Bad Breath

Cause

Bad breath is usually caused by an excessive presence of particular types of bacteria. These bacteria break down proteins, creating volatile sulfur compounds. These sulfur gases have a very unpleasant odor and are therefore responsible for bad breath. The abundance of bacteria is almost always caused by plaque deposits on the tongue. This tongue deposit is the white-yellow deposit which is particularly located on the rear part of the tongue. It may contain an accumulation of large amounts of bacteria.
Also when gums are inflamed, breath may be less fresh because of bacteria.
A dry mouth contains less saliva, so any gases produced in the mouth may come out easier. A dry mouth can occur when, for example, too much coffee or alcohol is drunk and not enough water. A dry mouth can also occur in case of using specific medications, chronic stress, hormonal problems, old age and poor saliva production.
In addition to the above-mentioned causes, bad breath can also be caused by:

• Inflammations in the mouth, nose (cavities) and the airway.
• Gastrointestinal problems (occurs rarely).
• Diabetes.
• Extra oral halitosis, from the lungs.

Symptoms

Bad breath is often noticed by the immediate environment, but also the patient may be bothered and, for example, have a bad taste in his or her mouth. Depending on the cause, other symptoms may also be present.
Some common signs and symptoms of bad breath are a white or yellow layer on the tongue, a bitter or sour taste in the mouth and inability to get rid of the odor by brushing and flossing properly.

Diagnosis

A doctor usually makes the diagnosis of bad breath by smelling the breath. Examinations can also be done to determine the cause of the bad breath, such as:

• Dental research to detect gum inflammation or tooth decay.
• Physical examination of the mouth and nose to check for defects.
• Throat culture to detect bacteria.

In rare cases, the following tests may be performed:

• Blood tests in order to determine conditions, such as kidney failure and diabetes.
• Gastroscopy, in which a camera is inserted into the throat in order to examine the lining of the esophagus.
• X-rays of the abdomen or chest to detect stomach or lung problems.

Treatment

Treatment depends on the cause of bad breath. At first, people with bad breath go to the dentist or general practitioner. They will give advice regarding nutrition, healthy digestion and proper oral hygiene. If the symptoms persist, searching is continued to find the cause. The general practitioner or dentist can refer the patient for further examination to the dental hygienist, the ear, nose and throat (ENT) specialist, a dietician or a gastroenterologist.

Prognosis

Many cases of bad breath are temporary and disappear with self-care. The prognosis for bad breath, caused by underlying medical conditions, varies depending on the disease.

Considerations

• Take care of proper oral hygiene. Using a tongue cleaner, mouth wash and dental floss can help. The dentist or dental hygienist may provide more tips and advice. Be careful with using mouth washes that include alcohol. Frequent use of alcohol can damage the oral mucosa.
• Drink a glass of water in the morning, immediately after getting up. This puts a kind of ‘water lock’ on the stomach.
• Note the food. (Regularly) eating garlic, onions and some herbs/spices can cause or worsen bad breath.
• Quit smoking and moderate alcohol consumption.
• The dentist may detect and treat inflammation at teeth.
• Eat healthy, varied and high in fiber and drink daily sufficient fluids. This improves healthy digestion and proper bowel movement.
• Use (sugar-free) candies, spray or chewing gum for fresh breath. This may temporarily help to reduce the symptoms.

Facts

• The term ‘halitosis’ is derived from the Latin words halitus (breath or odor) and osis (abnormal). The term ‘fetor oris’ is derived from the Latin words foetor (stench) and ore (mouth).
• The prevalence of chronic bad breath is over 15%. Many more people suffer occasionally or regularly from bad breath.