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Bad Breath

Category(s): Gastroenterology/Otorhinolaryngology

Overview

Synonyms : Halitosis, Fetor oris
Bad breath, is characterized by an unpleasant odour of the mouth. It may occur occasionally, or it may be a chronic condition. Bad breath, may result from poor dental health habits and may be a sign of other health problems. Persistent bad breath or a bad taste in the mouth may be a warning sign of periodontal (gum) disease.

Bad breath is a common problem which may affect anyone at any age. About one in four people are thought to have halitosis (bad breath) on a regular basis.
Cases / year in India :

Symptoms

  • Unpleasant odor or taste in the mouth                                             
  • Dry mouth                             
  • White coating on the tongue

Causes

Possible causes of bad breath (halitosis) are:

Poor oral hygiene: The most common cause of bad breath is poor oral hygiene. Bacteria that build up on the teeth, particularly between them, as well as the tongue and gums, can produce unpleasant-smelling gases. 

Food and drink:
Eating strongly flavoured foods, e.g. onions, garlic and spices, is likely to make breath smell. Strong-smelling drinks including coffee and alcohol, may also cause bad breath.
Bad breath caused by food and drink is usually temporary. It can be avoided by not eating or drinking these types of food and drink too often. Good dental hygiene will also help.

Smoking: Smoking is another cause of bad breath

Crash dieting: Crash dieting, low-carbohydrate diets and fasting are another possible cause of bad breath. 

Medicines: 
Some types of medicines may also cause bad breath.
These include:
Nitrates 
Some chemotherapy medication
Tranquillisers (phenothiazines)

Bad breath may be caused by certain medical conditions in rare cases such as dry mouth (xerostomia), the flow and composition of saliva may be affected.
In some cases, gastrointestinal conditions may also cause bad breath. 

Other medical conditions which may cause bad breath such as diabetes and lung, throat, or nose infections (e.g. bronchiectasis, bronchitis, tonsillitis, and sinusitis).
Halitophobia: Some people are convinced they have bad breath when they do not. This psychological condition is called halitophobia.

Diagnosis

Dentist will smell the breath of a patient and rate the odor on a six-point intensity scale. 

There are a variety of sophisticated detectors that can rate odor accurately, they include the following:

Beta-galactosidase test: This test measures the levels of the enzyme beta-galactosidase, which is found to be associated with mouth odor.    
                                                                  
BANA test: It measures for a specific enzyme produced by halitosis causing bacteria.    
   
Halimeter: It measures low levels of sulfur.

Gas chromatography: It measures 3 volatile sulfur compounds i.e. methyl mercaptan, hydrogen sulfide and dimethyl sulfide.



Treatment

The best method to reduce halitosis is good oral hygiene.

The dentist may prescribe a toothpaste that contains an antibacterial agent or an antibacterial mouthwash.

If gum disease is present, professional cleaning may be required to clear out the build-up of bacteria.

Home remedies and other lifestyle changes to avoid bad breath include:

  • Floss: Flossing reduces the build-up of food particles and plaque from between the teeth.  
                        
  • Brush teeth: Brush at least twice a day, but preferably after each meal.

  • Avoid dry mouth: Drink plenty of water. Avoid alcohol and tobacco, both of which dehydrate the mouth.      
                  
  • Chewing gum or sucking a sweet (sugar-free) can stimulate the production of saliva. 

  • Diet: Avoid onions, garlic and spicy food.  
         
  • Clean the dentures.

  • Clean the tongue.                                                  

Latest Treatment

Diagnosing the cause of bad breath holds the key to its treatment. However, maintaining good oral hygiene, visiting dentist regularly, avoiding dry mouth causing medications and smoking and alcohol, taking xylitol gums and using xylitol toothpastes can help to improve the condition.

Drink plenty of water and eat fibrous fruits and vegetables.

Alcohol-free mouthwash rinses by adding baking soda are effective. Recently, chlorine dioxide rinse has been found to be effective in 99 per cent of the cases.