Everything you need to know about Halitosis (Bad Breath)

Bad Breath

Bad breath is properly known as Halitosis which is what an unpleasant odour from one’s mouth is. More than 92% of cases of halitosis are related to the conditions in your mouth so a dentist should be your first port of call and not the doctor.

The smell is due to bacteria which proteolysis amino acids which causes VSCs to be released. Volatile Sulphur Compounds have the unpleasant smell characteristics.

The bacteria which are mainly thought to be responsible are Fusobacterium Nucleatum, Prevotella Intermedia, and Tannerella Forsythensis. These bacteria are located in stagnant areas in the oral cavity. If these stagnant areas are not cleaned, these bacteria will proliferate. Stagnant areas are the dorsal surface of tongue, periodontal pockets, and interproximal areas.

The management and treatment of bad breath involves identifying and removing the causes. There may be contributory factors, from certain medical conditions.

Professional dental advice should be given on oral hygiene especially in interdental areas.

Advice should be given for “plaque traps” such as dentures, amalgam overhangs and poor contact points of fillings.

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The mouth should be screened for gum disease and treated by dental scaling, root planning and debridement of the associated periodontal pockets.

Elimination of pockets will reduce the bacterial loading.

In addition to the normal oral hygiene advice given, the patient should know how to carry out tongue cleaning and use of mouthwash to reduce overall bacteria numbers.

Although everyone has temporary halitosis, if it is long-term, it can really impact a person’s self-image and self-confidence.

Halitosis is widespread and it permanently or chronically affects 25%.

Most people with bad breath are usually unaware possibly because of smell adaptation (also known as Olfactory Fatigue), but also in the way you breathe in and out.

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When you breathe out, the expelled air from the mouth travels horizontally and evades being detected by the nose.

Volatile Sulphur Compounds

It is now scientifically accepted that the compounds that cause the smell of halitosis are Volatile Sulphur Compounds (VSCs). These include hydrogen sulphide, dimethyl sulphide, and methyl mercaptan. Out of the three compounds, Methyl mercaptan (CH3SH) is the most unpleasant and malodourous VSC.

VSCs are produced by gram-negative proteolytic anaerobic bacteria in the mouth. These bacteria exist naturally in the mouth as the normal flora but when they are allowed to flourish, this is when the bad breath becomes apparent. The breakdown of amino acids in the oral cavity is a physiological normal process. These bacteria are Fusobacterium Nucleatum, Prevotella Intermedia, Tannerella Forsythensis. Porphyromonas Gingivalis and Treponema Denticola.

These bacteria are located in the stagnant areas of the mouth, such as gum / periodontal pockets, back of the tongue surface, and interproximal areas between the teeth.

Although having gum disease is a major factor in halitosis, patients who do not have periodontitis will have bacterial accumulations on their tongue.

Food And Drink That Cause Bad Breath

Exogenous sources of bad breath are the intake of certain food and drinks, which can either cause dry mouth, such as alcohol-containing liquids (wine and some mouthwashes). Some medications and smoking cause dry mouth also.

Both onion and garlic also contain high concentrations of sulphur, which can pass through the lining of intestine into the bloodstream, and subsequently exhaled via the lungs.

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Treatments For Bad Breath

Once halitosis is confirmed, the treatment regime is:

1. Oral hygiene instruction for brushing, flossing interdental cleaning, and including denture hygiene.

2. Scaling and root planing of the periodontal pockets.

3. Tongue cleaning.

3. Using mouthwash.

4. Dietary advice and to reinforce brushing after eating or drinking.

5. Stop smoking.

5. Regular review.