BAD BREATH (HALITOSIS)

Overview

Halitosis, or bad breath, refers to unpleasant odours (volatile sulphur compounds) exhaled in breathing, whether the smell is from an oral source or not. In most cases, the millions of bacteria that live in the mouth are the primary causes of bad breath. In 90% of cases, bad breath originates from the mouth itself. Halitosis has a significant impact, personally and socially, on those who suffer from it or believe they do. The intensity of bad breath differs during the day and may be transient or persistent.

Causes
Dental problems.

• Poor oral hygiene 
• Poor denture hygiene
• Gum disease and tooth decay
• Some bacteria in the mouth may produce gaseous compounds that cause bad breath.

Food.
Eating foods containing volatile oils (e.g. onions, garlic) is a source of bad breath. After these foods are digested and the pungent oils are absorbed into the bloodstream, they are carried to the lungs and are given off in the breath until the food is eliminated from the body.

Dry mouth.
A dry mouth enables dead cells to accumulate on the tongue, gums and cheeks. These cells decompose and cause odour. Dry mouth can be caused by

• certain medical conditions
• medications such as anti-hypertensives, anti-histamines
• smoking, alcohol
• caffeine
• mouth breathing

Diseases.

•  chronic sinusitis, post-nasal drip,
•  chronic lung infections and lung abscesses,
•  kidney failure, liver disease, < uncontrolled diabetes  gastroesophageal reflux disease.  

Symptoms
A person may not be aware of his own bad breath. This phenomenon is because odour-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Other people may notice and react by recoiling as you speak.

Other associated symptoms depend on the underlying cause of bad breath.

Prevention
Bad breath caused by dental problems can be prevented by

• daily toothbrushing, flossing and cleaning the tongue
• daily cleaning of your denture and soaking it in a denture cleaner overnight
• Antiseptic mouthrinses may also be used.
• A visit to your dentist will detect gum disease and decay

Bad breath caused by food can be prevented by avoiding the specific food types. Bad breath caused by dry mouth can be prevented by drinking plenty of water daily and chewing sugar free gum to stimulate salivary flow.

When to Seek Help
Call your dentist if you have bad breath with painful, swollen, bleeding gums or loose teeth or if you have painful teeth with decay.

Call your doctor if

• your bad breath occurs together with a fever, sore throat, a post-nasal drip, a discoloured nasal discharge or mucus-producing cough.
• you are a diabetic, have gastroesophageal reflux disease or chronic liver or kidney disease, ask your doctor how bad breath can be a sign that your underlying medical condition needs immediate medical attention.

If you have none of these associated symptoms, call your dentist or physician if your bad breath persists despite a good diet and proper oral hygiene. 

Treatment Options
Treatment of bad breath depends on its cause. See also “Prevention”.

If your dentist determines that your mouth is healthy, and you have no underlying dental cause for your bad breath, you may be referred to your family doctor or a specialist.

Bad breath caused by certain medications and / or underlying medical conditions can only be treated by receiving the appropriate medical intervention.