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Bad Breath

Introduction

One of the most common misconceptions is that halitosis or bad breath is caused by the foods you eat; actually, bad breath can be caused by the sulfur compounds released from your digestive process. The only fool-proof way of eliminating halitosis is to see your Periodontist or dentist to determine the cause. There could be many factors at play, such as gum Disease, a dry mouth or certain medical conditions. Many home remedies either aggravate the problem or are only temporary solutions. You should consult a specialist to find out the best treatment.

Halitosis/ Bad breath

Halitosis

Halitosis or bad breath is used synonymously and this is an unpleasant condition that causes embarrassment to many people. Many people are not even aware that they have bad breath; in case you have bad breath, you must see the dentist immediately. If case this problem is due to oral condition he/ she will be in a position to cure it.

The proteins in food, blood and diseased oral tissue are broken down by the anaerobic bacteria living within the surface of the throat and tongue; these bacteria, when they come into contact with certain amino acids in the above mentioned proteins releases sulfur compounds from the back of the tongue and throat causing bad odor.

Many manufacturers advertise for home remedies to overcome this problem; in fact, these remedies only mask the problem of bad breath thereby causing more harm than good. If you are serious about your bad breath problem, you must find the root cause of the problem.

How does halitosis occur?

It has been estimated that more than 95% of bad breath cases originate from your mouth; very few cases occur because of stomach disorders.

Your mouth, however clean it is, has millions of bacteria and they can decompose the food particles in your mouth resulting in what is known as plaque. Plaque can emit unpleasant smelling gases – hydrogen sulfide, dimethyl disulfide, methanol etc.

These gases are produced due to anaerobic metabolism – digestion of bacteria without oxygen around. If plaque collection is high – in the tooth gum edge, top and bottom of the tooth – the anaerobic bacterial activity also is high and this in turn results in greater volume of offensive gases. This means that if you remove the plaque effectively you might not suffer from bad breath. Accumulation of plaque causes halitosis and this includes the plastic dentures not maintained properly.

What are the symptoms of Halitosis?

Halitosis2

The main symptom for bad breath is the emission of bad odor from your mouth. You will not notice bad odor when you suffer from it because the odor detecting cells in your nose might have got used to it. You will realize it only when other people point out about this. Unfortunately, many people refrain from doing this because the will feel that you will get offended by this.

You will also have other symptoms depending on the main cause of bad breath:

1.Mouth infections

•Red or swollen gums that bleed after brushing or flossing

•Abscess at the root of tooth or pus between teeth

•Shaky teeth or modification in the denture fitting

•Painful, open sores either on the tongue or on gums

2.Infections of the Respiratory tract

•Fever

•Mucus producing cough

•Stuffy nose

•Sore throat

•Swollen glands in the neck

•Yellowish or greenish discharge from the nose

3.Dry mouth

• Burning in the mouth

•Difficult to speak for a long time due to dry mouth

•More number of cavities

•Sjögren’s syndrome or Dry eyes

•Swallowing difficulties – mainly dry foods

4.Illnesses

Lung disease, liver disease, kidney failure and diabetic symptoms.

What is Morning Mouth?

One of the things you will notice in the morning is that your mouth is dry. The main reason for this is that the saliva flow during sleep is low. Saliva is responsible for lubricating your mouth and less saliva means less lubrication and dryness. This causes the dead cells to stick to your tongue and inside your cheeks. Bacteria react with these cells thereby producing an unpleasant odor. This phenomenon is known as ‘Morning mouth’.

If you take medications for blood pressure or depression it worsens the morning mouth. Alcohol dehydrates your body and reduces your saliva flow. Breathing through your mouth also will cause dry mouth. Stagnant saliva also will cause odor because of bacterial activity.

This problem can be avoided by washing your mouth with clean water, drinking lots of water and eating things that stimulate saliva production. Avoid citric fruit juices in the early morning to avoid tooth enamel erosion.

What are the causes for Halitosis?

The reasons for halitosis/ bad breath can be broadly classified as –

1. Intra-oral

2. Extra-oral

3. Adverse habits

4. Others

Details are as given below.

Intra-Oral

a. Oral health –Poor dental hygiene is the most common cause for bad breath. Improper/ infrequent brushing and flossing causes food particles to be trapped between the teeth and this decay in your mouth. Poor oral maintenance could ultimately result in severe Gum Diseases – Periodontitis.

Good oral hygiene maintenance is a necessity for preventing bad breath. You should brush your teeth as well as tongue twice a day with fluoride toothpaste in order to get rid of food debris and plaque; also clean between teeth using floss. This should be preferably after your meal.

You should visit your dentists regularly for a checkup for this.

b. Dry mouth –Dry Mouth is caused by decrease in saliva; saliva is essential for cleansing the mouth as well as removing particles that cause odor. You must drink as much water as possible to keep your mouth moist.

c. Dentures –clean them well to remove the plaque; this also could cause halitosis.

2. Extra-Oral

a. Sign of a medical disorder –There are certain medical conditions such as sinusitis, bronchitis, diabetes, liver or kidney problems, periodontal disease, infection in the respiratory tract etc. might cause bad breath and requires treatment from a medical specialist.

For example, if you have diabetic ketoacidosis, you might have a fruity breath smell and this condition could be fatal in hours/ days. If there is a blockage in your intestine, you might have a fecal breath odor.

b. Psychiatric illness– some people have a feeling that they have bad breath, but others could not notice it and this is known as pseudo-halitosis.

Adverse Habits

1. Smoking and alcoholism – these cause odor and you must get rid of these habits.

Others

2. Foods – Garlic, onions etc. cause strong and objectionable breath odor; this is absorbed in the blood and then transferred to the lungs from where they are expelled thereby causing bad odor. Brushing, flossing and mouthwash mask the odor and do not eliminate it. In case you do not brush/ floss regularly, food particles collect between the teeth, tongue and gums and they start rotting thereby collecting bacteria, which causes bad breath.

How do you diagnose Halitosis?

It is simple to diagnose bad breath or Halitosis in a person and this is based on the symptoms as described by you and also physical examination of your mouth and tongue. In addition buildup of plaque and tartar as well as bleeding will be checked by your dentist. In addition, your dentist might ask for additional tests to find out any other reason for Bad breath or Halitosis.

How do you prevent Halitosis?

1.You must make sure that your mouth is always moist. This can be done by chewing sugar-free gum after meals so that it increases the saliva flow, avoid getting dehydrated and drink daily 3 liters of clean water.

2.Eat regularly vegetables and fruits. Minimize your meat product, that too red meat.

3.Avoid frequent snacking of products containing sugar. Refined sugars – glucose or sucrose – increase growth of bacteria in your mouth which increases the plaque formation. This results in the production of smelly gases.

4.Consume balanced diets containing vitamins and minerals. Vitamin C and zinc are necessary in the meal. Zinc reduces plaque development.

5.Chemicals in the tomato juice reduce plaque thereby reducing the anaerobic gases.

6.Stop smoking since it causes all sorts of health problems including bad breath.

7.Brush daily minimum twice a day and floss once. Clean tongue with tongue scrapers. If your bad breath is caused by dental problems, this will help in preventing bad breath.

8.Use oxidant tooth pastes or fluoride tooth pastes and mouth sprays for bad breath control.

9.Visit your dentist for regular dental checkup – say once in 6 months.

10.Use sugar free gum or sugar free breath mints that keeps your breath fresh and prevent plaque formation. You must be careful in this because some of these gums/ mints contain sorbitol that could cause side effects – bloating and diarrhea.

When should you consult your dentist/ doctor?

bad-breath

If you have bad breath with painful swollen bleeding gums or loose teeth consult your dentist immediately. If you have bad breath with sore throat, fever, mucus producing cough, postnasal drip and colorless nasal discharge go to a doctor immediately.

Some medical conditions – diabetes, GERD or chronic kidney or liver disease – might cause bad breath and you must consult the doctor early.

What are the treatment and medications for Halitosis?

As per the AAP (American Academy of Periodontology), the worst home remedies for bad breath are excessive use of mouthwash, breath mints, chewing gum, mint chew tobacco, infomercial Items, vodka martinis or sour mash whiskey, brushing with cleanser, intestinal cleansing methods, rinsing with kerosene and tongue piercing.

The Bad breath or Halitosis can be treated by maintaining dental hygiene, brushing and flossing teeth regularly, periodical dental checkups/ cleaning by a dentist, rinsing mouth with anti-septic mouth rinse and fixing dental restorations. In addition lifestyle changes such as quitting smoking, avoiding alcohol and having a low sugar and well balanced diet will keep the Bad breath or Halitosis away from you.

The first step in your treatment of Bad breath or Halitosis is thorough cleaning your teeth which includes scaling wherein all traces of plaque and tartar are removed. For people having sensitive gums and high buildup up of tartar and plaque the cleaning process is very uncomfortable. In order to clear the bacteria you might be asked to use an antiseptic mouth rinse. You will also be taught the correct brushing and flossing techniques. You have to practice good oral hygiene for life so that your gum problems don’t return.

Mouthwash mostly serves only for cosmetic purpose; special antimicrobial mouth rinse might help in controlling plaque.

How long Halitosis will last?

This depends mainly on the cause of bad breath. If the bad breath is caused by improper oral hygiene proper dental care will eliminate this problem immediately. Chronic sinusitis causes bad breath and this comes back repeatedly when there is a structural abnormality in the sinuses. If it is due to any of the illnesses it takes a longer time to go and this can be controlled by proper medication.

What are the complications due to Halitosis?

If you don’t treat Bad breath or Halitosis at the right time it will progress to Periodontitis which is a much more serious form of gum disease. You are susceptible for tooth loss because of periodontitis; also it might cause heart attack and stroke. The probability of giving birth to premature babies is high in women affected by periodontitis.