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Halitosis

Overview:

Halitosis or bad breath is an embarrassing condition where your mouth emits an odour that is very unpleasant. Depending on what creates this odour in your mouth, bad breath can last for a very long time, or can come and go. This is determined by the cause of the bad breath. You may not even know that you have halitosis, until others make you aware of it.

The mouth contains millions of bacteria that can cause bad breath. The majority of these are present on the tongue. These bacteria grow in the mouth, which has ideal conditions for these bacteria to thrive. Halitosis, in most cases, is caused by some kind of imbalance of bacteria in the mouth or some other issues with the mouth.

"Morning breath" and other types of bad breath can be considered usual, with no health-related problems associated with them. "Morning breath" usually arises due to mouth changes while you are asleep, such as reduction of salivary flow. This reduction in saliva during the evening doesn't wash away dead cells that are sloughing from dead skin in your mouth, along with decaying food debris and bacteria. Salivary flow is increased during the daytime hours and usually washes away bacteria and food debris that can cause bad breath.

Other causes of bad breath are:

  1. Inadequate oral hygiene, such as sporadic or inappropriate tooth brushing and flossing. This causes bacteria, plaque, and food debris to remain and thrive in the mouth.
  2. Mouth Infections, such as gum disease(s), severe decay, and an abscessed tooth or teeth.
  3. Respiratory infections, such as a sinus, throat, or infection in the lungs.
  4. Lifestyle effects, such as eat onions or garlic, drinking coffee, smoking or chewing tobacco use, or excessive alcohol use.
  5. Xerostomia (or dry mouth), which has been attributed to certain medications, breathing through your mouth, or problems with your salivary glands.
  6. General (systemic) disease, such as diabetes, reflux disease(s), or kidney, liver, lung, sinus, or other diseases.

Mental illness, such as "pseudo halitosis," where people think they have bad breath, but other people do not notice it.

Symptoms:

You may be the last to know that you have halitosis, because the cells in your nose get used to the bad breath smell. You may notice other people moving away from you when you speak. This can be very embarrassing. Symptom of halitosis is dependent on the cause and can include:

  • Poor oral hygiene, you may have heavy plaque and food build-up on the visible surfaces of your teeth or between your teeth. Your teeth can appear dull and you may have associated gingivitis.
  • Mouth infections, where the symptoms are dependent on the infection type, and may include:
  • Gingivitis, where the gums will appear swollen and red, and may bleed upon touch.
  • Pus may be present on your gums or between your teeth, due to an abscess or periodontal infection.
  • Teeth that are loose, can have significant bacteria, plaque and food debris build-up around them. Also, both partial and full dentures that do not fit properly may cause halitosis.
  • You may also have open mouth sores that can cause bad breath.
  • Respiratory tract infections, such as a sore throat, "swollen glands,"stuffy nose, fever, heavy nasal discharge, and a mucous-producing cough can lead to bad breath.
  • Outside agents, such as cigarettes, coffee, and/or alcohol, can lead to halitosis.
  • Symptoms of Xerostomia (or dry mouth) can include:
  • Problems with swallowing foods that are dry
  • Problems speaking
  • Sensitive or burning mouth
  • Numerous dental caries
  • Eye dryness, as in the case of Sj gren's syndrome sufferers.

Systemic symptoms, such as those from diabetes, lung, liver, or kidney disease

Diagnosis:

Your dentist or physician may realize that you have halitosis during your appointment. At times, the breath smell of a patient can reveal a lot about a patient. A breath that smells fruit-like may be indicative of diabetes that is not controlled A breath that smells like urine, may be indicative of kidney problems, especially in those patients that are at risk for this disease. At your dental appointment, your dentist will have you fill out a medical history form, and then go over your medical history with you for any medical conditions that can cause your halitosis and/or medications that cause xerostomia. The dentist will also ask you about your dietary and nutritional intake, and your lifestyle habits, such as use of tobacco products, alcohol, etc. Your dentist will also ask you who notices that you have bad breath and when.

The dentist will also perform a complete oral examination, checking your teeth, gums, tongue, other soft tissues of your mouth, and salivary glands; as well as a head and neck exam for any abnormalities. The dentist will also evaluate your breath upon breathing out through your mouth and nose. You may be referred to a physician if your dentist believes your bad breath is caused by a systemic problem. Or, you may be referred to a periodontist (gum specialist) if you have moderate to severe gum disease that may be the source of the bad breath.

In addition, you may require a blood test and urine test, as well as possible chest X-rays or sinus X-rays to determine the cause of your halitosis.

How Long Does Bad Breath Last?

The length of time that your bad breath will last is dependent upon what caused it. If the cause is inadequate oral hygiene, your bad breath may resolve itself after a professional dental cleaning, and continued tooth brushing and flossing. If the cause is from a sinus infection, your halitosis may resolve itself after the infection is resolved, or it may return if other sinus problems or anomalies exist. Halitosis that originates from systemic disease(s) may take a lot longer to resolve.

Prevention:

Make sure that you brush and floss your teeth, and brush your tongue at least twice daily and seek professional dental treatment on a regular basis (two times a year). You can also use approved mouth rinses, and make sure that you drink a lot of water throughout the day to help wash away any loose plaque or food debris. Using sugar-free breath mints or gum, as well as chewing carrots and celery can help to prevent halitosis.

Treatment:

As previously mentioned, treatment for halitosis depends on what caused it. When Should You Call A Professional? You should call your dentist immediately if you have halitosis, or any other dental problems that need to be addressed. You may also want to call your physician if you are experiencing postnasal drip, a sore throat, a fever, mucus producing cough, and/or discoloured discharge from your nose. If you don't have any of these problems and still have bad breath, visit a professional to find the cause. Especially, if you feel you are performing good oral hygiene and are eating properly. As previously mentioned, your halitosis may be a sign of a medical problem that needs to be addressed immediately.

Prognosis:

After the diagnosis of halitosis is made, the prognosis is very good if your follow your dentist's and/or physician's instructions.