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Monday, May 21, 2012

Fight Oral Malodour

Bad Breath

Bad breath is unpleasant breath regardless the source, oral or non-oral. Bad breath is synonym for malodour, fetor oris and foul breath. Along with growing public and media interest in malodour, dental professionals are becoming more aware of this problem. Let us hope that extensive researches will eliminate this problem. In this article I will explain the causes, management and how to fight bad breath.

There are several causes for bad breath. It may be due to eating habits, deleterious habits like smoking, pan masala, gutkha chewing or alcoholism. The degree of bad breath varies from person to person depending upon personal oral hygiene and above mentioned habits. It also varies with occupation and geographical areas. Like people who are residing in places where underground water levels contain excess fluorine will show mottling of enamel, gingival recession and periodontal infections with several bacteria which will result in bad breath. 

Some infections like anaerobic bacterial infections or spirochetes can result in chronic bad breath irrespective of person's oral hygiene which is more serious problem.

Classification of bad breath or halitosis

1) Genuine Halitosis

a)Physiologic Halitosis

b)Pathologic halitosis

This type(Genuine Halitosis) is an obvious malodour, with intensity beyond socially acceptable level.


Obvious malodour is not perceived by others, although the person stubbornly complains of its existence.

Causes of Bad breath
Of all malodour, 90% originate from oral cavity and the remaining 10% has systemic or normal causes. Bad breath is commonly the result of microbial infection of food debris, saliva and blood within the oral cavity. The breakdown of proteins (proteolysis) into amino acids and the resultant substrates react with free thiol (sulfur) groups forming Volatile Sulfur Compounds (VSC's), which are malodour substances.

Other causes will include:
-Mouth breathing
-Aging and poor dental hygiene
-Foods (onion, garlic) and alcohol

All the above mentioned causes result in physiologic halitosis (Genuine halitosis)

Causes of Pathologic Bad breath or Halitosis (caused due to a pathology/disease):
-Specific oral diseases like Acute Necrotizing Ulceraive Gingivitis (ANUG)
-Stomatitis, Xerostomia (Dry mouth)
-Faulty restorations retaining food and bacteria
-Unclean dentures
-Oral pathologic lesions like oral cancers
-Nasal infections like rhinitis, sinusitis, tumors
-Diseases of Gastrointestinal tract (GIT) like hernia, carcinomas, Gastroesophageal Reflux Disease (GERD).
-Pulmonary infections like bronchitis, pneumonia, TB.
_Certain hormonal changes that occur during pregnancy, ovulation and menopause
-Systemic diseases like diabetes mellitus, hepatic failure, renal failure, fever and cirrhosis of liver.

All the above mentioned causes will somehow result in bad breath. One should know the appropriate cause for bad breath and approach a nearby dentists for proper diagnosis.

Diagnosis of Bad breath
The personal history, dental and medical histories are essential in diagnosing bad breath. A thorough clinical examination is done by looking for evidence of mouth breathing, dry mouth, oral lesions or ulcers, any specific oral diseases and systemic diseases. Dental specific tests are also conducted to diagnose bad breath which include measurement of oral malodour with Gas chrmonatology, halimeters, Chemiluminescence and Benzoyl-d test.

How to control bad breath - Treatment Protocol.
To stop bad breath a step by step procedure is followed. But before commencing the treatment by a dentist, the dentist must determine the source of it whether is of oral or no-oral origin. There should be some specific diet habits in order to control bad breath. The management should be directed towards the cause. One must follow a perfect protocol in treatment procedure. If the origin is because of any systemic disease or due to nasal or medical etiology they must be referred to concerned specialist. Generally for genuine bad breath with oral causes the treatment is as follows

1)Reduction of anaerobic food by improving oral hygiene and periodontal health through basic dental care.

2)Conventional oral hygiene and tongue brushing must be done.

3)Rinsing and gargling with an effective mouthwash will reduce the chemical reactions by microbes.

4)Another strategy is conversion of volatile sulfur compounds by using metallic solutions like Halita. These solutions are quite advanced and effective then conventional mouthwashes.

5)Avoid deleterious habits like smoking, alcohol consumption, pan masala or gutkha chewing.

6)Brushing before sleeping at night is essential because it will greatly reduce microbial activity which is very high during night.

7)Use warm salt water gargles before brushing during morning after you wake up. It will increase osmolarity of the surrounding tissues which makes bacteria quite irresistible.

8)Use appropriate tooth brush. Tooth brush having medium bristles must be used and should be brushed with circular motion.

9)One must not put lot of pressure while brushing. This will cause damage to gums and enamel of teeth. Destruction of gums will result a way to microbes to infect resulting in bad breath. Use minimum amount of force for an average time of 3-5 minutes.

10)Finally visit your nearby dentist at least once in two months to have an overall oral checkup and diagnosis 

Since bad breath is long ignored by common people as well as dentists it became a major problem. With the advancement of latest treatment techniques the treatment procedure and management of bad breath is quite easy. So maintain proper oral hygiene along with proper general health care and avoid foul breath

Bad breath is unpleasant breath regardless of its sources, oral or non-oral. Bad breath is a synonym with oral malodour, foul breath and Fetor oris. Along with growing public and media interest in malodour, dental professionals are becoming more aware of this problem. Let us hope that extensive researches will eliminate this problem. In this article I will explain the causes, management and how to fight bad breath.


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