Bad breath/ Halitosis makes the patient feel embarrassed and conscious at the same time. This is often noticed by our near and dear ones leaving us in a compromised situation.
Medically halitosis has no proper definition to define it as there are no universally accepted objective or subjective criteria to define the bad odor produced. Though there are a lot of causes for bad breath proper definitions are not proclaimed.
Dental professional must be the first person to opt for the assessment and treatment of bad breath. Studies to assess levels of bad breath reveals that males have higher scores compared to females.
CAUSES FOR BAD BREATH:
Halitosis / bad breath can be divided into two categories namely:
- True halitosis.
- Delusional halitosis.
It’s a result of physiological (normal functions of our body and its parts) outcome of the body. The causes for true bad breath can be sub-divided into intra-oral causes and extra-oral causes.
Periodontal infections: Long-standing sub-gingival & supra-gingival plaque (deposits above and below the gums). Calculus formation (hard deposits on the tooth surface), gingivitis (gum inflammation) and increased bacterial activity.
Odontogenic Infections: Infections associated with teeth and their surrounding tissues like multiple tooth caries, deposits in the tongue & abscess formation.
Xerostomia (dryness of the mouth): In patients with salivary gland diseases & absence of salivary gland there is reduced saliva production. They have higher chances to have halitosis. Smoking and chewing tobacco cause dryness of the mouth. The habit of mouth breathing also plays a role in bad breath.
Mucosal lesions: Ulcers and erosive lesions that do not heal, harbors bacteria and causes bad breath.
a. People with development anomalies like cleft lip and palate show bad breath.
b. Children with tonsillitis infection.
c. Uncontrolled diabetic patients (acetone like odor).
d. Metabolic dysfunctions like trimethylaminuria, hypermethioninemia, hypothyroidism, etc.
e. Peptic ulcers.
f. Upper respiratory tract infections.
h. Lung/ kidney/ liver failure.
i. Cyst formations.
j. Hormonal imbalance.
h. Radiation therapy.
It is also called as imaginary halitosis. It happens in patients with no detectable malodor.
The patient usually presumes that his/ her breath gives a bad odor. It is considered a psychosomatic disorder (misconception of mind and body connection). These patients take more precautions and increase the frequency of mouth rinsing and tooth brushing.
Patients exhibit halitophobia, the fear of having bad breath. It is diagnosed by obtaining a proper history from the patient and examination to rule out the other causes for halitosis. Psychological counseling is given to the patient. A simple test is conducted to reassure the patient that they don’t have bad breath / associated signs of bad breath.
TESTS TO IDENTIFY BAD BREATH:
- Lick your wrist and let it dry. Smell the dried area to sense bad odor.
- Use a plastic disposable spoon to scrape your back teeth. Yellowish deposits can be obtained in the spoon that might have a bad odor.
BAD BREATH ASSESSMENT:
- Care should be taken by the dentist that he/she should allocate a separate consultation day for patients who complain of bad breath.
- The patient should be advised not to drink, smoke, eat, chew or rinse his/ her mouth 2 hours before the bad breath examination procedure.
- The patient should not use scented lipstick, perfumes & aftershave on the day of examination.
- The patient should be accompanied by a caring and concerned person (preferably spouse of the adult patient/ parent in case of children) to describe the nature and extent of the bad odor.
- The accompanied person should also judge the bad breath on the day of consultation and speak out its nature to the dentist if it is reduced or increased.
TREATMENT FOR BAD BREATH:
- Maintain good oral hygiene practices and schedule a regular dental check-up.
- Make a note of the foods you eat if you think you have bad breath. This might help the dentist to guide your diet plan accordingly.
- In case if you follow any medications for systemic disorder produce the list of medications to your dentist for him/ her to rule out the causes for bad breath.
- Use xylitol based chewing gums to promote saliva secretion. Never leave your mouth dry. Stay hydrated always.
- Avoid using mouth fresheners and mints.
- Brush twice daily with fluoride toothpaste and clean your tongue using tongue cleaners daily.
- Increase the use of dental floss to clean interdentally. This may serve as an opportunity for self-assessment of the bad breath by smelling the floss.
- Use antibacterial mouthwashes like chlorhexidine or fluoride mouth rinse as prescribed by your dentist.
- The use of mouthwash before going to bed gives a good effect as it stays for a longer duration.