Halitosis or Bad Breath: Causes and Management

What Is Halitosis?

Halitosis is an oral health problem affecting many individuals. It is commonly known as bad breath. It simply refers to a feeling of having bad breath with which no one feels comfortable. This condition affects around 20 to 25 percent of the population in general. Although it is not a dental emergency, due to its clinical, psychological, and social implications on the affected individual, it needs to be addressed immediately. If it remains unrecognized and untreated, leads to embarrassment, social stigma, and diminished quality of life for affected individuals. Understanding the causes of halitosis, healthcare professionals and individuals work towards effective treatment and management to alleviate this common oral health issue. The article discusses halitosis, causes, symptoms, diagnosis, treatment, and prevention.

What Are the Causes and Risk Factors of Halitosis?

There are several causes associated with it which are within the control of an individual and due to clinical disorders within the oral cavity and the general body.

Causes Within the Control of an Individual:

• Smoking and Tobacco Use: The use of tobacco and tobacco-based products, smoking, and snuff containing areca nut and lime not only dries out the mouth but also leaves behind chemicals that produce a foul odor.

• Poor Oral Hygiene: It is the common cause of bad breath. Failure to brush and floss regularly allows food particles to accumulate between teeth and tongue. Missing the habit of mouth rinsing after taking foods and beverages provides a ground for the growth of bacteria and leads to foul smells.

• Alcohol intake.

• Poor Cleaning of Dental Appliances: Not cleaning oral prostheses like dentures can lead to the accumulation of bacteria and cause bad breath.

Causes Due to Dental Problems:

• Oral Infections: Certain infections in the mouth, such as dental abscess, oral thrush (fungal infection), anddiseased teeth around which food collects or food impaction. It may lead to the presence of pus and bacteria.

• Dry Mouth (Xerostomia): Dryness of mouth due to old age or use of drugs for asthma. Saliva is used to wash away food particles and bacteria in the mouth. A reduction in salivary flow due to medications and medical conditions can lead to the development of dry mouth.

• Need for Regular Dental Check-Up: An inadequate frequency of professional checkups and scaling procedures which is mandatory every six months.

Causes Due to Systemic Diseases:

• Postnasal drip (when severe mucus drips down on the back of the throat).

• Acid reflux disease (back reflux of acid from stomach to esophagus).

• Accumulation of acetone bodies in the blood in diabetes leads to acetone breath.

• Gastrointestinal obstruction and constipation which can cause fecal breath.

• Liver failure or jaundice.

• Chronic renal failure leads to uraemic stomatitis as well.

Other Causes:

• Use of foods containing sulfur like onion and garlic.

• Stress can affect saliva production and cause halitosis.

How Does Halitosis Happen?

Halitosis happens due to the release of chemicals from the bacterial decomposition of foods, particularly fats and carbohydrates. Sulfur is one of the important ingredients of such processes.

Such chemicals are also generated due to impairment of bodily functions due to diabetes mellitus, chronic renal failure, and jaundice.

What Are the Symptoms of Halitosis?

Halitosis manifests through various symptoms and is observable by others. The common symptoms of halitosis are as follows:

• The most common symptom is the presence of foul and unpleasant breath odor.

• Individuals with the condition may experience persistent odor and metallic taste in the mouth.

• Reduced salivary flow causes the accumulation of bacteria and food debris in the mouth and causes bad breath.

• A thick white or yellow crusty layer can be present on the tongue surface. This consists of bacteria and food particles and causes bad breath.

• The saliva of the affected individuals is thicker than usual.

• Excess dripping of mucus on the back part of the throat from the nose.

• Sore throat.

• Tonsil stones.

• Difficulty in tasting and smelling.

• It has a psychological impact, causing embarrassment and social isolation in affected individuals.

How Is Halitosis Diagnosed?

The key steps to diagnose halitosis are as follows:

• Medical History: The healthcare provider may take a detailed history and ask them questions, such as dietary habits, oral hygiene practices, medication use, medical conditions, and lifestyle factors, such as smoking or alcohol consumption.

• Symptoms Assessment: The doctor may ask the patient about the symptoms they are experiencing, such as dry mouth, sore throat, and bad breath.

• Clinical Examination: The doctor may physically examine the oral cavity and assess for signs of dental problems, gum disease, and oral infections that may contribute to bad breath. They may assess the tongue, palate, teeth, and gums. The dentist may use a tongue scraper or spatula which is used to assess and remove the coating for further examination.

• Saliva Assessment: The healthcare provider may assess the quality and quantity of saliva to evaluate dry mouth which may contribute to bad breath.

How to Manage Halitosis?

The treatment strategies to manage halitosis are as follows:

• Maintain good oral hygiene by brushing the teeth regularly and rinsing after taking meals, beverages, and any kind of drugs or syrups.

• Get a prophylactic scaling done by a dentist every six months.

• It is necessary to get special care and follow-up in the case of medically compromised patients with diabetes, kidney failure, etc.

• Ensure cleaning the dentures and other removable oral prostheses daily.

• Restore oral health by treating problems like xerostomia and filling of carious teeth.

• Consult a general physician for diseases of the stomach, intestines, kidneys, etc.

Medications for Symptomatic Relief Are:

• Mouthwash containing Chlorhexidine.

• Gum paint to treat gingival diseases.

• Proton-pump inhibitors (PPI) like Pantoprazole to treat acid reflux.

How to Prevent Halitosis?

The key strategies to prevent halitosis are as follows:

• Maintain good oral hygiene by brushing twice a day and flossing to remove food debris and plaque between the teeth.

• Use a tongue cleaner to clean the tongue regularly.

• Use of antimicrobial mouthwash, such as chlorhexidine or mouth rinse to reduce bacterial growth and freshen breath.

• Stay hydrated.

• Chew sugar-free gums or mints to increase salivary flow.

• Avoid or limit consumption of food and beverages, such as onion, garlic, spicy foods, coffee, and alcohol.

• Quit smoking.

• Use salivary stimulating products.

• Regular dental check-ups.

Conclusion

Halitosis occurs by the Sulphur-producing bacteria in the oral cavity. Other chief causes include dry mouth due to smoking, poor oral hygiene, and certain foods. Treatment of halitosis is based on the underlying health condition. However, with proper prevention strategies and treatment, halitosis can be effectively managed and prevented. Maintaining good oral hygiene through regular brushing flossing, and tongue cleaning, is essential for preventing the accumulation of oral bacteria that contribute to bad breath. Awareness of proper oral hygiene practices, lifestyle modifications, and seeking professional dental care are the key components of preventing and managing halitosis.