What is Bad Breath?
Bad breath (halitosis) is a condition which causes breath to smell unpleasant. It is not just the occasional instance of bad breath, but a more lasting complaint which might cause embarrassment or distress.
More than half of the general population suffer from bad breath (halitosis) and it affects all genders and age groups. (1)
Good oral hygiene will resolve bad breath (halitosis) in many cases, however, if it persists there may be underlying causes.
Instances of halitosis can impact a person’s self esteem and confidence, especially if they notice people keeping their distance or turning away. Often someone may not know they have bad breath (halitosis) until someone else points it out. This can be both distressing and embarrassing.
The main symptom of bad breath (halitosis) is a malodorous smell emitting from the mouth. This could be accompanied by a white coating all over, or just at the back of the tongue. You might also experience a bitter metallic or sour taste in the mouth.
Often the mouth will feel dry and if there is saliva it will be thick. You could feel the need to clear your throat frequently.
Bad breath (halitosis) is the result of a number of chemicals which vaporize and are released from the mouth. These chemicals are produced by bacteria either in the mouth, respiratory system or digestive tract. They include: volatile sulfur compounds, aromatic compounds, short-chain fatty acids, alcohols and ketones. (4)
To better understand the symptoms of bad breath (halitosis) we will detail some of the contributing factors.
Although this is usually short lived, some of the foods we eat can cause bad breath (halitosis). Specifically garlic, onions, pickles and spices leave behind an unpleasant odor.
Another factor to be considered is the breakdown of food residue between the teeth by oral bacteria. This process releases an unpleasant smelling gas. (5)
Poor dental hygiene is one of the major contributors to bad breath (halitosis). There are more than 500 species of bacteria in our mouth, majority of which can produce bad smelling compounds. (7)
These bacteria live on the tongue and in between the teeth, breaking down food debris. When we don’t clean our teeth properly or floss, plaque can build up on the teeth and gums. Bacteria can also get trapped in the tiny grooves on our tongue.
A buildup of plaque that is not removed can lead to gingivitis or periodontitis; gum diseases which cause inflammation and halitosis.
Poorly fitting or improperly cleaned dentures can also trap food and bacteria. (8)
Dry Mouth (Xerostomia)
Saliva plays an important role in cleaning our mouths and keeping bacteria levels down. When we don’t produce enough, bacteria can flourish and the mouth becomes dry.
There are many reasons this can happen including medication or diseases affecting the salivary glands and also alcohol consumption. (9)
Illnesses or diseases which affect the respiratory system can result in bad breath (halitosis). Bacteria associated with these conditions produce gases which smell unpleasant and can be detected on the breath.
Respiratory tract conditions include sinusitis, tonsillitis, lung infections and bronchitis. Foreign bodies in the nose or lung can also cause bad breath (halitosis).
The first step would be to rule out a temporary cause for bad breath (halitosis) and establish whether the halitosis is genuine or imagined.
This recognizes a detectable malodour which is extreme enough to be deemed socially unacceptable. This is the further classified as follows:
This is the most prevalent type of bad breath (halitosis) accounting for about 90 percent of cases. (13)
It is divided into three sub-types:
Firstly, The odor originates in the mouth due to bacteria and decay of residual food and no disease or other condition is found.
Secondly, the odor originates from the tongue, mainly at the rear.
Thirdly, the odor is not the result of dietary factors, like eating foods that cause a temporary bad smell.
This is again divided into types and sub types. The two are oral, originating in the mouth and extraoral (originating elsewhere in the body).
Oral Pathological Halitosis
The two subtypes in this category are:
Firstly, halitosis caused by disease or another anatomical or physiological condition or oral tissues that are not functioning properly.
Secondly, halitosis caused by a coating on the tongue or another oral condition like dry mouth, periodontitis or gingivitis.
Extraoral Pathological Halitosis
This is divided into three sub-types:
Firstly, halitosis originating from the nose or throat.
Secondly, halitosis originating in the lungs or upper digestive tract.
Thirdly, halitosis originating anywhere in the body where odor is transported in the blood and expelled in the lungs. This includes conditions like diabetes, cirrhosis of the liver, internal bleeding and kidney disease.
This is described as bad breath (halitosis) perceived to be present when it isn’t. A person might be constantly insisting their breath smells but it is not noticeable by others.
Pseudo halitosis can be resolved by counselling and education about the condition. Guidance of and employing good oral hygiene is also beneficial.
This is a phobia following treatment for genuine or pseudo halitosis a person still persistently believes they have bad breath (halitosis). This is even though there is no medical or social evidence they have the condition. (14)
Treatment will depend on the classification and type of bad breath (halitosis) diagnosed. (15)
In all cases a full explanation of the condition will be provided and you will be advised of good oral hygiene practices. This treatment is usually carried out by a dental professional.
If the bad breath (halitosis) is purely physiological then this treatment should be successful in resolving the condition. However if not, then additional treatments will be administered or advised.
Oral pathological halitosis is treated by dental cleaning of plaque and any build up (tartar) from the teeth and gums. If there are any gum or mouth diseases they will also be treated.
If the pathological halitosis is extraoral then referral will be made to a medical professional that can deal with the underlying cause.
In the case of pseudo halitosis the results of an oral examination will be fully explained. You will be given advice about oral hygiene as well as support and reassurance; further counselling might be given by a medical professional.
Halitophobia is a condition that needs to be treated by a psychological specialist. Counselling will be the focus of treatment to try and dispel the belief halitosis exists. This can be a challenge as people might believe they have bad breath (halitosis) despite evidence to the contrary and resist counselling. (16)
What is bad breath (halitosis)? Bad breath (halitosis) is a condition which causes breath to smell unpleasant.
What are the signs of bad breath (halitosis)? This condition is characterized by an unpleasant odor emanating when your exhale. It might be noticed by you, or by other people.
How do you develop bad breath (halitosis)? Sometimes medication or disease can cause bad breath (halitosis), however majority of cases arise from poor dental hygiene.
How are you diagnosed for bad breath (halitosis)? Diagnosis will be made by a doctor or dentist smelling your breath as you exhale. Called an organoleptic measurement, this grades the smell of the breath from zero, no odor, to five, very strong odor. (17)
What is the best treatment for bad breath (halitosis)? Good oral hygiene practices can help treat and negate this condition. Cleaning the teeth, gums and tongue properly and regularly is the best form of defence against bad breath (halitosis).
What are the long term complications of bad breath (halitosis)? There could be underlying issues causing bad breath (halitosis) therefore it’s important to get a diagnosis. This condition, if not dealt with, can affect a person’s self esteem and confidence, leading to social anxiety disorder. (18)
Is bad breath (halitosis) considered a disability? Halitosis is not considered a disability, however, it may be prevalent in people with mental disorders. (19)
Is there a cure for bad breath (halitosis)? For the most part good oral hygiene has a positive effect on bad breath (halitosis). If it is due to an underlying condition, treatment could alleviate the symptom.
Is bad breath (halitosis) life threatening? There are conditions associated with bad breath (halitosis) which are life threatening, however the condition itself is not. (20)
Bad breath (halitosis) is a condition which causes breath to smell unpleasant and affects about 50 percent of the general population.
Most cases of bad breath (halitosis) are successfully treated with education surrounding good oral hygiene practices, and then carrying them out.
There are many products which help your breath smell sweeter, however they can also just mask the smell. If you think you have bad breath (halitosis) make sure you see a medical professional for advice.