HALITOSIS (BAD BREATH, FETOR ORIS, GUTTER MOUTH)

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(Being a Presentation by Dr Chris Ekiyor, founder/President, RAHI Medical outreach at a health seminar in Benin City, Nigeria)

Definition of Halitosis

Halitosis, or mouth odour is a term used to describe noticeably unpleasant odours or foul breath exhaled in breathing. It is estimated to be the third most frequent reason for seeking dental attention, following tooth decay and periodontal diseases.

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Epidemiology

This is extremely common.

  • Majority of Adult population have had it at some point in time
  • Unpleasant condition which creates huge embarrassment with potentially grave consequences

Etiology of Halitosis

  1. Oral and throat causes (90%)
  2. Nasal/Nasopharyngeal problems
  3. Systemic diseases (8%)
  4. Physiological considerations
  5. Drugs
  6. Food
  7. Psychotic disorders (Halitophobia)

Oral and throat Causes:

The real reason for the bad breath is bacteria that accumulate on back of tongue, in pockets of gum or in the throat. Anaerobic bacteria produce volatile sulphur compounds (VSC) such as methyl mercaptan and hydrogen sulphide. These VSC’s are sources of malodor’.

Patients-with-fissured-tongue-dorsum-may-have-enlongated-filiform-papillae-along-the-dorsum-walls
Patients-with-fissured-tongue-dorsum-may-have-enlongated-filiform-papillae-along-the-dorsum-walls
Black-hairy-tongue
                                            Black-hairy-tongue

Dental and Gum Disease

  • Periodontal disease
  • Dental caries
  • Faulty restoration
  • Denture
  • Impacted or abscessed tooth
  • Infected extraction sites
  • Residual post-operative blood
  • Debris under bridges or appliances kept in mouth at night or not cleaned properly

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Nasal/Nasopharyngeal problems

  • Sinusitis and Nasopharyngitis
  • Chronic nasal airway obstruction
  • Adenoid hypertrophy
  • Rhinolithiasis and Naso-pharyngeal lithiasis
  • Nasal and Sinus granulomas
  • Nasal and Sinus tumors
  • Nasopharyngeal Carcinoma

Systemic Diseases

  • Diabetes Mellitus, Diabetic ketoacidosis
  • Renal failure, Bowel obstruction, etc
  • Liver failure
  • Lung abscess, Bronchiectasis
  • Severe GERD with H. pylori
  • Pharyngeal pouch
  • Gastric and esophageal Carcinima
  • Carcinoma of the larynx and Tracheobronchial Tree
  • Granuloma of the Laryns and Tracheobronchial Tree
  • Sjogren Syndrome and Post irradiation therapy
  • Trimethylaminuria

Physiological considerations

Reduction of salivation

  • Dehydration
  • Vitamin deficiency
  • Hunger
  • Morning breath
  • Aging
  • Gastroesophageal reflux
  • Menstruation

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Pathophysiology

  • Formed by bacteria putrefaction of food debris, cells, saliva and blood
  • Proteolysis of proteins, peptides, amino acids, free thio groups and volatile sulphides
  • Results from any form of sepsis; Increased anaerobic activity of pathogens
  • Despite rigorous hygiene, good dentition, posterior dorsum of tongue is often a source.
  • Anaerobic sulphur producing bacteria which normally live below the surface of the tongue and in the throat (Fusobacterium, Actinomyces and Bacteriods forsythus). They assist humans in digestion by breaking down proteins found in specific foods, mucus or blood and in diseased or “broken-down” oral tissue. Under certain conditions, these bacteria start to break down proteins at a very high rate.
  • Proteins are made up of Amino acids. Two of Amino acids in the mouth (Cystein and methionine) are dense with sulphur.
  • When “beneficial” bacteria breakdown this compounds, the odorous and “Lousy-tasting” volatile sulphur compounds (VSCs) are released, Hydrogen Sulphide, Dimethyl sulphide and methyl mercaptan with other bad tasting compounds.

Other Causes

  • An imbalance in the levels of good bacteria found in the bodies digestive system
  • Eating strong smelling foods such as garlic, acidic beverages, spicy foods or fish
  • Candida or fungal infection of the digestive system
  • GERD (gastroesophageal reflux)
  • Cigarette or tobacco smoking
  • Diabetes can result in bad breath
  • Dry mouth (Xerostomia) which can be caused by salivary gland problems, excessive mouth breathing or certain medication may cause Halitosis

Management

Dental and Oral hygiene

  • Regular Dental consultation
  • Regular proper tooth brushing
  • Inter-dental flossing
  • Tongue cleaning, brushing, scraping
  • Tongue cleansing by tongue scrapper, guaze, tooth brush without paste
  • Mouth rinses
  • Baking soda etsaphtoot or mouthwash. This changes the acidity of the mouth
  • Denture care and soaking in antiseptic solution over night
  • Halitosis doesn’t have to be a condition that prevents you from keeping close friends or starting lifelong relationships.
  • Numerous other treatments target just the oral cavity, offering mouthwashes and toothpaste-type substances with accompanying special toothbrushes. However, these are only effective in cleaning the oral cavity of bacteria and do not target the remainder of the digestive system together with the nasal cavities which are both linked to the oral cavity and may be the original culprits of halitosis instead of improper oral hygiene.

Thank you and keep a date with a Dental surgeon

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