Halitosis (Bad Breath)
Everyone experiences bad breath occasionally but it is estimated that 25% of adults have a persistent problem (often being unaware of the existence of the problem). Perhaps another 25% think they have a problem but do not. The stomach is virtually never the cause of bad breath.
At East Keilor Dental we have a halimeter (the first ever in Victoria) to measure sulfur gases in your breath.[/dt_sc_toggle_framed]
When the tissues and saliva no longer have the ability to absorb the gases we start to smell them.
- diet – garlic, onions, hot spices eg paprika, heavy protein foods meat/fish with the sulphur-containing amino acids, fatty foods, cabbage, vitamin supplements (especially high dosages).
- The mouth – after diet has been eliminated as the cause, the mouth is the origin of bad breath in more than 90% of cases
- tongue coating – especially in kids through to younger adults. The tongue coating is composed of dead tissue, dead blood cells, food debris and bacteria. The bacteria that produce the smelly gases naturally reside in the grooves on the top, back 1/3 of the tongue.
- gum disease & tongue coating – especially in older adults. Usually patients with gum disease have a heavier tongue coating.
- poor oral hygiene.
- dieting – ketosis (a situation that occurs when the body changes from burning carbohydrates to burning fats).
- morning breath (decreased saliva during sleep).
- alcohol – both the smell of the alcohol and its drying effect on the mouth.
- smoking – specific odour & drying of mouth.
- local factors – mouth ulcers, decayed teeth, food traps, dentures etc.
- dry mouth – which can be caused by medications (antihistamines, tranquillizers, anxiety, irradiation), Sjorgren’s Syndrome, alcohol, smoking and nighttime mouth breathing. This leads to less flushing of debris, less swallowing of Volatile Sulphur Compounds (VSCs – the fould smelling gases), less absorption of VSCs.
- menstruation – hormones alter protein production ie more ‘food’ for the oral bacteria to break down to produce smelly gases.
- The airway in less than 5%
- tonsillitis, pharyngitis, sinusitis, bronchitis etc.
- acute smell in kids – foreign object or sore throat.
IT IS POSSIBLE TO DISTINGUISH BETWEEN THESE TWO GROUPS BY SEPARATELY MEASURING THE SMELL EMANATING FROM THE MOUTH & THE NOSE (AND RARELY THE LUNGS) AND FROM THE HISTORY (THROUGH OF VARIETY OF QUESTIONNAIRES)
- Major illnesses – kidney failure/fishy smell, diabetes/fruity smell, liver cirrhosis/sulphur smell.
- Imaginary – perhaps 25% of people who suffer from bad breath do not have it. You cannot detect bad breath on your own breath. So you must rely on someone else to assess it for you – a friend or relative. We suggest that patients attend our clinic ACCOMPANIED by such a person to confirm (or deny) the presence of the problem AND where the problem actually exists, to measure the improvement that occurs with treatment – otherwise people never know whether they’re better.
- Organoleptic reading – smelling the breath from a distance of about 10 cm and scoring the smell (0 = no smell, 5 = extremely offensive).
- Halimeter reading above ~125 ppb sulphur. A Halimeter is a portable sulphide monitor based on a liquid electrochemical cell through which a gas sample passes at a constant flow rate – ie a machine that measures sulphur gas levels.
- Gas chromatography.
- Third party corroboration.
If we consider some of the common oral causes:
- tongue coating – scraper/brush
- poor oral hygiene – brush and floss
- gum disease, decay or other local factors – see a dentist
- diet – avoid garlic etc
- dieting – eat & drink frequently
If these hints do not help, then a consultation may be useful – after asking a friend/spouse/family member whether you do indeed suffer from this affliction. Specialised mouthwashes are sometimes required for intractable cases. The most popular OTC products are not particularly helpful. Chlorhexidine is excellent for diagnosis/short term management and perhaps a mouthwash with chlorine dioxide or zinc for longer term use.
Nasal/respiratory problems are referred to ENT specialists.
Psychosocial problems (ie believing there is bad breath when in fact none exists) are the most difficult to cure, and depending on the severity encountered, psychological or psychiatric referrals may be appropriate.