this procedure. Halita is a new solution containing 0.05% chlorhexidine without alcohol is more effective than the above-said mouthwashes.

• Brush twice daily and rinse your mouth after every meal so that no food particles are left for germs to attack.
• Do not eat between meals or snack often. This helps in maintaining oral hygiene very well.
• Gargle with warm saline water at least three to four times daily water must be boiled and brought to the lukewarm temperature before rinsing the mouth.
• Mustard Oil: you are recommended a spoonful of mustard oil and heat it a bit you may add a pinch of salt In it and apply in a massaging motion our your gums to improve your gingival heath the motion of massaging should always be from the gums towards the tooth which increases the tooth attachment and blood circulation and thus the gingival health.
• Gumpaints: you are recommended to massage your gums with gum paints for example occident, dental kind, etc
• Vitamin C: it helps your gum to recover faster and always citrus fruit like lemon, oranges etc are a good source of vitamin C. Medications for the same are also available in the market but should only be taken on doctors prescription.

Complications of bad breath include social withdrawals and a psychological feeling of low self-esteem. The person living with oral malodor begins to stay aloof or speak from a distance or choose not to speak at all. In some cases, the person himself/herself cannot sense the foul smell but family members and friends notify that the condition exists leading to social withdrawals and guilt. 

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