BAD BREATH/HALITOSIS

BAD BREATH/HALITOSIS

HALITOSIS colloquially called bad breath, feter oris,fege bosta, is  a symptom in which a noticeably unpleasant odor  is present on the exhaled breath. 

CAUSES

- The most common cause is of  the odor is caused by bacteria present below the gum line and on the back of the tongue.
- Of those who feel they have halitosis, significant percentages 5-72% have been reported to have no genuine halitosis when professionally examined. 
- The remaining 10% is accounted for by many different conditions, including disorders in the nasal cavity,sinus,lungs,throat, esophagus,stomach or elsewhere.


Other causes are

• 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
• Inter dental 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 inter dental 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 ulcerations
• Fasting
• Stress/anxiety
• Menstrual cycle – at mid cycle and during menstruation, increased breathvolatile sulfur compounds 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
• Alcohol
• Volatile foodstuffs – e.g. onion, garlic, 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 halitosis via the blood borne halitosis mechanism.
• Medication – often medications can cause xerostomia (dry mouth) which results in increased microbial growth in the mouth.

MANAGMENT

The following strategies may be suggested:

1. CLEANING OF TONGUE SURFACE twice daily is the most effective way to keep bad breath in control; that can be achieved using a tooth brush, tongue cleaner or tongue scraper to wipe off the bacterial biofilim, debris, and mucus. Brushing a small amount of mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.
2. EATING HEALTHY FOODS with rough foods helps clean the very back of the tongue.
3. CHEWING GUM Since dry-mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. 
4. GARGLING right before bedtime with an effective mouthwash .  
5. MAINTAINING ORAL HYGIENE, including daily tongue cleaning,brushing,flossing and periodic visits to dentist. . 
6. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by one's dentist).
7. PROBIOTIC TREATMENTS specifically Streptococcus salivarius K12 has been claimed to suppress malodorous bacteria growth, however well designed randomised control clinical trails are needed to assess this.

by,

DR.RENJU T GEORGE,
SIGNAL DENTAL SPECIALITY CLINIC,
KALAVATHU ROAD ,
PALARIVATTOM,
COCHIN-25,
KERALA,INDIA.