Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant odor is present on the breath. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder.
Concerns of bad breath may be divided into genuine and non-genuine cases. Of those who have genuine bad breath, about 85% of cases come from inside the mouth. The remaining cases are believed to be due to disorders in the nose, sinuses, throat, lungs, esophagus, or stomach. Rarely, bad breath can be due to an underlying medical condition such as liver failure or ketoacidosis. Non-genuine cases occur when someone feels they have bad breath but someone else cannot detect it. This is estimated to make up between 5% and 72% of cases.
The treatment depends on the underlying cause. Initial efforts may include tongue cleaning, mouthwash, and flossing. Tentative evidence supports the use of mouthwash containing chlorhexidine or cetylpyridinium chloride. While there is tentative benefit from the use of a tongue cleaner it is insufficient to draw clear conclusions. Treating underlying disease such as gum disease, tooth decay, or gastroesophageal reflux disease may help.Counselling may be useful in those who falsely believe that they have bad breath.
Estimated rates of bad breath vary from 6% to 50% of the population.Concern about bad breath is the third most common reason people seek dental care, after tooth decay and gum disease.It is believed to become more common as people age. Bad breath is viewed as a social taboo and those affected may be stigmatized. People in the United States spend more than $1 billion per year on mouthwash to treat the condition.
History, society and culture
The earliest known mention of bad breath occurs in ancient Egypt, where detailed recipes for toothpaste are made before the Pyramids are built. The 1550 BC Ebers Papyrus describes tablets to cure bad breath based on incense, cinnamon, myrrh and honey. Hippocratic medicine advocated a mouthwash of red wine and spices to cure bad breath.Note that alcohol-containing mouthwashes are now thought to exacerbate bad breath as they dry the mouth, leading to increased microbial growth. The Hippocratic Corpus also describes a recipe based on marble powder for female bad breath sufferers. The Ancient Roman physician Pliny wrote about methods to sweeten the breath.
Ancient Chinese emperors required visitors to chew clove before an audience. The Talmud describes bad breath as a disability, which could be grounds for legal breaking of a marriage license. Early Islamic theology stressed that the teeth and tongue should be cleaned with a siwak, a stick from the plant Salvadora persica tree. This traditional chewing stick is also called a Miswak, especially used in Saudi Arabia, an essentially is like a natural toothbrush made from twigs. During the Renaissance era, Laurent Joubert, doctor to King Henry III of France states bad breath is “caused by dangerous miasma that falls into the lungs and through the heart, causing severe damages”.
In B. G. Jefferis and J. L. Nichols’ “Searchlights on Health” (1919), the following recipe is offered: “[One] teaspoonful of the following mixture after each meal: One ounce chloride of soda, one ounce liquor of potassa, one and one-half ounces phosphate of soda, and three ounces of water.”
In the present day, bad breath is one of the biggest social taboos. The general population places great importance on the avoidance of bad breath, illustrated by the annual $1 billion that consumers in the United States spend on deodorant-type mouth (oral) rinses, mints, and related over-the-counter products. Many of these practices are merely short term attempts at masking the odor. Some authors have suggested that there is an evolutionary basis to concern over bad breath. An instinctive aversion to unpleasant odors may function to detect spoiled food sources and other potentially invective or harmful substances. Body odors in general are thought to play an important role in mate selection in humans, and unpleasant odor may signal disease, and hence a potentially unwise choice of mate. Although reports of bad breath are found in the earliest medical writings known, the social stigma has likely changed over time, possibly partly due to sociocultural factors involving advertising pressures. As a result, the negative psychosocial aspects of halitosis may have worsened, and psychiatric conditions such as halitophobia are probably more common than historically. There have been rare reports of people committing suicide because of halitosis, whether there is genuine halitosis or not.
Scientists have long thought that smelling one’s own breath odor is often difficult due to acclimatization, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis is not easy because of preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of bad taste (metallic, sour, fecal, etc.), however bad taste is considered a poor indicator.
Patients often self-diagnose by asking a close friend.
One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. This test results in overestimation, as concluded from research, and should be avoided. A better way would be to lightly scrape the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs are now available, but there are few studies showing how well they actually detect the odor. Furthermore, since breath odor changes in intensity throughout the day depending on many factors, multiple testing sessions may be necessary.
If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath. They often use some of several laboratory methods for diagnosis of bad breath:
Halimeter: a portable sulfide monitor used to test for levels of sulfur emissions (to be specific, hydrogen sulfide) in the mouth air. When used properly, this device can be very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical applications. For example, other common sulfides (such as mercaptan) are not recorded as easily and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.
Gas chromatography: portable machines, such as the OralChroma, are currently being introduced. This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.
BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
β-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor.
Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts (“organoleptic measurements”). The level of odor is usually assessed on a six-point intensity scale.
Causes of bad breath
- Deep carious lesions (dental decay) – which cause localized food impaction and stagnation
- 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. Food debris becomes trapped, undergoes slow bacterial putrefaction and release of malodorous 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 (plastic false teeth) – inadequate denture hygiene practises 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. 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.
- Oral infections
- Oral ulceration
- 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 malodor. Smoking also has many other negative effects on the mouth, from increased rates of dental decay to premalignant lesions and even oral cancer.
- Volatile foods – e.g. onion, garlic, durian, cabbage, cauliflower and radish. Volatile foodstuffs may leave malodorous residues in the mouth, which are the subject to bacterial putrefaction and VSC release. However, volatile foodstuffs may also cause halitoisis via the blood borne halitosis mechanism.
- Medication – often medications can cause xerostomia (dry mouth) which results in increased microbial growth in the mouth.
According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is a remedy for bad breath. In South Asia, it was a custom to chew areca or betel nut and betel leaf among lovers because of the breath-freshening and stimulant drug properties of the mixture. Both the nut and the leaf are mild stimulants and can be addictive with repeated use. The betel nut will also cause dental decay and red or black staining of teeth when chewed. Both areca nut and betel leaf chewing, however, can cause premalignant lesions such as leukoplakia and submucous fibrosis, and are recognised risk factors for oral and oropharyngeal squamous cell carcinoma (oral cancer). Other traditional remedies for halitosis include guava leaves in Thailand, eggshells in China, parsley in Italy, and urine-based mouth rinse in certain European cultures.
Practitioners and purveyors of alternative medicine sell a vast range of products that claim to be beneficial in treating halitosis, including dietary supplements, vitamins, and oral probiotics. Halitosis is often claimed to be a symptom of “candida hypersensitivity syndrome” or related diseases, and is claimed to be treatable with antifungal medications or alternative medications to treat fungal infections.
1.Brush your teeth regularly.
Two major sources of mouth odor are bacteria and decaying food particles. There are hundreds of nooks and crannies in the fertile landscape of your mouth where these offending bits of “rot” can get lodged.
Squeeze a pea-sized amount of toothpaste onto a soft bristled toothbrush, and hold the brush at a 45 degree angle to the gums. Brush your teeth on every surface in short, gentle strokes, being careful not to press too hard or irritate the gums. If done properly, brushing should take about three minutes.
Brush your teeth and rinse with mouth wash at least twice a day, and floss at least once a day.
Take care to brush all the areas of your mouth, including gums and tongue, and not just your teeth.
2.Clean your tongue.
It is not enough to simply brush your teeth. Since your tongue has a lot of surface area and is covered with textured bumps and grooves, it harbors more bacteria than the rest of your mouth combined. Removing the bacteria on your tongue can go a long way in reducing your bad breath.
You can buy Orabrush or other tongue brushes from stores, or simply use your regular soft bristled toothbrush.
Brush your tongue from back to front, rinsing the brush between strokes.
If you have a sensitive gag reflex, tongue-brushing may aggravate the problem. Read How to Suppress the Gag Reflex for some tips.
3.Floss every day.
Flossing your teeth is just as important to good oral health as brushing, and even more important for reducing bad breath. Make it as much of a mindless habit as brushing your teeth.
At first, your gums might bleed as you dislodge chunks of food that have “stuck” to your teeth and gum for who knows how long. But take a second to smell the floss after you pass it through your teeth, if you dare. You’ll see (or smell) where the bad breath is coming from.
Mouthwash helps to keep your mouth moist and helps to prevent bad breath.Choose a mouth wash containing chlorine dioxide. Many of the bacteria that cause halitosis live on the back of the tongue, too far back to remove with regular brushing or scraping. Luckily, vigorous swishing with a chlorine dioxide-containing wash can neutralize those bacteria.
Try rinsing with mouth wash before brushing, flossing, and brushing or scraping the tongue, and again when you’re done. This will ensure that you neutralize any bacteria that remain after the process is complete.
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This Is The Conclusion
Bad breath, medically called halitosis, can result from poor dental health habits and may be a sign of other health problems. Bad breath can also be made worse by the types of foods you eat and other unhealthy lifestyle habits.
How Does What You Eat Affect Breath?
Basically, all the food eaten begins to be broken down in your mouth. If you eat foods with strong odors (such as garlic or onions), brushing and flossing — even mouthwash — merely covers up the odor temporarily. The odor will not go away completely until the foods have passed through your body.
Why Do Poor Habits Cause Bad Breath?
If you don’t brush and floss teeth daily, food particles can remain in your mouth, promoting bacterial growth between teeth, around the gums, and on the tongue. This causes bad breath. Antibacterial mouth rinses also can help reduce bacteria.
In addition, odor-causing bacteria and food particles can cause bad breath if dentures are not properly cleaned.
Smoking or chewing tobacco-based products also can cause bad breath, stain teeth, reduce your ability to taste foods, and irritate your gums.
What Health Problems Are Associated With Bad Breath?
Persistent bad breath or a bad taste in the mouth may be a warning sign of gum (periodontal) disease. Gum disease is caused by the buildup of plaque on teeth. Bacteria cause the formation of toxins to form, which irritate the gums. If gum disease continues untreated, it can damage the gums and jawbone.
Other dental causes of bad breath include poorly fitting dental appliances, yeast infections of the mouth, and dental caries (cavities).
The medical condition dry mouth (also called xerostomia) also can cause bad breath. Saliva is necessary to moisten the mouth, neutralize acids produced by plaque, and wash away dead cells that accumulate on the tongue, gums, and cheeks. If not removed, these cells decompose and can cause bad breath. Dry mouth may be a side effect of various medications, salivary gland problems, or continuous breathing through the mouth.
Many other diseases and illnesses may cause bad breath. Here are some to be aware of: respiratory tract infections such as pneumonia or bronchitis, chronic sinus infections, postnasal drip, diabetes, chronic acid reflux, and liver or kidney problems.
What Can I Do to Prevent Bad Breath?
Bad breath can be reduced or prevented if you:
- Practice good oral hygiene. Brush twice a day with fluoride toothpaste to remove food debris and plaque. Brush teeth after you eat (keep a toothbrush at work or school to brush after lunch). Don’t forget to brush the tongue, too. Replace your toothbrush every 2 to 3 months or after an illness. Use floss or an interdental cleaner to remove food particles and plaque between teeth once a day. Rinse with an antibacterial mouthwash twice a day. Dentures should be removed at night and cleaned thoroughly before being placed in your mouth the next morning.
- See your dentist regularly — at least twice a year. He or she will conduct an oral exam and professional teeth cleaning and will be able to detect and treat periodontal disease, dry mouth, or other problems that may be the cause of bad mouth odor.
- Stop smoking and chewing tobacco-based products. Ask your dentist for tips on kicking the habit.
- Drink lots of water. This will keep your mouth moist. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates the production of saliva, which helps wash away food particles and bacteria. Gums and mints containing xylitol are best.
- Keep a log of the foods you eat. If you think they may be causing bad breath, bring the log to your dentist to review. Similarly, make a list of the medications you take. Some drugs may play a role in creating mouth odors.
Who Treats Bad Breath?
In most cases, your dentist can treat the cause of bad breath. If your dentist determines that your mouth is healthy and the odor is not of oral origin, you may be referred to your family doctor or to a specialist to determine the odor source and treatment plan. If the odor is due to gum disease, for example, your dentist can either treat the disease or refer you to a periodontist, a dentist who specializes in treating gum conditions.
What Products Can I Use to Eliminate Bad Breath?
An antiseptic mouthwash can help eliminate bacteria that cause bad breath. Ask your dentist about which product is best for you.