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Summary

Bad breath is characterised as a prominent unpleasant odour from mouth exhaled during breathing. In medical terminology bad is breath is referred to as Halitosis or Oral Malodor. Unpleasant odour from the body regardless of its sources (mouth or body) is also known as halitosis. But oral malodor especially describes bad breath from the mouth. Researchers believe that Bad breath affects large populations globally. It is often ignored and people suffering from bad breath face significant psychological and social handicap. The most common reason for bad breath are microorganisms such as gingival which usually form a coat in our gums and tongue. Good news is a good oral hygiene and certain prescribed medicines from a doctor usually help in recovering from oral malodor completely.

Did you know?

Chronic bad breath is a serious condition affecting approximately 25% of the world's population. Men and women suffer from bad breathe in equal proportions but studies suggest that women seek faster help and treatment than men. Doctors claim that bad breath is often curable requiring minimal medical interventions. However unpleasant odour and bad breath can be caused due to certain underlying medical conditions also. Hence Don't ignore it, please consult a doctor preferably a dentist or ENT specialist if you have a persistent bad breath for more than 15 days.

  1. What is Bad Breath
  2. Bad Breath Symptoms
  3. Types of Bad Breath
  4. Causes of Bad Breath
  5. Prevention of Bad Breath
  6. Diagnosis of Bad Breath
  7. Treatment of Bad breath
  8. Bad Breath self-care
  9. Bad Breath Complications
  10. Ayurvedic medicine, treatment and remedies for Halitosis (bad breath)
  11. Medicines for Bad Breath

What is Bad Breath

Bad breath is a common condition caused mainly due to bacteria and other medical reasons, which results in a foul smell from the oral cavity (mouth) while talking or exhaling air. It has been observed that the intensity of the bad breath differs during different timings of the day. For example, in the morning your breath may smell foul but the smell may fade away by the evening. Researchers claim that there are several factors which are directly responsible for oral malodor such as stress, fasting, eating certain foods (garlic, onion, meat, fish, and cheese) aid to bad breath. Additionally, smoking and alcohol consumption have also been found to be responsible for causing unpleasant odours and bad breath. Typically, our morning breath contains odour normally because the mouth is dry and inactive during the night allowing the growth and actions of microorganisms. But oral malodor is a chronic condition which needs dental attention followed by treatment. 

Bad Breath Symptoms

The symptom of oral malodor is a distinctive bad smell itself. Smells can be of various origins such as of rotten meat, decayed food or of any unpleasant odour. They are usually felt while a person is inhaling or exhaling air. A person in close proximity can feel the same while your talking, sneezing or coughing. 

When to see a doctor?

If you experience the following signs and symptoms along with bad breath, you should consult a dentist preferably a periodontist. A periodontist is an expert in the field of dealing with problems of the gums, buccal mucosa and soft tissues of the mouth. 

See a periodontist if you experience:

  • bad breath or a foul smell with a strong intensity.
  • visible white coating on your teeth or gums.
  • a metallic taste.
  • bleeding in gums.
  • reduced amount of saliva in the mouth.

Types of Bad Breath

Medically bad breath can be typically characterised into two types

Physiological bad breath

The causes of physiological bad breath can be because of our day to day lifestyle. For example like our eating habits, poor oral hygiene, alcohol and tobacco consumption. Research suggests that usually physiological type bad breath is not associated with any underlying medical reasons they can be prevented and cured with a change of lifestyle and eating habits.

Pathological bad breath

The causes of pathological bad breath may be due to certain microorganisms or underlying medical conditions. Doctors recommend investigations and instant commencement of treatments.

It can further be sub-classified into two categories as follows-

  • Oral: This category includes diseases the oral cavity that is the mouth, teeth, gums, tongue, buccal mucosa, cheeks, palate etc
  • Extraoral or systemic: This category includes the diseases of the entire human body like nose, liver, lungs, stomach, etc.

Bad breath medically can further be classified into two more categories-

  • Pseudo halitosis: This is a typical kind mostly in this case the bad breath or the foul breath is not perceived or detected by others, although it has been observed that the patient persistently complains about it and searches a cure from doctors for curbing it. Studies are suggestive that this condition improves by counselling and by keeping oral hygiene.
  • Halitophobia: This is a very interesting condition often connected with human psychology, where it is believed that the person assumes or perceives foul smells even after the treatment from genuine halitosis or false halitosis the patients constantly believes that he/she still suffering from oral malodor or bad breath.

Causes of Bad Breath

Doctors claim that 90% of all bad breath originates from the oral cavity (mouth), whereas, the remaining 10% responsible is systemic, underlying or normal causes. Oral bad breath is commonly the result of microbial putrefaction (decomposition) of food debris, cells, saliva and blood within the oral cavity. This is with special reference to the breakdown of proteins into peptides and amino acids which take place in the presence of a thiol group.

Bad Breath could be a result of a number of causes. We are listing known common reasons for bad breath.

Causes of physiologic bad breath

  • Certain medicines
  • Growing age
  • Poor oral hygiene
  • Fasting or starvation
  • Tobacco consumption
  • Alcohol consumption
  • Foods like onion, garlic, etc.

Causes of pathologic bad breath

Pathological factors which mainly contribute are Periodontal infection foul odour from dental biofilm that is present beneath the gums, it is formed as a result of the accumulation of food debris and microorganisms. Specific diseases like acute necrotizing ulcerative gingivitis (ANUG) and pericoronitis

Prevention of Bad Breath

As it is always said, “ prevention is better than cure ”. Please start taking care if you find visible signs of plaque formation and sense of mild odour from your mouth. You can prevent from having oral malodor by taking the following precautions:

  • brush your teeth twice daily, this will protect your oral cavity (mouth) from no of bacteria and other pathogens (Germs).
  • use chlorhexidine mouth rinse with a dentist guidance twice daily after brushing.
  • get your teeth clean that is scaling and polishing procedure by ultrasonic scalers and air polishing by a professional dentist so that your subgingival (beneath the gum level) microorganisms (germs) activity can be reduced to the maximum.
  • don't smoke, or consume tobacco products, alcohol and other harmful substances.
  • make dietary changes if you consume a lot of sugar, onion, garlic, fish, meat, cheese, etc in your normal diets.
  • get a whole body check-up by a doctor.

Diagnosis of Bad Breath

How to diagnose bad breath?

One can self-diagnose bad breath without having to go to a dentist, however, u may need to consult a dentist if the signs and symptoms persist more than 4 to 5 days. Your dentist will physically check your gums and review your oral hygiene, medical and family history. In addition to this, the dentist will also check with you for any ongoing medicines or medicines you have taken previously. A dentist may also physically examine the following to rule out other underlying medical conditions.

Clinical examination by your dentist may include the following-

  • Intraoral Examination.                              
  • Your dentist might check for tongue coating.
  • Evidence of mouth breathing (to check whether the person is regularly breathing from the mouth). 
  • Xerostomia ( lack of saliva secretion ) or dry mucosa.
  • Other oral causes like faulty fillings, broken dentures if any, etc.    

Your dentist might also go for a complete periodontal examination which might include-

General personal care, state of oral hygiene, brushing habits and brushing techniques Gingival Probing and Periodontal status Evidence of negligence in past history of dental hygiene care.

Investigations

Your dentist may recommend you some test to investigate the severity and the type of infection. These test may include the following-

  • Subjective organoleptic method. This test has been used as a benchmark for bad breath measurement.
  • Gas chromatography in order to assess the bad breath, a portable industrial monitor has been developed these machines are specifically designed to digitally measure
  • Halimeters– These machines measure the level of sulfide gas found in a person's breath.
  • Bana test- (benzoyl-d,l-arginine-naphthylamide) -Some of the bacteria like P. gingivalis, T. denticola, and B. forsythus produce waste products which result and contributing for causing bad breath. These bacterias in question have the characteristics of being able to produce an enzyme that breaks down the compound BANA. When a sample of patient saliva with bad breath containing these bacteria is placed within the BANA testing compound they caused it to break down as a result of this breakdown the test compound changes its colour indicating a positive reaction.
  • Chemiluminescence this test involves mixing a sample of saliva containing VSC”S with the mercury. This Inturn causes a reaction in which produces fluorescence this test is highly sensitive and can measure low levels of bad breath as well.

Treatment of Bad breath

Treatment of bad breath is a step by step problem-solving procedure. Before starting the treatment of bad breath a dentist must take care to determine the source of bad breath. The simplest way to distinguish mouth and non-mouth origin bad breath is to compare the smell from mouth and nose. If the origin is nasal or due to any other medical causes they must be referred to a concerned specialist doctor.

The bad breath generated from the mouth often requires a dental treatment. There are no standard and protocols for the treatment of bad breath, however, the possible protocol contains the basic elements including standard dental and periodontal treatment.

 Bad breath can be treated as follows;

  • A reduction of microorganisms (germs) by improving oral hygiene and periodontal health to a basic dental care, If necessarily incorporation of advanced hygiene methods like oral irrigation , sonic and ultrasonic toothbrushes.
  • If  bad breath persists inspite of maintaining proper oral hygiene, brushing your tongue is advisable.
  • 0.2% chlorhexidine mouthwash for example Listerine can be used to decrease the germ load in the mouth. However there long-term effect remains to be determined and it might lead to tooth staining.
  • Another treatment strategy for treating bad breath is the conversion of VSC’S using various metal ions zinc is the most common ion used in this procedure. Halita is a new solution containing 0.05% chlorhexidine without alcohol is more effective than the above-said mouthwashes.

Bad Breath self-care

  • Brush twice daily and rinse your mouth after every meal so that no food particles are left for germs to attack.
  • Do not eat between meals or snack often. This helps in maintaining oral hygiene very well.
  • Gargle with warm saline water at least three to four times daily water must be boiled and brought to the lukewarm temperature before rinsing the mouth.
  • Mustard Oil: you are recommended a spoonful of mustard oil and heat it a bit you may add a pinch of salt In it and apply in a massaging motion our your gums to improve your gingival heath the motion of massaging should always be from the gums towards the tooth which increases the tooth attachment and blood circulation and thus the gingival health.
  • Gumpaints: you are recommended to massage your gums with gum paints for example occident, dental kind, etc
  • Vitamin C: it helps your gum to recover faster and always citrus fruit like lemon, oranges etc are a good source of vitamin C. Medications for the same are also available in the market but should only be taken on doctors prescription.

Bad Breath Complications

Complications of bad breath include social withdrawals and a psychological feeling of low self-esteem. The person living with oral malodor begins to stay aloof or speak from a distance or choose not to speak at all. In some cases, the person himself/herself cannot sense the foul smell but family members and friends notify that the condition exists leading to social withdrawals and guilt. 

Medicines for Bad Breath

Medicines listed below are available for Bad Breath. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Medicine NamePack SizePrice (Rs.)
RantacRantac 150 Mg Tablet18
ZinetacZinetac 150 Mg Tablet17
AcilocAciloc 150 Tablet17
Viscodyne SViscodyne S 4 Mg/100 Mg/1 Mg/2 Mg Syrup53
Reden OReden O 2 Mg/150 Mg Tablet33
R T DomR T Dom 10 Mg/150 Mg/20 Mg Tablet7
Aciloc DAciloc D 10 Mg/150 Mg Tablet0
AcispasAcispas 10 Mg/150 Mg Tablet12
ConrinConrin 10 Mg/10 Mg/20 Mg Tablet0
RadicRadic 10 Mg/150 Mg Tablet14
Pepdac DPepdac D 10 Mg/10 Mg/20 Mg Tablet4
CycloranCycloran 10 Mg/150 Mg Tablet16
Rt Dom ForteRt Dom Forte 10 Mg/10 Mg/20 Mg Tablet21
RanidicRanidic Tablet4
Ranitas DcRanitas Dc 10 Mg/150 Mg Tablet0
DicloplastDicloplast Patch110
Rd SRd S 10 Mg/150 Mg Tablet4
FremovFremov Capsule64
Reden PlusReden Plus 10 Mg/150 Mg Injection7
ZidiumZidium Injection42

Do you or anyone in your family have this disease? Please do a survey and help others

References

  1. Yaegaki K1, Coil JM. Genuine halitosis, pseudo-halitosis, and halitophobia: classification, diagnosis, and treatment. Compend Contin Educ Dent. 2000 Oct;21(10A):880-6, 888-9; quiz 890. PMID: 11908365.
  2. Touyz LZ1. Oral malodor--a review. J Can Dent Assoc. 1993 Jul;59(7):607-10. PMID: 8334555.
  3. Bahadır Uğur Aylıkcı, Hakan Çolak. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013 Jan-Jun; 4(1): 14–23. PMID: 23633830.
  4. National Health Service [Internet]. UK; Bad breath.
  5. Walter J. Loesche, Christopher Kazor. Microbiology and treatment of halitosis. First published: 09 July 2002; periodontology 2000, vol. 28, 2002, 256-279 [Internet].
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