Bad breath (halitosis)

Bad breath (halitosis)
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Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. Halitosis is not infectious. About 2.4% of the adult population suffers from bad breath.

Causes of halitosis
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Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:
Dental factors – such as periodontitis (infection around the teeth) or poor oral hygiene
Dry mouth – caused by medicines, alcohol, stress or a medical condition
Smoking – which starves the mouth of oxygen.

Less common causes of halitosis include:
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Acid and bile reflux from the stomach
Post-nasal discharge – for example, due to chronic sinusitis
Kidney failure, various carcinomas, metabolic dysfunctions, and biochemical disorders, together account for only a very small percentage of halitosis suffers
Foods - such as onions, garlic or cauliflower, which induce certain odours. However, these effects are only short-lived


Factors that affect the mouth and cause bad breath
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Dental decay.
Gum disease.
Food stagnation between the teeth.
Dry mouth.
Excessive bacterial activity on the tongue, possibly due to postnasal drip (catarrh coming down the back of the throat from the sinuses and nasal passages).
Throat or tonsil infection.
Catarrh.


Factors that affect the airways and cause bad breath
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Sinusitis.
Polyps.
Dryness.
Foreign body.
Hindered air or mucus flow.
Bronchitis.
Pneumonia.
Bronchiectasis (dilation of the bronchi of the lungs, usually from previous infection).


Factors that affect the oesphagus and stomach and cause bad breath
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Gastritis and food reflux.
Food stagnation

Symptoms of halitosis
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The features of halitosis can include:
A white coating on the tongue especially at the back of the tongue
Dry mouth
Build up around teeth
Post-nasal drip, or mucous
Morning bad breath and a burning tongue
Thick saliva and a constant need to clear your throat
Constant sour, bitter metallic taste.
Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.


Treatment of halitosis
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There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis.

Gentle but effective tongue cleaning may also be required. A variety of tongue brushes and scrapers have been produced in recent years. The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue, keeping in mind that the hardest to reach back portion smells the worst.

People with chronic sinusitis may find the regular use of a saline nasal spray helpful. A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help. Speak to your dentist, doctor or chemist to identify the cause of your halitosis and to find the most effective treatment for you.


What can you do for yourself?
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Maintain a high level of oral and dental hygiene. In addition to brushing, it is important to clean between the teeth using dental floss, woodsticks or an inter-dental brush as recommended by your dentist or pharmacist.
Use a tongue cleaner and clean right to the back of the tongue.
Use a mouthwash recommended by your dentist or pharmacist. The best time to use it is just before sleeping.
Drink plenty of fluids, avoiding too much coffee.
Clean your mouth after eating milk products, fish and meat.
Chew sugar-free gum, especially if your mouth feels dry.
Eat fresh, fibrous vegetables.
Visit your dentist regularly and have your teeth professionally cleaned as required

Things to remember
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Halitosis is caused by sulphur-producing bacteria in the tongue and throat.
The major causes include a dry mouth caused by certain foods, smoking, poor oral hygiene and a coated tongue.
The treatment of halitosis will depend on the underlying cause —



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