Halitosis is the technical term for bad breath, a condition estimated to affect 50 to 65%
of the population.
Up to 90% of cases are thought to originate from sources in the mouth, including poor oral hygiene,
periodontal disease, coating on the tongue, impacted food, faulty dental restorations, and throat infections. The remaining
10% are due to systemic disorders, such as peptic ulcer (when associated with infection), lung infections (bad breath can
be the first sign in some cases), liver or kidney disease, diabetes mellitus, cancer,10 or even a person's imagination
(healthy individuals sometimes complain of bad breath that cannot be smelled by anyone else and is not linked to any clinical
disorder).
In most cases, bad breath in the mouth can be traced to sulfur gases produced by bacteria in the
mouth. Factors that support the growth of these bacteria will predispose a person to halitosis. Examples include accumulation
of food within pockets around the teeth, among the bumps at the back of the tongue, or in small pockets in the tonsils; sloughed
cells from the mouth; and diminished saliva flow. Mucus in the throat or sinuses can also serve as a breeding ground for bacteria.
Conditions are most favorable for odor production during the night and between meals.
Although bad breath primarily
represents a source of embarrassment or annoyance, research has shown that the sulfur gases most responsible for halitosis
(hydrogen sulfide and methyl mercaptan) are also potentially damaging to the tissues in the mouth, and can lead to periodontitis
(inflammation of the gums and ligaments supporting the teeth). As periodontal disease progresses, so may the halitosis, as
bacteria accumulate in the pockets that form next to the teeth.
Improved oral hygiene and and treatment of underlying infections
may be effective in some cases. Mouthwashes might help to control oral bacteria. Persistent halitosis requires professional
dental care.
Home oral hygiene is probably the most effective way to reduce accumulations of debris and bacteria that lead
to halitosis. This includes regular tooth brushing and flossing, and/or the use of mechanical irrigators to remove accumulations
of food after eating. Brushing the tongue or using a commercial tongue scraper, especially over the bumpiest region of the
tongue, may help remove the odor-causing agents as well as lower the overall bacteria count in the mouth.
Because
of the role of gum disease in halitosis, regular dental care is recommended to prevent or treat gum disease. Treatment for
a person with periodontal pockets might include scaling of the teeth to remove tartar.
A reduced saliva flow increases
the concentration of bacteria in the mouth and worsens bad breath. One of the most common causes of dry mouth is medication,
such as antihistamines, some antidepressants, and diuretics; however, chronic mouth breathing, radiation therapy, dehydration,
and various diseases can also contribute. Measures that help increase saliva production (e.g., chewing sugarless gum and drinking
adequate water) may improve halitosis associated with poor saliva flow. Avoiding alcohol (ironically found in many commercial
mouthwashes) may also help, because alcohol is drying to the mouth.
Access by oral bacteria to sulfur-containing
amino acids will enhance the production of sulfur gases that are responsible for bad breath. This effect was demonstrated
in a study in which concentrations of these sulfur gases in the mouth were increased after subjects used a mouth rinse containing
the amino acid cysteine. Cleaning the mouth after eating sulfur-rich foods, such as dairy, fish, and meat, may help remove
the food sources for these bacteria.
