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Halitosis (Bad Breath)

Overview

Halitosis is the medical terminology for bad breath. It can be due to multiple physiological or psychological causes. The most common cases of halitosis occur due to certain ingredients in the food that have a strong smell. These ingredients include garlic, onion, cheese, alcohol, etc. Bad breath caused by these substances is short-lasting and can be lessened by employing various techniques. However, bad breath caused by any physiological abnormality or psychological reason can be long-lasting and affects your social life if it persists consistently.

Causes

Causes of halitosis can originate either inside or outside your mouth. A person with poor oral hygiene maintenance has a higher chance of halitosis than who regularly brushes. Common causes include gingivitis, periodontitis, dental caries, excessive plaque accumulation on teeth and tongue, pericoronitis, or oral ulcers. Food substances having a strong, pungent smell are another common cause. Frequent smoking, alcohol, or caffeine intake results in temporary bad breath. Any diseases or medications that cause dryness of the oral cavity are another contributing factor. Outside the oral cavity, inflammation of the tonsils or sinuses is another important factor that affects the quality of breath. Gastric diseases, especially gastroesophageal reflux, are another cause of halitosis.

Types

Based on the underlying cause, halitosis is divided into three classes: Physiologic halitosis, pathologic halitosis, and psychogenic halitosis. Food substances usually cause physiologic halitosis with a strong smell, such as onion, garlic, etc. In other cases, the accumulation of food particles within the oral cavity for a long time can also cause bad breath. Any abnormality that reduces the salivary flow rate or causes dry mouth contributes to physiologic halitosis.

Certain pathological diseases cause Pathologic Halitosis. Most of these occur inside the mouth, such as dental caries, gingivitis, periodontitis, etc. But some of these pathologies might arise from tonsils or sinuses. Tonsillitis, postnasal drip, sinusitis, etc., are typical examples.

Psychogenic halitosis generally has no apparent cause. In this case, the person constantly feels lousy breath coming from their mouth, but another person or any diagnostic test does not detect it. This type can also be associated with other psychologic abnormalities.

Signs and Symptoms

Halitosis itself is a symptom of an underlying problem. If you feel a foul odor on your breath when you exhale, look out for the possible causes inside and outside your oral cavity. Another way to check whether your breath has an odor or not is to lick your wrist and let the saliva dry. After a few minutes, smell your wrist to figure out if you have bad breath or not. Since most of the causes arise within the oral cavity, the patient might also present with plaque deposits on the tongue and around teeth, redness and bleeding from gums, and multiple carious lesions.

Risk Factors and Epidemiology

People with ill-maintained oral hygiene are at a prime risk of halitosis. Older people or patients with neurological diseases with poor coordination of hand and wrist movements can develop halitosis since they cannot maintain their oral hygiene. Dehydration, diabetes, and other diseases that reduce the body’s water content can also be risk factors. Patients with gastric diseases such as H.pylori infection or gastro-esophageal reflux might also develop halitosis if their primary disease is not treated.

On a global scale, men and women are affected equally by halitosis. Considering its causes, it is more common in underdeveloped countries with lesser awareness. 

Diagnosis

Before any diagnostic test, the examiner should have a detailed history and physical examination to identify the possible causes of bad breath. The easiest method to diagnose halitosis is testing your breath for any unpleasant odor. Either you can smell your exhaled breath, use the lick your wrist method or ask another person to detect if you have bad breath. Although some researchers have suggested that testing your breath might not be a reliable method because it majorly consists of what you conceive as a bad smell. Similarly, organoleptic methods where another examiner measures the odor of breath are subjective. There are other laboratory tests available to correctly diagnose halitosis, out of which the most common one is the use of a halimeter. It is a portable device that can diagnose the presence of volatile sulfur compounds in your breath. Other tests include the BANA test and gas chromatography.

Differential Diagnosis

It is necessary to understand the cause of halitosis to initiate treatment. Certain diseases that might present with similar features as halitosis include dehydration, diabetes mellitus, liver failure, kidney failure, bronchi or lung infection, tuberculosis, or internal bleeding.

Treatment

Treatment for short-term halitosis caused by food substances, smoking, caffeine, or alcohol can be lessened by brushing your teeth, using a mouthwash, or chewing mint-containing gums. If there is substantial plaque accumulation on your tongue or around your teeth, it is necessary to consult a dentist. Your dentist might perform scaling, curettage, or any other essential procedure that treats the cause of bad breath. Drinking plenty of water in a day is necessary to keep your oral cavity hydrated and your breath free of odor. Sugar-free chewing gums are suggested to stimulate salivary flow rate in people with reduced salivary flow due to underlying diseases or medication. For any case of pathogenic or psychogenic halitosis, the patient should concern the respective doctor to treat the primary cause.

Medications

There are no specific medications required to treat halitosis.

Prognosis

With proper treatment and prevention methods, halitosis can be cured within a short period. For bad breath associated with pathologic diseases, the prognosis depends on the severity and treatment of the underlying condition.

Prevention

The primary method to prevent halitosis is to brush twice a day, floss regularly, and use mouthwashes to clean and plaque-free your oral cavity. Staying well-hydrated and lessening smoking, alcohol, and caffeine consumption is beneficial. Maintain regular visits with your healthcare provider to identify possible causes before they worsen.