Bad breath

B A D    B R E A T H   ( H A L I T O S I S )

Halitosis or bad breath or breath melador is caused by the presence of volatile sulfur compounds on the breath, principally methylmercaptan and hydrogen sulfide compounds. The nature of the odour may vary in intensity and quality i.e. strength and type respectively. Though studies have shown that 85% of the patients suffering from halitosis have an oral condition as a source but there are other non oral conditions which are also the cause of halitosis. The factors associated with halitosis can be summarised into two broad groups ORAL and NONORAL.

Risk Factors Associated With Halitosis
Non-disease related Disease related
  • Inadequate oral hygiene
  • Long period of mouth closing (i.e., morning breath after sleep)
  • Xerostomia (e.g. Dry mouth, due to mouth breathing, medication)
  • Tongue coatings
  • Candidiasis
  • Cancer
  • Gingivitis
  • Mouth Infection, Inflammation, Ulceration
  • Periodontitis
  • Aging (reduced salivary flow)
  • Alcohol
  • Hunger
  • Pungent foods ( i.e. onion, garlic)
  • Tobacco
  • Therapeutics (Amphetamines, anticholinergics, antidepressants,antihistamines/decongestants, antihypertensive drugs, antiparkinsonian agents, antipsychotics, anxiolytics, chemotherapeutic agents, diuretics, narcotics/analgesics, radiation therapy)
  • Gastrointestinal (gastroesophageal reflux, hiatus hernia, cancer)
  • Nasal (rhinitis, sinusitis, tumors, foreign bodies)
  • Pulmonary (bronchitis, pneumonia, tuberculosis, cancer)
  • Systemic (cirrhosis, dehydration, . diabetes, fever, hepatic disease, leukemias, uremia, rheumatalogic disease)
  • Psychogenic (delusions, depression; hypochondriasis suicidal tendencies, schizophrenia also associated with temporal lobe epilepsy)

Regardless of the type of halitosis, proper diagnosis is important. Some self-monitoring tests and in-office tests are available to aid in the diagnosis.

Self-monitoring tests generally involve obtaining feedback from a spouse or friend. Individuals may have difficulty in detecting halitosis themselves, because the brain has the ability to suppress odours stemming from ourselves. The patient can scrape the posterior region of the tongue with a spoon or place saliva on the wrist by licking it. The spoon or wrist can then be smelled and assessed by the odour judge. There is also a home microbial test which is comprised of cotton-tipped applicators and test tubes containing a specific medium. After the applicators are placed on the tongue, they are inserted in the test tubes. If the color in the test tube changes within a certain time period, this is an indication that you have chronic bad breath.

In-office testing can include odour judge testing, microbial and fungal testing, the salivary incubation test, volatile sulfur detection test, and, in the future, artificial noses. Among other problems, the current tests lack specificity, i.e. it is difficult to determine the existence or the cause of chronic halitosis. There is a portable sulfide monitor available in the market for detecting halitosis by measuring sulfur content in the breath, but it can be inaccurate. Hence it is better to monitor a patient's progress, than obtaining an initial diagnosis. Most dental clinics do not have the facility yet to perform these tests. Organoleptic measurements, over all assesment of odour emanating from whole mouth, tongue, and saliva or chemical analysis of odour are also used to identify halitosis.

One of the easiest and most efficient treatments for halitosis is by regular flossing and brushing of your teeth and tongue. By using a tongue scraper, it is best to clean as far back on the tongue as possible, starting from the back and moving toward the front. This scraping motion is done several times in row. Other management tools include antibiotics, nasal mucous control methods, avoidance of certain foods and medications, salivary substitutes, and management of systemic diseases. One of the most potentially promising and lucrative areas of bad breath control is the development of various oral rinses.

Effective oral rinses must eliminate the problematic bacteria while maintaining the balance of normal bacteria in the oral environment. The assorted types of rinses being developed and marketed contain quaternary ammonium, zinc, chlorhexidine (already in use to help treat periodontitis), chlorine dioxide, or triclosan. Chlorhexidine is a strong antimicrobial hence it is advised to use this type of rinse as a short-term adjunct for treatment. At present, chlorine dioxide can be used on a long-term basis.

Currently, many of these rinses provide limited effectiveness in the treatment of chronic halitosis. Regular dental care and proper oral hygiene including tongue cleaning are the most effective. The detection and treatment of halitosis is a relatively new aspect of dentistry. The future is sure to bring better diagnostic techniques and treatments.