BAD BREATH

BAD BREATH - HALITOSIS 


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Causes of bad breath? 

Bad breath is a general health problem which seriously affects the day to day activities of common people. The offensive smell from the mouth is causing discomfort to those who come in near contact with bad breathers. 

The problem will be doubled by psychological trauma leading to depression. The sufferers from this problem will be self-isolated from society. This can even lead to marital disharmony between couples, breakups with girlfriends even close friends keep them away. 

Seriously speaking all human beings on earth are bad breathers. The oral cavity contains millions plus of anaerobic bacteria like Fusobacterium (Gram-negative, non-spore forming bacteria, similar to Bacteroides) and actinomyces (filamentous or rod-shaped bacteria) which acts on the protein of food materials and putrefies them. 

This process results in the formation of offensive gases like hydrogen sulphide, methyl mercaptan, cadaverine, skatol, putrescine etc., causes bad smell. 

If oral hygiene is not maintained properly then all humans will have to suffer from bad breath. Most of us control this by regular brushing teeth, tongue cleaning and gargling. Even after keeping cleanliness in the mouth, some people suffer from offensive smell due to various causes which have to be diagnosed and treated timely, properly. 

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Some common reasons cause bad breath. 

1) Poor oral hygiene: 

If oral hygiene is not maintained properly the mouth becomes the storage for millions of bacteria which produce offensive gases by degrading the food debris. 

Bad breath is critical in those who do not brush their teeth regularly and clean their mouth after having food every time. Chats and snacks taken in between meals will also produce bad breath because of improper cleaning. 

Bad breath is very common in almost all people in the morning on waking. During sleep, there is less production of saliva. Saliva has got some antibacterial properties which help to keep the mouth clean odour free. 

Saliva contains oxygen molecules which are needed to make oral cavity aerobic. So the reduction in its quantity during the sleep makes a favourable condition for anaerobic bacteria. 

2) Food habits: 

The main reason for the bad smell is due to the degradation of protein by the bacteria and hence all food products rich in protein influence bad breath. Meat, fish, milk products, eggs, grains, cakes, nuts, pear, etc., can cause bad breath. 

Some food articles will produce a distinct type of smell which may be unpleasant. Raw onion may produce typical bad smell. Popularly it is said that an apple a day keeps the doctor away, a raw onion or garlic a day keeps everybody away. 

Eating white radish also produces very bad smell; similarly eating groundnuts will also produce bad smell. However, if proper timely cleaning is done smell can be reduced irrespective of the nature of food. 

Improper in the timing of food will also produce bad breath. Small food articles taken in between the meals will also produce bad smell. 

3) Biofilm: 

There is the formation of a thin sticky coating called biofilm (A biofilm comprises a syntrophic consortium of microorganisms wherein cells stick to each other and also to a surface)on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram-negative bacteria are seen. 

The sticky coating on the tongue is always connected with bad breath. Even a thin biofilm can make anaerobic condition favourable for bacterial proliferation. 

4) Dental caries: 

This is a destructive process causing decalcification with the destruction of enamel and dentine resulting in cavitation of the teeth. These are produced mainly by the lactobacilli. 

Food particles are stacked inside these cavities and are putrified by the anaerobic bacteria resulting bad smell. Normal brushing will not remove the food debris easily from the tooth and hence they are putrified completely. 

Caries is common in school going children and in those who don’t maintain proper oral hygiene. Calcium and vitamin deficiency will also predispose caries. 

5) Gingivitis: 

Gum is a mucus membrane with helping connective tissue wrapping the teeth bearing borders of the jaw. The main working of gum is protection. Gingivitis is the inflammation of the gum. Due to many causes gum tissue gets infected resulting in swelling, pain and discharge. If the condition becomes worse the infection spread towards periodontal area leading to continuous discharge or bleeding called pyorrhoea. Sometimes the infection enters deep resulting alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis. All these conditions can produce an offensive smell. 

6) Gum retraction: 

When the gums retract from the teeth a gap is developed which will store food particles and cause bad breath. 

7) Dental plaques and tartar deposits; 

Plaques and tartar are deposited mainly in the gaps between the teeth and gum. This will offer shelter for the food debris and bacteria resulting bad breath. 

8) Ulcerative lesions & coatings: 

Almost all of the ulcerative lesions of the mouth are associated with bad breath. These lesions can be resulted by bacteria, viruses, food allergies or due to autoimmune disorders. 

Aphthous ulcer is the commonest among ulcerative lesions. Others are herpes, fungal infections, vincents angina, infectious mononucleosis, scarlet fever, diphtheria, drug reactions etc. 

Cancerous ulcers produce severe bad breath. All fungal infections produce white coating (candidiasis). Leucoplakia is a white thick mark on the mucus membrane of the mouth & tongue. It is considered a precancerous condition. Offensive breath is associated with these conditions. 

9) Diseases of the salivary glands: 

Saliva is very helpful in supply oxygen to all parts of the oral cavity. Even a tiny film of coating called biofilm may provide an anaerobic condition in the mouth. 

Saliva can wet these layers and create an aerobic condition which is not favourable for the bacteria. Any reason which reduces the production of saliva can increase bacterial activity. 

Sometimes the salivary duct is obstructed by stones or tumours. Cancer of the salivary gland is associated with an offensive odour. In supportive parotitis purulent discharged into the mouth causes bad smell. 

10) Tonsillitis: 

Tonsils are a set of lymphoid tissue present in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both critical and chronic tonsillitis. Quinsy or peritonsillar abscess may also result in bad breath. 

11) Tonsillar plaques & tonsillar fluid: 

If bad breath exists even after managing proper oral hygiene there is the possibility of this problem. 

Serous fluid secreted from the folds of the tonsil is very offensive. Some people complain that they hawk some cheesy materials from the throat; which are very offensive in nature. 

These are formed inside the tonsillar crypts which contain thousands of bacteria. In such circumstances, tonsillectomy gives noticeable relief from bad breath. 

12) Pharyngitis & pharyngeal abscess: 

The pharynx is a fibromuscular tube which forms the upper part of the digestive & respiratory tract. Inflammation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. 

Bad smell is present in pharyngitis beside with other signs like cough and throat irritation. Abscesses in the wall of the pharynx can also produce an offensive discharge of pus into the throat. 

13) Dentures: 

Denture using people may complain about bad smell due to the lodgement of small food debris in between. Proper brushing may not be possible in denture users especially fixed dentures. 

14) Tobacco: 

Tobacco chewing is associated with bad breath. The smell of tobacco itself is irritating for others. Tobacco can irritate the mucus membrane and cause ulcers and coatings. 

Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly close to the gums. Tobacco chewers get gastric acidity with eructations. All these cause the offensive smell. 

15) Smoking: 

Smokers always have a bad smell. It can also generate lesions inside the mouth & lungs causing bad breath. Smoking raises carbon dioxide in the oral cavity & decreases oxygen level, causing a favourable condition for bacteria. 

Smoking reduces appetite & thirst hence the acid peptic disease is common in chain smokers. 

16) Lesions in the nose & ear: 

Bad breath is sometimes seen in sinusitis (infection of Paranasal sinuses). In case of post nasal dripping bad smell is common due to the presence of protein in the discharges. 

These proteins are degraded by the bacteria. Infection in the middle ear with the discharge of pus in to the throat through the Eustachian tube (passage from the middle ear to the throat) can also cause an offensive odour. 

Chronic rhinitis (infection of the mucus membrane of the nose) and alien bodies in the nose can also release bad smell in the expired air. 

17) Diabetes mellitus: 

Mostly 99% of all diabetic patients suffer from bad breath smell. Coated tongue, ulcers & coatings in the mouth, raised sugar level in tissues etc., are reasons for bad breath smell. Bacterial growth in diabetic patient is very faster than non-diabetic individuals. 

18) Fevers: 

Bad breath is very common in almost all types of fevers. Even an acute fever can create bad breath. Serious bad breath is seen in typhoid. Other infectious diseases like Tuberculosis, AIDS etc., produce bad breath. 

19) Fasting & dehydration: 

Dry mouth influences bacterial activity. So any condition which produces dryness inside the mouth makes the breath offensive. 

Even though the food particles are known to create bad breath, fasting can also produce the same result. Production of saliva is also reduced when fasting. Chewing and swallowing can help to keep the mouth clean. 

20) Bedridden patients: 

Bedridden patients suffer from offensive bad breath due to thick coating on the surface of the tongue. Water intake is also limited in these people. 

Regurgitation of food worsens the condition. Since they talk less aeration in the oral cavity is less which favours anaerobic bacteria to become very active. 

21) Diseases of stomach & oesophagus: 

Eructation of gas and food produce an unpleasant irritating smell. Abnormality in the function of the lower sphincter can force the food to regurgitate upwards causing bad breath. 

Bad breath is generally common in gastritis, gastric ulcer and cancer of the stomach. 

22) Intestinal diseases: 

Bad breath is common in people suffering from ulcerative lesions of intestine like ulcerative colitis. Other diseases are malabsorption syndrome intestinal tuberculosis, peritonitis etc. 

23) Diseases of lungs: 

Lung diseases like pneumonia, lung abscess, chronic bronchitis, bronchiectasis, tuberculosis, lung cancer etc., may release bad odour during expiration. 

24) Liver disorders: 

Liver problems like hepatitis, cirrhosis, can cause bad breath smell. Gall bladder diseases with vomiting can also cause an unpleasant smell. 

25) Psychiatric patients: 

Bad breath is generic in psychotic patients due to poor hygiene, irregular food habits, less water intake and etc. 

26) Somatisation disorder: 

This is a psychiatric disorder characterised by the presence of a physical symptom that represent a medical illness. These people come with physical complaints like pain, nausea difficult respiration, and bad breath etc; 

this condition is diagnosed after a thorough examination of the patient with all investigations. Since this is a psychiatric disorder it has to be treated with a psychological approach. 

[The information mentioned in this article are for general knowledge. Any person suffering from bad breath should consult a qualified doctor]

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