Halitosis (Bad Breath) : Symptom, Cause, Diagnosis Approach, Treatment, And Prevention

Halitosis (Bad Breath) is a symptom in which a noticeably unpleasant odor is present on exhaled breath.The foul oral odor is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area.The term anaerobic literally means living without oxygen.The bacteria occur naturally in the oral environment.They are essential because they assist in digestion by breaking down proteins into amino acids.

The symptoms of Halitosis

• Post-nasal drip
• A bitter metallic taste
• A white coating on the tongue
• Thick saliva

The Author suggested that halitosis can be divided according to the character of the odor into three groups :

• Sulfurous or fecal caused by volate sulfur compounds (VSC), most notably methyl mercaptan, hydrogen sulfide, and dimethyl sulfide.
• Fruity caused by acetone, present in diabetes.
• Urine-like ammoniacal caused by ammonia, dimethyl amine, trimethylamine (TMA), present in trimethylaminuria and uremia.

An Etiologic classification of halitosis has been proposed :

• Type 0 : Physiologic
• Type I : Oral
• Type II : Airway
• Type III : Gastroesophageal
• Type IV : Blood-borne
• Type V : Subjective

The causes of Halitosis

1. Mouth is exposed to less oxygen and is inactive at the night, the odor is usually worse upon awakening.Dry mouth can cause the growth of bacteria.
2. Tongue.Large quantities of naturally-occuring bacteria are found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity.This part of the tongue is relatively dry and poorly cleansed, and the convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, wgich flourish under a continually-forming tongue coating of food debris, dead epithelial cells, postnasal drip, and overlying bacteria, living and dead.
3. Nose and sinuses.Nasal odor may  be due to sinus infections.
4. Gums.Waste products from anaerobic bacteria growing below the gumline  (subgingival) have a foul smell and have been clinically demonstrated to produce a very intense bad breath.
5. Tonsils are the most significant cause of halitosis after the mouth.
6. Esophagus.A Zenker's diverticulum may result in halitosis due to aging food retained in the esophagus.
7. Stomach is considered as a very uncommon source of bad breath.
8. Halitophobia is bad breath suffer from a highly exaggerated concern of having bad breath.
9. Systemic disease  may cause foul breath odor 

• Fetor hepaticus
• Lower respiratory tract infections, such as lung and bronchial infections
• Diabetes mellitus
• Renal infection and renal failure
• Carcinoma
• Trimethylaminuria (fish odor syndrome)
• Metabolic conditions

10. Other potential can cause oral malador

• Deep carious lesions (dental decay) cause localized food and stagnation.
• Recent dental extraction sockets provide an ideal habitat for bacterial proliferation.
• Interdental food packing.
• Acrylic dentures (plastic false teeth).
• Oral infection.
• Oral ulceration.
• Fasting.
• Stress and anxiety.
• Menstrual cycle.At mid cycle and during menstruation can increase volate sulfur compound.
• Smoking.
• Alcohol.
• Volatile foodstuffs, such as garlic, onion, durian, cauliflower, radish  and cabbage.
• Medications can cause dry mouth that increases the growth of bacteria.

Diagnostic Approach

1. Self Diagnosis is not easy because of preconceived notions of how bad someone think it should be.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 minutes and smell the result.This test results in overestimation.Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds and tongue swabs are available.
2. Professional Diagnosis is to use several laboratory methods for diagnosis of bad breath :

• Halimeter is a portable sulfide monitor used to test for levels of sulfur emissions (hydrogen sulfide) in the mouth air.It can be very effective at determining levels of certain volate sulfur compound-producing bacteria if the device is used properly.
• Gas chromatography is portable machines, such as OralChroma that is designed to digitally measure molecular levels of the three major volate sulfur compounds in a sample of mouth air, including hydrogen sulfide, methyl mercaptan, and dimethyl sulfide.
• Bana Test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
• Beta-Galactosidase Test is to find salivary levels of this enzyme to be correlated with oral malador.

Treatment of Halitosis

The treatment of halitosis effectively is not easy to find.There are some strategies to treat halitosis or bad breath :

• Gently cleaning the tongue surface in twice a day.
• Eating a healthy breakfast with rough foods that helps in cleaning the very back of the tongue.
• Chewing gum aids in provision of saliva, which washes away oral bacteria.It has antibacterial properties and promotes mechanical activity which help in cleansing  the mouth.Some chewing gums contain special anti-odor ingredients, such as mastic gum, cinnamon sticks, fennel seeds, and fresh parsley.
• Gargling right before bedtime with an effective mouthwash.Mouthwashes often contain antibacterial agents, such as cetylpyridinium chloride, chlorhexidine, zinc gluconate, hydrogen peroxide, chlorine dioxide, and essential oils.
• Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to desntists and hygienists.
• Probiotic treatment by specifically Streptococcus salivarius K12 is to suppress maladorous bacteria growth.
• Brushing teeth occasionally with baking soda can neutralize excess acids found in the oral cavity.

Prevention of Halitosis

• Avoid drying medication or avoid using antidepressant, diuretics, antihisthamines unless it is medically necessary because these drugs inhibits saliva flow and can cause  chronic dry mouth.
• Stop smoking.Smoking can develop periodontal disease and dry mouth.
• Keep the mouth moist by drinking plenty of water.
• Breathe through the nose instead of the mouth.
• Eliminate dairy products from your diet.
• Clean dentures at least once a day.
• Avoid products with sodium lauryl, sulfate and alcohol.
• Clean the mouth after eating meat, fish, and dairy products.
• Drink green and black teas that contain polyphenols to eliminate sulfur compounds and reduce oral bacteria.
• Eat food with high fibers and avoid eating heavily processed foods that contain refined carbohydrate, such as ice creams, cookies, and cakes.