Halitosis is an annoying disease which affects interpersonal relationships. The aim of this article is discrediting all those believes which consider our stomach, our respiratory system, or a poor personal hygiene as the main causes of the problem. We will also make a distinction between the frequent or rare causes and the persistent or transient forms of the disease.
Please note that halitosis can be eliminated in the majority of the cases, or at least kept under control in order to prevent it from affecting interpersonal relationships.
It is nowadays easy to find professional dentists specialized in halitosis diagnosis and therapy who, thanks to the use of special equipment such as the Halimeter, can obtain precise informations regarding the quantity and type of smelly gases present in our breath. This measurement helps isolating forms of pseudo halitosis or halitophobia (also very frequent) and monitors changes in breath quality during halitosis therapies.
Only after the existance of halitosis has been objectively proved, we can move on to determining its main causes and the right therapy to eradicate it.
Halitosis, mainly known as bad breath, is a disease largely spread worldwide. If we take into consideration both the most serious and the less worrying forms of the illness, we can estimate that almost 50% of the global population suffers from this problem.
In most cases, halitosis generates in the oral cavity itself; inflammatory parodontal diseases create a whitish coating on our tongue and gum pouches, where germs settle down generating smelly gases. It can also be caused by systemic diseases such as cirrhosis of the liver or diabetes mellitus, even though in rarer occasions.
The phsycological influence of this disease is easily intuitable and was already well known in the past, as multiple remedies have been used thorughout the centuries. Bad breath can indeed become a strong limitation to interpersonal relationships, leading those who suffer from it to avoid any close contact with other people. Social rules highlight the importance of personal image in interpersonal relationships. In this contest, those who suffer from halitosis are not only affected by particular conditions of oral or general health, but they also have to face serious relational problems,which could lead in the worst cases to social isolation. With this awareness, people pay higher attention to the disease, and those who are affected try to get rid of it.
Halitosis:
frequent causes
Particular kind of foods.
Healthy breath doesn’t smell at all; if it does become smelly, and that isn’t due to foods ingested shortly before, it’s a clear sign that something is starting to go wrong. It is well known that certain foods such as garlic and onion provoke halitosis, and they are therefore carefully avoided by those who want to keep their breath in optimum conditions. Once such foods are absorbed into the bloodstream, they are transferred to the lung and then breathed out. This process continues until the system eliminates them completely, and this can be cause of bad breath for a long time, even though personal oral hygiene is timely and accurately carried out.
Oral cavity bad breath
Even though it could be a result of systemic (non oral) medical conditions (liver, kidneys, stomach, intestine, lungs and respiratory system) or pharmacological therapies, bad breath is 90% of the cases attributable to oral cavity problems. In this cases, halitosis is determined by the production of volatile sulfur compounds yielded by bacterium present in the oral cavity. Anaerobic bacteria proliferate liberally and alter breath quality through the production of smelly volatile substances; these substances are present in every mouth, but when their percentage exceeds 30 parts per billion, a bad smell becomes objectively perceptible. Human noses can smell those substances in a percentage of 3 to 8 per billion (Halimeter Test).
Different kinds of Halitosis exist:
Transier Halitosis; it is typical of certain moments of the day, and it’s due to physiological or paraphysiological conditions.
Pathological and persistent halitosis; it is bound to the existance of medical disorders or, more frequently, to oral cavity bad conditions.
A third type of halitosis, which can’t be considered a true disease, concerns the constant fear of having bad breath and is known under the name of pseudohalitosis or halitophobia.
Transier Halitosis – physiological or paraphysiological
Transier bad breath is a temporary disease attributable to the following factors: consumption of certain foods such as garlic, onion and certain spices; alcohol consumption (included alcohol contained in medicines); assumption of medicines which introduce smelly substances into the blood system and which are subsequently exhaled in breathing; assumption of medicines which dicrease the quantity of saliva necessary to cleanse the mouth, and which lead therefore to bacteria multiplication; extended fasting; morning awakening (“morning breath”). Even in these two last situations, bad breath is caused by dry mouth. There is no enough saliva left to rinse and dilute the volatile sulfur compounds, and this leads to an increase of PH present in the oral cavity. This condition of oral dryness favours the production of sulfur compounds responsile for the emission of bad breath.
Persistent Halitosis – pathological
Persistent halitosis is more complex and requires a complete and scrupulous anamnesis that could lead to pathologies which involve either the sole mouth or the whole organism.
Halitosis caused by systemic (non oral) medical conditions concerns only 10% of the people affected by the disease, and bad breath is usually not the first symptom they experience. Many people believe that bad breath depends on patologies of the digestive system, and that for this reason there is nothing to do to get rid of it; it is instead very important to note that only 1% of the people affected by halitosis has problems related to the digestive system. Halitosis provoked by gastric causes is very rare and requires an incorrect functioning of the cardia, the sphincter which separates the stomach from the esophagus, with esophageal reflux. Medical disorders which can create halitosis are diabetes mellitus, chronic renal failure, serious hepatopathy caused by metabolic dysfunctions etc.
Other ears, nose and throat diseases, such as sinus infections or tonsillitis, can be cause of bad breath as they involve presency of small bits of calcified matter or bacteria colonies in tonsillar crypts and areas which are in communication with them; they still represent a minor percentage if compared to the cases of halitosis provoked by dental problems.
Organic detritus are accumulated in the tonsillar crypts and colonized by bacteria which produce sulfur compounds, giving rise to halitosis.
Pseudohalitosis or halitophobia
Halitophobia is the exaggerated phobia of suffering from bad breath.Those who suffer from breath phobia usually avoid social situation, tire themselves out to hide bad breath by constantly brushing their teeth, chewing gum, sucking sweets, keeping distance or bending their head slightly when talking to people. Many of those people have had, during their childhood, at least one of their parents suffering from the same problem; once they reach maturity, they believe they have inherited the same disease.
Dentistry and halitosis
Once having cleared that halitosis caused by general health diseases is extremely infrequent among the general population, we can concentrate on its more frequent cause, which is to be found in all those pathological oral conditions related to dentistry.
Oral cavity role
Holes, gum or periodontal tissues inflammation, bad oral hygiene etc. lead to an increase in the number of negative anaerobic oral bacteria. These bacteria live in partial or total absence of oxygen, riproducing in big quantities by eating food left-overs found within the mouth and on the tounge after each meal; most of the compounds that cause bad breath are the waste products of such bacteria.
These bacteria provoke the putrefaction of the organic and proteinic substances contained in the saliva, food remainings and blood present within the mouth in case of gingivitis and periodontitis. Because of their action, chemical elements responsible for halitosis (volatile compounds) are released. They include hydrogen sulfur which smells like rotten eggs, methyl mercaptan which smells like decomposing cauliflower, isovaleric acid which smells like sweaty feet, together with compounds such as putrescine and cadaverine. Bacteria settle below the gum line and on the posterior dorsum of the tongue; the convulted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, encouraging the metabolism and reproduction of such organisms. A fundamental role in this case is played by the quantity of saliva present inside the mouth, as the moisture found in our mouth helps to cleanse it. The presence of oral fluids encourages us to swallow; with each swallow we wash away bacteria, as well as the food and debris on which they feed. So, when our mouth becomes dry, all the benefits are reduced. It is known in fact that healthy people can temporarily suffer from halitosis as it happens during the sleep, prolonged fast or when talking for a long time.
The main causes of halitosis are to be found in the oral cavity
In almost 90% of the cases, bad breath originates in the oral cavity. Your dentist should be the first professionist to address if such problem appears.
It is important to understand that an accurate and constant oral hygiene doesn’t solve halitosis if the disease is caused by oral cavity patologies such as those which involve periodontal tissues; a professional dentist should be addressed to cure it.
Patients affected by pyorrhea have developed deep spaces between the teeth and the gums (periodontal pockets), wich provide an ideal location for bacteria to live in. Such bacteria not only damage the bone that holds our teeth in place, but become the main cause of bad breath as a person cannot effectively cleanse them. Such germs cannot be removed with the sole help of domestic oral hygiene or antibiotics, but only with the professional intervention of an expert dentist.
Various oral cavity patologies can determine the emission of bad breath. Patients affected by halitosis should undergo a professional check up and measure the quantity of volatile sulfur compounds exhaled when breathing (Halimeter); after determining the patological conditions which cause them, patients should promptly undertake the necessary cures.They should also learn how to carry out correct oral hygiene procedures in order to eliminate bacterial plaque form teeth, gums and tongue, paying extra attention to this last one; the aim is that of keeping long-lasting results and a breath pleasently free from bad odours.
Responsible substances for halitosis
Volatile sulfur compounds are the main cause of halitosis originating in the oral cavity.
They are produced by anaerobic bacteria which live in the white coat that covers our tongues, and which provoke serious parodontal diseases such as pyorrhea. When such bacteria proliferate, the concentration of smelly substances increases within our mouth, with the result of an objective olfactory perception from the outside.
Halimeter, a professional tool for the diagnosis and monitoring of halitosis therapies
A wide survey carried out in Japan among a sample of 2672 human beings revealed that 6-23% were exhaling bad odours during certain times of the day; this has been proved by measuring the concentration of volatile sulfur compounds present in the exhaled air. Such measurements have been taken with the help of a professional tool called Halimeter, which is used to diagnose, quantify and monitor halitosis during therapy sessions.
FAQ
What is bad breath?
It’s a frequent disease which affects about 50% of the world population; it consists in the emission of smelly air through phonation and breathing.
Can gastrointestinal problems provoke halitosis? Very rarely and only with the presency of organic diseases; an example could be the bad functioning of the cardia, a valve which connects our esophagus to our stomach, which would provoke food reflux (gastroesophageal reflux).
Can respiratory problems provoke halitosis? Very rarely; if halitosis caused by respiratory problems is persistent though, it could be a sign of more serious diseases.
Which are the most frequent causes of halitosis?
In almost 90% of the cases halitosis originates in the oral cavity and is due to holes, poor oral hygiene, gingivitis, parodontal diseases, badly executed dental prosthesis or reconstruction etc.
Can any medicine help? There are no medicines which can cure persistent halitosis.
Can poor oral hygiene provoke halitosis?
Breath quality would surely improve with an accurate oral hygiene, comprehending tongue brushing.
Can bad breath persists even if an accurate oral hygiene is carried out?
Yes, bad breath can persist even after repeated brushing and use of dental floss. Many of those who are affected by halitosis pay high attention to their oral hygiene, but they obtain only scarce results as far as a decrease in bad odours is concerned. Please note in fact that among the prejudices against halitosis we can find the common believe that this disease depends always and simply on poor teeth cleaning. Recent studies have proved that a positive correlation exists between the presency of volatile sulfur compounds, parodontal tissues conditions and the whitish coating which covers our tongues. A complete oral hygiene should therefore include tongue brushing too. As stated before, halitosis is accompanied in many cases by parodontal diseases; if such problems are not cured, the disease persists. Nasal drainage difficulties can also provoke the decay of all the proteins contained in it, a condition which generates smelly gases too. To sum it all up, halitosis can generate thanks to a variety of conditions, and it often requires complex interventions which go beyond simple teeth brushing.
What should I do if halitosis persists? If halitosis persists, an odontostomatological check up is requested as there could be a presency of periodontal lesions not reachable by teeth cleansing. Bacterial plaque and microorganisms settle down and proliferate in such cavities, producing all the volatile sulfur compounds which lead to periodontal tissues destruction and bad breath.
Who should I refer to for a professional diagnosis and therapy? As most of the times the cause of halitosis is to be found in the oral cavity, a professional dentist should be the first person to address. A dentist specialized in periodontitis will be able to provide you with professional diagnosis and treatments to cure gums, tissues and all those oral patologies which generate halitosis.
It is possible to prove objective presence of bad breath?
Your dentist can measure the concentration of volatile sulfur compunds responsible of bad breath with a professional tool called Halimeter. He can therefore objectively prove the existence of halitosis, even though an almost as precise diagnosis can be made by smelling the air exhaled by the patient’s oral cavity and nose. A precise etiological diagnosis is only possible if the patient undergoes an accurate clinical/radiological exam of his/her own oral conditions.
Conclusions: to conclude we can say that halitosis is not only a very common disease among the worldwide population, but it very frequently pertains odontostomatology. A variety of oral cavity patologies can determine the emission of smelly air when breathing or talking. Patients affected by halitosis should undergo a dental check up to ascertain the existence of patological conditions which generate it, followed by the necessary cures. They should also find out about behavioural norms related to oral hygiene, in order to be able to eliminate bacterial plaque from teeth, gums and tongue, mantaining long-lasting results and a breath free from bad odours.
