Bad Breath & Halitosis

BAD Breath and Halitosis Solutions Port Macquarie

happy couple after bad breath treatmentLets Talk About The Breath Problem and
Historical Facts Related to The Breath Problem

Many children and adults have a pleasant odour to their breath without doing anything other than ordinary mouth care. However, there are many individuals of all ages who suffer from both an unpleasant taste and breath. Manufacturers of mouthwashes, toothpaste, breath mints and chewing gum sell millions of dollars worth of products. These products mask the odour temporarily but most of those individuals suffering from breath problems have found little or no relief.

Records of breath problems date back as far as 1550 B.C. Hippocrates suggested a rinse made from herbs and wine to reduce unpleasant breath odours. A young Roman cosmetics manufacturer became very wealthy when he set up a business in aromatic pastilles that were designed to reduce mouth odour. Since those early times breath problems cast a shadow over the lives of those who suffered this condition. For example, it has been recorded that Maccius Plautus (254 to 184 B.C.) decided that his wife’s foul breath was just cause for infidelity. Thousands of years later, tainted breath continues to be a problem socially and in the workplace.

Most individuals who suffer from bad breath feel that they have been afflicted by an embarrassing problem experienced by few others. There is a feeling of isolation and a diminished quality of life.

Why Do We Have a Breath Problem?

Bad breath, a condition with many causes, is sometimes called halitosis or oral malodour. The odour of the breath may change with the cause but the result is generally an unpleasant, chronic, irritating problem that erodes the individuals self image.

A. Mouth Odours Caused by Foods That We Eat

One of the most common causes of offensive breath is the food that we eat. For example, foods prepared with garlic or onions taste delicious at the time of the meal but often leave an unpleasant breath odour (and sometimes body odour) for many hours. Foods that are highly spiced, have a high fat content or contain sulphur may cause a temporary problem. Breath tainted with food odours is not considered true “bad breath”. It is now socially acceptable to eat foods that contain garlic and onions. Others in your social group who have indulged in the same foods will not find your mouth odour unpleasant, in fact may not even notice it. We choose the foods we eat voluntarily. If we find the odour unsettling, that food could be easily avoided.

B. Hunger Odour

Hunger odour is most noticeable in those individuals who eat infequently, as many do when they are on a diet. Anyone who is in the habit of skipping meals, fasting or simply not eating enough can have hunger breath. The result is a very objectionable breath odour that remains even after brushing. This odour is ketosis and is the incomplete use of body fats for energy. It happens when there is a lack of available carbohydrate in the diet. Fruits and fruit juices are good examples of carbohydrate rich foods that,
when used as snacks, will help to control hunger odour.

C. Morning Breath

If we experience a bad taste and odour when we first wake up in the morning, we have morning breath. When we sleep the glands that produce saliva also rest and the amount of wetness in the mouth is minimal. This amount is not enough to wash away some of the food debris that has been left on or between the teeth even after careful brushing. These conditions allow odour producing bacteria to grow rapidly on the tongue and teeth. Morning breath is a temporary condition that can be easily eliminated with a good tooth brushing and breakfast.

D. Systemic Diseases and Conditions

Many systemic diseases and conditions have their own characteristic breath odour when they are not under control. This odour is useful because it can help us to diagnose the condition. Some examples are the fruity odour associated with diabetes, the fishy odour that alerts us to possible kidney failure, and the strong cheesy odour of infected tonsils.

Sinusitis may contribute considerably to bad breath as the discharge can be foul smelling. Other conditions such as allergies and post nasal drip may also be factors.

There is virtually no part played by the stomach in the production of halitosis unless the person regurgitates or burps. Constipation is not considered a cause of halitosis as aromatic substances are absorbed from the small intestine and not from the stomach or large intestine. On the other hand, a hiatus hernia may contribute substantially to malodour.

E. Drug Intake

Drugs such as alcohol or tranquilizers are exhaled through the lungs and add their own distinctive odour to other chemicals that make up mouth air. Some of these drugs contribute to a dry mouth that further increases the intensity of the breath problem.

F. Dental Diseases

Individuals who have cavities, inflamed gums or periodontal disease may have very unpleasant and pungent breath problems. The breath problem generally disappears when the conditions are corrected.

G. Hormonal Changes

Hormonal changes such as those that occur during menstruation can contribute to bad breath. Noticed around the time of ovulation and just before menses, it has been described as a mousy odour.

H. Stress

There is increasing indication that stress may play a role in bad breath. When we are stressed, our mouths are very dry. A thick coating on the tongue may result from the dry mouth. Tongue coatings can have a very unpleasant odour.

I. Subjective Halitosis

Subjective halitosis can occur and is often a serious problem for the afflicted individual. This is a condition where individuals with a disordered sense of smell believe they have severe halitosis. However, there is no detectable odour.

J. Bacteria

When there is a noticeable breath problem but the cause is not apparent, it is most often caused by bacteria present in the mouth, throat, lungs or sinuses. These bacteria prefer an oxygen-free environment and obtain their energy from proteins. Protein is very available to the bacteria in the form of plaque, food debris and dead cells. Some bacteria attack living cell tissue as well. Most bacteria use components of proteins called amino acids, primarily cystine and methionine for their nutrition. They may utilize hydrogen and proteins from saliva. The products of their digestion are volatile (gaseous) sulphur compounds, butyric, acetic and propionic acids. How quickly the breath returns to normal varies with each individual. Some individuals take longer to bring this problem under control. It takes time, patience and working with the staff at the clinic to achieve the proper results. It is encouraging to note that this treatment is generally very successful.

Everyone fights bad breath at some point or another, here’s some suggestions to help you tip the odds in your favor:

Eliminate the causative agents – bacteria and food particles. Floss first, then brush your teeth, gums, and tongue after each meal. Make it easier on yourself by keeping floss, toothpaste, and a toothbrush in your desk and/or car.

If you can’t brush and floss after every meal, at least rinse your mouth with water to dislodge any food particles.

Learn the proper way to brush. Ask the dental office staff for a brochure.

Use an oral irrigation device such as a water-pik to remove particles of food wedged between your teeth.

Avoid mouthwashes which contain alcohol; instead, try a mouthwash that contains chlorine dioxide. Unlike conventional mouthwashes, chlorine dioxide actually neutralizes the odor-causing sulphur compounds.

Baking soda is an effective odor eliminator. If you can handle the taste, try brushing with a mixture of baking soda and water. Or, try a toothpaste which contains baking soda.

Snack on raw vegetables such as carrots, celery, and red peppers. This stimulates saliva production and helps to remove plaque from your teeth.

If your mouth feels dry, try chewing sugarless gum to help stimulate saliva production.

Throughout the day drink lots of liquids, preferably water, to keep your mouth moist.

If your wear dentures or a retainer, make sure you’re cleaning them frequently.

If your bad breath continues for an extended period of time, seek out the professional help of a dentist in your area.

Have your teeth professionally cleaned and examined at least twice a year.

Recommendations on How To Prevent and Stop bad Breath

Improve oral hygiene by flossing every day / Brush and use Amosam mouthwash after every meal and snack for the next two weeks
Use Chlorhexidine mouthwash once per day for next 2 weeks
Avoid onions, garlic, asparagus and eggs
Use RED plaque disclosing dye (Colgate DiscloGel) twice per week

REFERENCES

1. Prinz, H. (1930): “Offensive Breath, Its Causes and Its Prevention”, The Dental Cosmos. 700-707.

2. Attia, E.L. and Marshall, K.G. (1982): “Halitosis”, Canadian Medical Association Journal 126:1281- 1285.

3. Tonzetich, J. (1978): “Oral Malodour: An Indicator of Health Status and Oral Cleanliness”, International Dental Journal 28(3): 309-317.

4. Pruet, C.W. and Duplan, D.A. (1987): “Tonsil Concretions and Tonsilloliths”,Otolaryngologic Clinics of North America 20(2):305 309.

5. Bogdasarian, R.S. (1986): “Halitosis”, Otolaryngologic Clinics of North America 19(1):111-117.

6. Rosenberg, M.; Kulkarni, G.V.; Bosy, A. and McCulloch, C.A.G. (1991): “Reproducibility and Sensitivity of Oral Malodor Measurements with a Portable Sulphide Monitor”, Journal of Dental Research 70(11):1436-1440.

7. Bosy, A.; Kulkarni, G.V.; Rosenberg, M. and McCulloch, C.A.G. (1994): “Relationship of Oral Malodour to Periodontitis: Evidence of Independence in Discrete Sub-Populations”, Journal of Periodontology 65(1): 37-46.

Dental Halitosis (Bad Breath)

The current consensus is that bad breath originates from gases called VSCs. VSCs are volatile (gaseous) sulfur compounds. Hydrogen sulfide and methyl mercaptan are the most prevalent. The origins of the VSCs are bacterial. Bacteria break down proteins into amino acids and some of theses are converted to VSCs The highest concentrations of these bacterial are the back of the tongue and the gingival sulcus around the neck of the teeth. If these bacteria are left to grow in significant amounts, dental mal odor can occur. Quantifying the mal odor is very difficult because no instrumentation shows consistent results. However, a simple test for the origin of mal odor can be preformed to distinguish where it is oral, nasal, or gastric. The patient is asked to breath from the mouth, then the nose. After comparing the odors, the source can be narrowed. A gastric source is suggested if the odors from the mouth and nose are the same. Bad breath from the stomach is rare.
Treating dental bad breath deals with controlling bacteria. By reducing the amounts of bacteria you reduce the quantity of odor gases. Bacteria can be reduced mechanically and chemically. Mechanically reducing the bacterial concentrations is the most efficient and beneficial technique. Mechanical reduction involves thorough brushing and flossing around and about all tooth surfaces as well as cleaning the top of the tongue at least twice a day. Although a toothbrush can be used to clean the tongue, some people find using a special tongue scraper to be more tolerable. Keep in mind that the entire top of the tongue harbors bacteria but the back one third is the target. Chemical cleaning is more controversial. Chemicals can be washes, rinses or compounds added to toothpastes. They can be over the counter types or prescriptions. A good over the counter anti-bacterial mouth wash is Listerine. The process of using a mouthwash is very important. It is critical for the patient to gargle. This forces the mouthwash to the back of the tongue and throat. Rinsing and gargling must be done for 30 seconds. Do not rinse with water after using a mouth wash for 30 minutes. The best time to rinse and gargle is just prior to going to bed. Ideally, it is best to separate tooth brushing and using a mouthwash by 30 minutes, because toothpaste can interfere with the disinfecting properties of the mouthwash.
Over the counter mouthwashes and rinses are not regulated by the FDA. So product claims must be scrutinized with care. Mouth washes with high alcohol contents can dehydrate the mouth and actually promote bacterial growth. Others are merely cosmetics. At times a prescription mouth rinse is needed to control bacteria.

Recently Colgate has added Triclosan to its Total Toothpaste. Tricolsan is a disinfectant that has been used for many years with good success.
Keys to remember

Practice good oral hygiene and techniques

  •  Avoid mouthwashes that have high alcohol contents because they tend to dry the mouth. Coffee can also have a similar effect.
  •  Sugarless breath sprays or drops can be used during the day
  • Use a dehumidifier during dry weather to prevent the nasal passages and the mouth from drying
  • Patients with dry nasal passages or dry throats should use a saline nasal spray
  • Try to keep the mouth moist. Patients suffering from xerostomiashould increase their water consumption, particularly during period of physical exertion, stress, menstrual periods, and pregnancy. Chewing sugarless gum can also reduce xerostomia.
  • Chewing sugarless gum can be used to stimulate saliva flow which in turn buffers the VSCs produced by bacteria.
  • Treat bad breath like any other body odor. Eliminate the source of bacteria.

 

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