HALITOSIS: science speaks for bad breath. Most of us have experienced it at some time and a few of us may have wondered whether those around us detected the same funky smell we noticed coming from our breath that morning. Well, apparently, people stepping back during conversation or covering their noses is NOT a sign that you suffer from halitosis. Your loved ones telling you: “your breath smells, love”, on the other hand, IS a sure sign you do have halitosis and it is probably time to talk to your dentist about it.
All halitosis comes from the mouth and 90 % of it is caused by something within the mouth. Rarely, the cause of halitosis can also be external, such as an upper respiratory tract infection, lower respiratory tract infection, systemic cause (e.g. Gastroesophageal reflux disease) or blood-borne cause (you may have heard of Trimethylaminuria). What I really want to focus on in this post are the different forms of halitosis, the differences between physiological (‘normal’) and pathological (disease-linked) bad breath, and give some advice on how they can be managed.
Halitosis can be classified as genuine (you really have it and there is a cause for it), pseudo-halitosis (you don’t have it but you think you have it) and halitophobia (you’re plain paranoid about having bad breath).
Genuine halitosis is either physiological (caused by the body’s normal function, i.e. morning breath) or pathological (caused by disease, like periodontal disease, tooth decay, old fillings breaking down, ulcers, or cancer).
Genuine halitosis results from bacteria breaking down organic material in the mouth (e.g. cells on the tongue surface, food in the gum pockets) and releasing volatile sulphur compounds, which can be pretty smelly. The smell usually comes from the back of the tongue. This is a rough surface, made even rougher by the constant shedding of dead cells, which can attract up to 20 times more bacteria than any other soft tissue surface in the mouth (like cheeks, lips, and the floor of the mouth). In the absence of steady saliva flow at night, bacteria stick to the back of the tongue, left there for hours overnight. Hence, we wake up smiling at our loved ones or lean over for a kiss, only to be shown the way to the nearest bathroom….
FEAR NOT: physiological halitosis is temporary and totally treatable! Morning breath is made better with a glass of water, and a crunchy, grainy breakfast (helping to clean out dead cells) followed by regular brushing of teeth and tongue and occasionally finishing with a mouth rinse (if advised by your dentist).
Pathological bad breath, the other kind of genuine halitosis, is a little harder to deal with. It’s usually caused by gum (periodontal) disease, whether localized or generalized. This disease causes gums to pull away from teeth, creating pockets for food and bacteria to become lodged. The bacterial breakdown of food in these areas causes the smell. An excellent example of this is the bad breath associated with an impacted wisdom tooth. Other causes of pathological bad breath may also be a decayed tooth, an abscessed tooth, an old ‘leaky’ filling, or an ulcer…these conditions should be treated by your dentist and hygienist and the bad breath should disappear.
Here are some tips that will put sufferers on the path to a minty fresh mouth:
See your dentist– they can tell you whether or not you suffer from genuine halitosis. If so, they will look for possible causes and recommend a combination of multiple treatment possibilities:
- Oral hygiene advice, combined with treatment.
- Replacement of bad fillings or other dental work.
- Dental treatment to eliminate the disease from decaying or abscessed teeth.
- Possible removal of impacted wisdom teeth.
Brush your teeth regularly (twice per day) and always brush your tongue (do this very gently along the back of the tongue).
Floss daily– this will remove food debris between the teeth, eliminating potential bacterial breeding grounds.
Drink plenty of water. It may help to keep a glass of water by your bedside at night if you feel your mouth is super-dry.
Chew sugar-free gum after meals. This stimulates saliva flow, good for washing away the debris of food and dead cells from your mouth. It also has antibacterial properties.
See a hygienist regularly for thorough cleaning.
Occasionally, mouth rinses containing chlorhexidine, triclosan, cetylpyridinium chloride (CPC), zinc or essential oils, can help eliminate bad breath. They do this in two ways, either by killing some of the bacteria or by binding to the foul-smelling sulfur compounds (which only works in the short run). Some scientists have even researched rough lollies with zinc and propolis and found that they had an effect on removing bad breath, but I’m not aware if they are available to purchase in Australia. It’s best to use mouth rinses only when recommended by your dentist.
If your dentist determines you have halitosis from systemic causes, they may refer you to your GP. Some systemic causes of bad breath can be sinus and throat infections, tonsil stones (calcified debris), chest infections, gastroesophageal reflux disease, poorly controlled diabetes, etc.
If your dentist cannot determine any bad breath or see any possible cause, and even with the professional advice you still think you have bad breath, you may need to seek a consultation with a GP concerning the possibility of halitophobia.