Bad breath or halitosis is an embarrassing problem and a great selling point for literally every toothpaste and mouthwash on the market. Around 50% of the population globally suffers from this condition.
What Causes Bad Breath?
Halitosis is mostly due to volatile molecules that originate from the mouth or nearby structures. These molecules can include a variety of amines, short-chain fatty acids, nitrogen-containing compounds, and even hydrogen sulfide.
Bacteria in the oral cavity are responsible for the production of these gases which are released when bacteria feed on food material in the mouth. If you have gum disease or dental caries, bacteria grow here as well and lead to bad breath.
In fact, 80-85% of cases are due to causes within the mouth.
If you have poor saliva production (a condition called xerostomia), then your breath can smell bad as a consequence of this. A coated tongue, not brushing teeth regularly and dentures is another cause.
But halitosis can also originate from non-oral sources. Those people who suffer from acid reflux disease, tonsil infections, lung infections, and some forms of gastrointestinal cancer are prone to bad breath.
High alcohol intake and smoking also affect breath.
Certain foods such as garlic, onion, radish, and pickles can lead to foul-smelling breath as well.
You May Not Have Bad Breath
There is a condition called ‘delusional halitosis’, where you believe you have stinky breath, but everyone around you thinks it’s fine. It is sometimes called imaginary halitosis.
Believe it or not, TV advertising of oral hygiene products (remember the old Close-UP toothpaste ads – you need a fresh breath to get the girl!) has led to an increased number of cases of delusional halitosis.
Some people even develop a morbid fear of bad breath, called Halitophobia. It is seen in 0.1 – 1% of the population. Such individuals may need counseling if the fear affects their quality of life.
Why Do We Wake Up With Smelly Breath?
Every morning you may find that your breath stinks. This is called physiological halitosis and is a natural phenomenon.
It happens because, throughout the night, your saliva is stagnated inside your mouth. Any food particles undergo a mild decaying process and are infected by any bacteria in the mouth. This releases smelly gases. The dead cells that line the gums also are released into the saliva, leading to bad breath.
Assessment Of Halitosis
Bad breath is evaluated through a test called organoleptic measurements. Here a patient holds their breath for a short while and then breathes out through a pipette. The doctor/examiner smells the breath from 20 cm away and scores it according to a scale.
There are other tests as well that measure gas levels in the breath. A detailed discussion on this is out of the scope of this article.
If you suffer from halitosis, then see a dentist first. It is likely to be an oral cause.
Chewing gum may help as it improves saliva production. Good oral hygiene is essential.
Brushing teeth twice daily, gargling after meals, and using mouthwash helps mask the smell. Listerine is particularly helpful.
For some of my patients with bad halitosis, I recommend chlorhexidine mouth rinses. It is an effective killer of bacteria in the mouth. I don’t recommend it long-term as it can stain the teeth.
Clean your tongue when you brush your teeth. This can lower the smell by more than 40%. Using a tongue cleaner is better than using your toothbrush.
Flossing also helps get rid of germs between teeth. Always floss before you brush your teeth.
Patients who suffer from delusional halitosis may require cognitive behavioral therapy. There are many modalities of treatment available now that help one get over the fear of bad breath.
Dr Vivek Baliga is a medical practitioner and the director of a diagnostic center – Baliga Diagnostics – in Bangalore. He specializes in diabetes and heart disease, and is a visiting consultant in Internal Medicine at corporate hospitals. He is married and has one son.