Table of Contents
Introduction
Bad breath can be not only a source of embarrassment for the patient, but also others may find it socially unpleasant. Further, because the mouth is the mirror to general health and needs to be composed of a healthy and immune oral microbiome, bad breath-causing microorganisms or pathogens can interfere with the oral and social quality of life (because speech is the primary factor or plays an important role in social communication). Hence, managing bad breath is important from both perspectives be it from a social or a systemic health perspective. In developed countries, almost 8 to 50 percent of all individuals suffer from bad breath or halitosis. Though there may be several causes or etiopathologic factors for bad breath, it is the intra-oral causes that need to be effectively managed by a dentist, who will also instruct oral care or hygiene methods to be implemented from home for sustaining a healthy oral microbiome. Halitosis can be managed or reduced by eliminating the intra-oral causes or by effective hygiene management, in almost 85 to 90 percent of patients.
What Is the Pathogenesis of Halitosis?
In a majority of cases, dental researchers have found that bad breath is caused by oral tissue diseases such as gingivitis (gum inflammation) and periodontal disease (the sequel of gingivitis that progresses to periodontium destruction of the tooth) or other systemic pathological conditions or in certain oral or systemic syndromes as well. In many systemic conditions, dry mouth or xerostomia would be a common occurrence that leads to the long-term persistence of bad breath in individuals throughout the day. The occurrence of bad breath is mainly linked to the presence of proteolytic anaerobic bacteria that are present in the oral cavity. Anaerobic bacteria or pathogens that act on amino acids such as methionine, cysteine, cystine, and others are responsible for interacting with the oral epithelial cells to produce VSCs or volatile sulfur compounds. Because the sulfur present in the oral detachments or the epithelial cells, leukocytes, and saliva interact further with the food one consumes, volatile sulfur compounds (VSC) mainly the following: hydrogen sulfide (H2S), methyl mercaptan (CH3SH), and dimethyl mercaptan ((CH3)2S) are produced in the oral cavity.
In a major research study by Hinodes, the major components of bad breath are these volatile sulfur compounds (VSCs) that are persistent because of the detrimental anaerobic bacterial infiltration and interaction in the mouth. Further, dental research shows that these anaerobic bacteria that are present in the periodontal pocket around the tooth, or especially those organisms that are retained on the dorsum of the tongue can further degrade or get easily decomposed. This formation of sulfur-containing amino acids to form volatile sulfur compounds (VSCs) in the periodontal pockets and the tongue dorsum are deemed responsible according to dental research for chronic states of halitosis.
What Is the Research Insight Into the Need for Professional Dental Treatment?
In healthy individuals, food interacts with the anaerobic bacteria that accumulate in the dorsum of the tongue and if there is a possibility of bad breath by VSC formation, by proper oral hygiene maintenance and tongue cleaning, bad breath can be at bay or prevented. However, in pathogenic oral conditions such as gingivitis, periodontitis, and dry mouth, dental patients who resort to only self-treatment such as tooth brushing, tongue cleaning, and mouth rinsing may also not be of any use. For dental cases, professional approaches such as dental scaling, periodontal treatment, gingival preservation treatment, and dental prosthetic treatment would be a necessity to be performed by a dentist.
Even for healthy individuals, current dental research implies the link between oral diseases or gingivitis and periodontitis to several systemic diseases and an increase in the HbA1c levels in diabetics and further even a risk factor for metabolic diseases, cardiovascular disease, and many more. Hence professional dental scaling and periodontal treatment are required for all individuals to sustain ideal oral health and immunity, with dental cases suffering from the accumulation of VSCs needing frequent quarterly six-monthly, or once-yearly dental follow-ups for professional dental treatment, as deemed necessary by the dental surgeon. Non-surgical periodontal treatment (scaling, tooth polishing), awareness or promotion of oral health education (right tooth brushing, interdental brushing techniques, and others) along with mechanical and chemical plaque control measures, proper oral care at home by tongue cleaning can be much needed preventive measures for bad breath or chronic halitosis.
How To Prevent Volatile Sulfur Compounds by Tongue Cleaning?
Research demonstrates through the measurement of the organoleptic test scores conducted in control groups after tongue cleaning- that was significantly reduced in the group that used either only a toothbrush, the group that used tongue scraper only, and the group that used both a toothbrush and a tongue scraper together.
These studies are indicative and consistent with previous medical research. They show that irrespective of the method of cleaning the tongue coating, bad breath can be significantly reduced in individuals (based on the organoleptic scores). Mechanical tongue cleaning is now advised by dental experts worldwide as an oral hygiene procedure or an adjunct for home care. Mechanical cleaning can significantly reduce the cause of production of volatile sulfur compounds (VSCs), by preventing the hydrolysis of anaerobic pathogens. Dentists commonly recommend effective tongue cleaning using a soft tongue scraper or by wiping the back of the tongue with the back side or front side of the toothbrush.
Doing so can firstly eliminate food residue, dead cells, anaerobic bacteria, or fungus present in between the tongue papilla, thereby interfering with the hydrolysis reaction and stopping the production of VSCs in the mouth.
Conclusion
It is important to understand that personal oral hygiene may alone not be enough to keep pathogenic oral bacterium in check. There is a necessity for professional dental treatment to ensure oral health. Dental hygiene awareness or oral education campaigns are to be given utmost importance across the globe by not only dental practitioners but even by other specializing medical professionals, due to the direct evidential link between oral health and general or systemic health. By preventing the production of VSCs or volatile sulfur compounds in the mouth through professional dental care or visits and personal oral care, one is also likely to ensure a better systemic health status as well.
