Bad breath sometimes referred to as Oral malodor is of intense impact on the victim’s social and personal life.The problem can precipitate psychological stress which can in turn lead to depression.
Many studies place bad breath as the third most frequent reason for seeking dental treatment following tooth decay and gum disease. Each year, Americans are estimated to spend their money to the tune of nearly $3 billion a year on fresh breath remedies, including gum, mints and mouth rinses,
Time magazine even referred to Listerine's PocketPaks®, the first breath strips that dissolved on the tongue, as one of their “Products of the Year” when they debuted in 2001, underscoring the impact and importance of halitosis, bad breath, to the public.
TYPES OF BAD BREATH
1.Physiologic halitosis(Early Morning Bad Breath)This is transient and usually doesn't require any kind of treatment, most of the time it originate from tongue surface.
2.Pathologic halitosis.This is halitosis caused by an underlying disease.It is persistent and will not be remedied by regular oral hygiene and prevents patient from caring normal lifestyle.
3.Pseudo halitosis. In this case the patient thinks he has halitosis.When patient continue to feel that they have halitosis even after successful treatment the are called suffering from Halitophobia.(fear of halitosis)
CAUSES OF BAD BREATH
1.Sugar: Not only does sugar cause cavities and rot your teeth, but it can actually help feed the bacteria that causes bad breath, Herskovits explains. Cutting down on sugary foods and simple carbohydrates will help, so you might want to swap your usual snack of chips or cookies for an apple if your breath stinks. Additionally, if you have bad breath and constantly chew gum or pop mints, they should always be sugar-free.
2.Food:The breakdown of food particles in and around your teeth can increase bacteria and cause a foul odor. Eating certain foods, such as onions, garlic and spices, also can cause bad breath. After you digest these foods, they enter your bloodstream, are carried to your lungs and affect your breath.
3.Faulty teeth arrangement:When there is much space between teeth,food particle s may find a hidden place.This can cause mouth odour
4.Poor dental hygiene:If you don't brush and floss daily, food particles remain in your mouth, causing bad breath. A colorless, sticky film of bacteria (plaque) forms on your teeth. If not brushed away, plaque can irritate your gums and eventually form plaque-filled pockets between your teeth and gums (periodontitis). Your tongue also can trap bacteria that produce odors.
5.Dry Mouth:Saliva assist in cleansing the mouth, doing away with particles that produce awful odors. A medical condition known as dry mouth or xerostomia can make contributions to bad breath because manufacturing of saliva is reduced. Dry mouth normally occur for the duration of sleep, causing "morning breath," and it worsens in case you sleep with your mouth not closed. In situations where the salivary gland is diseased,dry mouth can also occur.
6.Drugs: Many individuals are ignorant of the fact that the drugs they've been taking for a long period have honestly contributed to their awful breath. All of it boils down to the unlucky side effects of many medicines which consist of dry mouth.Some other medications are metabolised within the body to release chemical substances that can be carried on to your breath.
7.Dental caries:This is a destructive process causing decalcification with destruction of enamel and dentin, resulting in cavitisation of the tooth. These are produced mainly by the lactobacilli.
Food particles are deposited inside these cavities and are putrefied by the anaerobic bacteria producing bad smell. Normal brushing will not remove the food debris easily and hence they are putrefied completely.Caries are common in school-going children and in those who do not maintain proper oral hygiene. Calcium and vitamin deficiency can also predispose caries.
8.Gingivitis:Gum is a mucus membrane with supporting connective tissue covering the tooth bearing borders of the jaw .The main function of gum is protection .Gingivitis is the inflammation of the gum .Due to various causes gum tissue get infected resulting in swelling,pain and discharge. If the condition become worse the infection spread towards periodontal area leading to continuous discharge called pyorrhoea. Some times the infection goes deep producing alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis. All these conditions can produce offensive smell.
9.Bedridden patients:
Bedridden patients suffer from offensive breath due to thick coating on the tongue. water intake is also limited in these patients. Regurgitation of food aggravates the condition. Since they talk less aeration in the oral cavity is reduced which favours anaerobic bacteria to become active.
10) Tonsillitis:
Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.
11) Tonsillar plaques & tonsillar fluid:
If bad breath persists even after maintaining proper oral hygiene there is possibility of this condition. Serous fluid secreted from the folds of tonsil is very offensive. Some patients complain that they hawk some cheesy materials from the throat;which are very offensive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteria. In such conditions tonsillectomy gives noticiable relief from bad breath.
12.Wounds in the nose & ear:Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with discharge of pus in to the throat through the eustachian tube(passage from middle ear to the throat)can also cause offensive odor. Chronic rhinitis(infection of mucus membrane of nose) and foreign bodies in the nose can also produce bad smell in the expired air.
13) Diabetes mellitus: Mostly all diabetic patients suffer from bad breath. Coated tongue,ulcers &coatings in the mouth ,increased sugar level in tissues etc are responsible for bad breath.Bacterial growth in diabetic patient is very faster than non diabetic individuals.
14) Fevers: Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. Severe bad breath is seen in typhoid .Other infectious diseases like Tuberculosis , AIDS etc produce bad smell.
15) Fasting:Regardless of the reason for fasting, missing out on meals can lead to halitosis. Without regular meals or fluids, the mouth slows its production of saliva. Without this bacteria-fighting moisture in the mouth, your tongue and palate can start breeding billions of extra bacteria
16.Dehydration:When you become dehydrated, you do not produce as much saliva. The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath.
17.Fish odour syndrome (trimethylaminuria)
This is a rare medical cause but worth being aware of. It typically causes breath and body odour that is often like a fishy smell. It occurs because the body loses the ability to properly break down trimethylamine which is found in certain foods. There is then a build-up of trimethylamine in the body which is released in sweat, urine, and breath. Urine and blood tests can help to confirm this diagnosis if it is suspected.
18.Stomach and Esophagus Diseases. Eructation of gas and food produce unpleasant smell. Abnormality in the function of lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis,gastric ulcer and cancer of stomach.
19. Intestinal diseases: Bad breath is common in patients suffering from ulcerative lesions of intestine like ulcerative collitis..Other diseases are malabsorption syndrome intestinal tuberculosis, peritonitis etc.
20.Alcohol Consumption:The reason for why alcohol consumption leads to bad breath can be explained by the way the body deals with it. This substance is treated as a toxin by the body so it tries to convert it to a less harmful chemical. Through metabolism 90% of the alcohol will be converted into acetic acid but some of it is released via the respiratory system and through sweat. It is this that accounts for the bad odor associated with overindulgence with alcohol. There is also an unpleasant smell that can originate from the stomach – this is particularly noticeable if the individual belches. Some alcoholic drinks create a more noticeable smell than others – liqueurs and other aromatic concoctions are the worst offenders.
21.Smoking:Tobacco causes chronic bad breath by drying out the palate. It's not too hard to see how this happens. Repeatedly inhaling hot gases parches the tongue and gums, leaving a dry, chemical-filmed environment where anaerobic oral bacteria can run amok.
Apart from this Multiple investigations have been conducted over the years to determine just what it is in smoke that leaves the mouth smelling so awful. A 1968 report published in the journal Chemical reviews found that tobacco smoke contains more than 60 aromatic hydrocarbons, most of which are carcinogenic in addition to conveying a fragrance.
A more recent study published in the Journal of Agricultural and Food Chemistry focused only on which compounds can be found in the saliva after smoking one-half of a cigar.
Its authors determined that ethyl pyrrole, 2,3-dimethyl pyrazine and 2-ethyl pyridine are some of the most pungent chemicals found in what is often referred to as cigar breath. They added that many such compounds are generated during the combustion of tobacco and its chemical additives.
22.Biofilm:There is formation of a thin sticky coating called biofilm on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram negative bacteriae are seen .The thick coating on the tongue is always associated with bad breath. Even a thin biofilm can make anaerobic condition favourable for bacterial proliferation.
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