Bad Breath (Halitosis)

Causes of Bad Breath (Halitosis)

Mouth

• The most common causes are due to poor oral hygiene.
• In order of descending prevalence, inter-dental also sub-gingival niches, faulty dental work, food-impaction areas in between the teeth, abscesses, and unclean dentures Oral based lesions caused by viral infections like herpes simplex and HPV may also contribute to bad breath.
• Due to eating certain foods such as garlic, onions, meat, fish, cheese, smoking, and alcohol consumption.
• Since the mouth is exposed to less oxygen and is inactive especially, during the night, the odour is usually worse upon awakening.

Tongue

• Dry also poorly cleansed posterior dorsum of tongue.
• The presence of halitosis-producing bacteria on the back of the tongue is not to be confused with tongue coating. Additionally, Bacteria are invisible to the naked eye, and degrees of white tongue coating are present in most people with and without halitosis.
• A visible white tongue coating does not always equal the back of the tongue as an origin of halitosis; however, a “white tongue” is thought to be a sign of halitosis. In oral medicine generally, a white tongue is considered a sign of several medical conditions.
• Lastly, Halitosis patients were also shown to have significantly higher bacterial loads in this region compared to individuals without halitosis.[1]

Gums

• Periodontal disease is a common cause of severe halitosis
• Multiple gingival and periodontal abscess
• Subgingival calculus
• Gingivitis and periodontal disease (in other words, periodontopathogens)

Nose and sinuses

• Nasal odors may be due to sinus infections or foreign bodies.
• Halitosis is often stated to be a symptom of chronic rhinosinusitis; however, gold standard breath analysis techniques have not been applied.

Tonsils

• Conditions of the tonsils which may be associated with halitosis include chronic caseous tonsillitis ,Tonsillolithiasis (in other words tonsil stones),peritonsillar abscess, actinomycosis, fungating malignancies and inflammatory myofibroblast tumor.

Esophagus

• The lower esophageal sphincter, which is the valve between the stomach and the esophageal may not close properly due to a hiatal hernia or GERD, allowing acid to enter the esophagus and gases to escape to the mouth.
• A Zenker’s diverticulum may also result in halitosis due to aging food retained in the esophagus.

Stomach

• Generally, the esophagus is a closed and collapsed tube, and continuous flow of gas or putrid substances from the stomach indicates a health problem—such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the oesophagus—which will demonstrate more serious manifestations than just foul odors^.

Systemic diseases

There are a few systemic (e.g. non-oral) medical conditions that may cause foul breath odour, but these are infrequent in the general population. Such conditions are:

1. Factor hepaticus an example of a rare type of bad breath caused by chronic liver failure
2. Lower respiratory tract infections (e.g. bronchial and lung infections)
3. Kidney infections and kidney failure
4. Carcinoma
5. Trimethyl-aminuria (e.g. “fish odors syndrome”)
6. Diabetes mellitus.
7. Metabolic conditions, e.g., resulting in elevated blood dimethyl sulphide [1]

Delusional halitosis

• One quarter of the people seeking professional advice on bad breath have an exaggerated concern of having bad breath, known as halitophobia, delusional halitosis.

Other causes

Other less common reported causes from within the mouth include:

• Deep carious lesions (in other words dental decay)
• Recent dental extraction sockets – fill with blood clot, and provide an ideal habitat for bacterial proliferation
• Interdental food packing – (food getting pushed down between teeth) – this can be caused by missing teeth, tilted, spaced or crowded teeth, or poorly contoured approximal dental fillings. Moreover, Food debris becomes trapped, undergoes slow bacterial putrefaction and release of malodourous volatiles. Food packing can also cause a localized periodontal reaction, characterized by dental pain that is relieved by cleaning the area of food packing with interdental brush or floss.
• Acrylic dentures (i.e. plastic false teeth) – inadequate denture hygiene practices such as failing to clean and remove the prosthesis each night, may cause a malodour from the plastic itself or from the mouth as microbiota responds to the altered environment. Besides this, the plastic is actually porous, and the fitting surface is usually irregular, sculpted to fit the edentulous oral anatomy. These factors predispose to bacterial and yeast retention, which is accompanied by a typical smell.[1]
• Oral infections
• Oral ulceration
• Fasting
• Either Stress or anxiety

Menstrual cycle –

• at mid cycle and during menstruation, increased breath VSC were reported in women.

Smoking –

• Smoking is linked with periodontal disease, which is the second most common cause of oral mal odors. Smoking also has many other negative effects on the mouth, from increased rates of dental decay to premalignant lesions and even oral cancer.
• Alcohol
• Volatile foods – e.g., onion, garlic, durian, cabbage, cauliflower and radish. Volatile foodstuffs may leave malodourous residues in the mouth, which are the subject to bacterial putrefaction and VSC release. However, volatile foodstuffs may also cause halitosis via the blood borne halitosis mechanism.
• Medication – often medications can cause xerostomia (in other words dry mouth) which results in increased microbial growth in the mouth.

Sign & Symptoms of Bad Breath (Halitosis)

• A white coating on the tongue especially at the back of the tongue
• Dry mouth
• Build up around teeth
• Post-nasal drip, or mucous
• Morning bad breath and a burning tongue
• Thick saliva and a constant need to clear your throat
• Constant sour, bitter metallic taste.

Diagnosis of Bad Breath (Halitosis)

• Diagnosis of halitosis is made from full history, examination or assessment of halitosis simply by smelling the exhaled air (i.e. organoleptic method), heliometer which give the amount of volatile amines, Sulphur compounds, methyl mercaptans and others in the breath

Treatment of Bad Breath (Halitosis)

• All nutrients necessary for efficient digestion are essential, as well as digestive enzymes.
• Improve the intestinal bacteria by eating yoghurt or supplementing with acidophilus can also be helpful.
• Other treatments for halitosis involve proper mouth hygiene, including regular tooth brushing.
• Often the use of dental floss is recommended.
• Vitamin C is needed to prevent scurvy, which can cause gums to bleed also become infected.
• A carefully balanced diet is essential for prevention of halitosis.
• Avoid excessive consumption of carbohydrates may help prevent tooth decay that can cause bad breath.

What is Bad Breath?

Bad Breath (Halitosis) Is an unpleasant odor of the breath, the state or condition of having bad breath.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Bad Breath?

• Arnica
• Pulsatilla
• Mercury
• Kreosotum
• Aurum Metallicum
• Nitric Acid

What are the symptoms of Bad Breath?

• White coating on back of the tongue
• Dry mouth
• Build up around teeth
• Post-nasal drip, or mucous
• Morning bad breath
• Burning tongue
• Thick saliva
• Constant need to clear your throat
• Constant sour, bitter metallic taste

What are the causes of Bad Breath?

• Poor oral hygiene
• Viral infections (herpes simplex, HPV)
• Dry and poorly cleansed tongue
• Periodontal disease
• Subgingival calculus
• Sinus infections or foreign bodies
• Chronic caseous tonsillitis ,Tonsillolithiasis
• Hiatal hernia or GERD
• Chronic liver failure
• Lower respiratory tract infections
• Diabetes mellitus