Breath odor

Halitosis (medical term), oral malodour (scientific term), breath odour, or most commonly bad breath are terms used to describe noticeably unpleasant odours exhaled in breathing. Transient bad breath is a very common temporary condition caused by such things as oral dryness, stress, hunger (ketosis), eating certain foods such as garlic and onions, smoking, and poor oral care. Morning breath is a typical example of transient bad breath. Chronic bad breath is a more serious and highly persistent condition affecting up to 25% of the population in varying degrees, and typically has a serious negative impact on the individual's ability to maintain personal and business relationships, leading to poor self-esteem and increased stress. This condition is usually caused by persistent overpopulation of certain types of oral bacteria and requires specialised treatment. Xerostomia (dry mouth sydrome) will increase bad breath problems.

Currently, chronic halitosis is not well understood or even recognised as a treatable condition by most doctors and dentists, so effective treatment is difficult to find. There are a growing number of bad breath clinics responding to this endemic problem; unfortunately, most are simply outlets for one breath product or another. However, as with all general-purpose formulations, any one particular product may be effective for some, partly effective for a few, and not help others at all. A very small number of clinics use a detailed assessment process including microbiology to determine the specific type or types of odour-causing bacteria. The specific bacteria are then controlled by individualised treatments. This procedure results in a very high success rate.

Though the causes of breath odour are not entirely understood, most unpleasant odours are known to arise from food debris trapped in the mouth which is processed by normal mouth flora. There are over 400 types of bacteria found in the average mouth. Several dozen of these can cause trouble when allowed to flourish or are genetically disposed to overpopulate. Large quantities of these naturally-occurring bacteria are often found on the posterior of the tongue, where they are undisturbed by normal activity. The rough surface of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, and hundreds of thousands of bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescence smell of polyamines, or the "rotten-egg" smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide, depending on the bacteria type. It is generally these compounds which, when mixed with mouth air and exhaled, produces unpleasant breath.

Other causes of chronic bad breath may be periodontitis (gum disease), diabetes, kidney failure, sinusitis, tonsilloliths, gastroesophageal reflux disorder (GERD), trimethylaminuria (TMAU), hormonal changes, and a wide variety of prescription drugs (especially when taken on a longterm basis).

Diagnosis

One's own breath odour is often undetectable due to the process of habituation, although many people will have an accompanying bad taste (metallic, sour, fecal, etc) depending on oral dryness and the degree of breath odour.

A somewhat effective home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. Another way would be to lightly scrape the posterior of the tongue with an inverted spoon or a piece of dental floss, and to smell the dried residue. A spouse, family member or close friend may be willing to smell one's breath and provide honest feedback. Highly reliable home tests are now available which use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs. Remember that breath odour changes in intensity throughout the day depending on many factors, so test several times.

If bad breath is persistent, and all other medical and dental factors have been ruled out, specialised testing and treatment is required.

Hundreds of dental offices and breath clinics now use a portable sulfide monitor called the Halimeter to test for levels of sulfur emissions (specifically, hydrogen sulfide) in the mouth air. When used properly this device can be very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical applications. For example, other common sulfides (such as mercaptan) are not recorded as easily and can be misrepresented in test results. Certain foods such as garlic and onions produce sulfur in the breath for as long as 48 hours and can result in false readings. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.

New technology is appearing in the form of portable gas chromatography machines such as the OralChroma, which is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is extremely accurate and produces visual results in graph form via computer interface.

Microbiological testing of swab samples of teeth and tongue residue remains the most accurate method of determining the specific bacterial causes of oral malodour.

Home care

Using commercial breath-freshening mouthwashes, mints, or lozenges gives only temporary relief at best, since these products only mask mouth odours for a few minutes. Rinses containing antibacterials such as chlorhexidine, zinc gluconate, or chlorine dioxide may provide better control depending on the individual. Avoid alcohol-containg rinses, since alcohol is a drying agent and will worsen the problem.

Bad breath may be temporarily reduced by using a hydrogen peroxide rinse. Hydrogen peroxide at a concentration of 1.5% can be taken as an oral antiseptic by gargling 10 ml, about two teaspoons. Hydrogen peroxide is commonly available at a concentration of 3% and should be diluted to 1.5% by mixing it with an equal volume of water. Hydrogen peroxide is a powerful oxidizer which kills most bacteria, including useful aerobic bacteria.

The most effective products are generally not available in drugstores, but can be found on the internet. High-quality home breath tests and antibacterial rinses, spritzes, toothpastes, gums, mints, and tongue gels tend to be higher in price, like any premium product; but unlike the well-known inexpensive brand names, they do a much better job of controlling persistent breath problems. In the case of internet shopping for breath products, two caveats apply: the consumer must do extra research to make sure the vendor can be trusted (look for established halitosis clinics or dental supply companies); and remember that without professional assessment to guide you, there will be a certain amount of trial-and-error involved in finding the best solution for your problem.

Brushing after meals and flossing at least once daily is necessary to remove rotting food debris from between the teeth, especially at the gumline. Gently cleaning the tongue surface twice daily with a tonguebrush, tongue scraper or tongue cleaner will reduce this primary source of breath odour. An inverted teaspoon is also effective; a toothbrush less so, as the size and angle of the head do not allow it to reach as far as necessary. Be careful to avoid scraping the V-shaped row of taste buds found at the extreme back of the tongue. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.

Since dry mouth can increase bacterial buildup and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Some gums, toothpastes, sprays, and gels which combat dry mouth for several hours have recently been marketed over the counter. Maintain water levels in the body by drinking several glasses of water a day. Adding lemon juice to your water is refreshing and also beneficial. Parsley is a natural breath freshener when chewed slowly, and is easy to grow at home.

Some studies have shown that eating yoghurt, drinking green tea, or chewing cinnamon or sugarless cinnamon gum can reduce bad breath.