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Halitosis or chronic
bad breath often indicates a more serious oral health condition. More often
than not, halitosis means periodontal disease that is often treated by
reducing the level of bacteria in an individual's mouth through manual
plaque removal and proper home care.
Halitosis is one of
mankind's oldest, yet least discussed health problems. A study by the
American Dental Association estimates that as many as 85 million Americans
are plagued by halitosis. The accuracy of this study is borne out by Americans
spending over one billion dollars a year on over-the-counter toothpastes,
mouthwashes, and mints to fight bad breath. While such aids may mask
halitosis, they will not solve the problem of bad breath itself. Moreover,
most individuals fail to realize that bad breath is often symptomatic of a
more serious health problem that must be diagnosed and treated. For this
reason, individuals suffering from halitosis should not dismiss their
problem as a nuisance, but treat bad breath as an oral health issue. Most
dentists, myself included, find halitosis a difficult subject to broach
without embarrassing or offending patients. The purpose of this up-date
letter is to discuss chronic bad breath, its causes, and how patients can
identify and begin to treat halitosis.
First, transient bad
breath must be understood as a condition that is distinct from chronic bad
breath. As its name suggests, transient bad breath is temporary and
physiological in nature. Transient halitosis is most often associated with
bad breath that emanates from the lungs. When certain foods are digested
such as onions, garlic and peppers, small odor molecules from these foods
enter the bloodstream. Some molecules make their way into the lungs, and
are exhaled causing bad breath. Transient bad breath can also stem from low
salvia levels in the mouth, and in such cases is associated with morning
breath.
Chronic bad breath is
pathological in nature, more intense, and more persistent than transient
halitosis. The mouth is the dominant source of chronic bad breath. Studies
show that in 80 to 90% of chronic halitosis cases, breath malodor emanates
from the mouth. Other sources of chronic halitosis can include the nose,
sinuses, or even diabetes. Only in very rare cases is the stomach a cause of
bad breath. In the mouth, oral carcinomas as well as tooth and periodontal
abscesses are primary causes of bad breath. Conditions such as partially
impacted third molars, open contacts between teeth, food traps and faulty
restorations contribute to and in some instances are a direct cause of bad
breath. More often than not, halitosis means periodontal disease. In all of
these cases, halitosis is a symptom of a more serious oral condition. In
this respect, when a patient's total health is considered, bad breath must
be understood as a component of oral disease. The underlying cause of the
halitosis must first be treated before a significant reduction in odor
levels will occur.
Chronic bad breath is
primarily caused by dying bacteria in the mouth that reside on the gums and
the tongue, and release hydrogen sulfide, methyl mercaptan, dimethyl
sulfide and dimethyl disulfide. These sulfur-based gases are commonly known
as Volatile Sulfur Compounds (VSC's), and are the byproducts of bacteria
that break down in the mouth. The greater the amounts of bacteria present
in the mouth, the greater the amount of bacteria dying, and generating
VSC's. VSC's are responsible for the odor associated with bad breath.
Research shows that
periodontal disease is linked to halitosis as periodontal pockets are home
to the bacteria that produce VSC's. As periodontal pockets deepen,
conditions increasingly favor the bacteria responsible for breath odor and
periodontal disease. Breath problems, then, are often indicative of
periodontal problems. Just as brushing, flossing and manual plaque removals
are effective in preventing and managing gum disease, halitosis can also be
treated by reducing the level of bacteria in an individual's mouth through
manual plaque removal and proper home care.
Individuals with good
oral hygiene practices, good teeth and healthy gums can still suffer from
halitosis. In such cases, the main cause of bad breath is likely to be the
back of the tongue. The back of the tongue is commonly overlooked as an area
that collects coatings on its surface that harbor bacteria, debris and
plaque. In such halitosis cases, tongue brushing and scraping along with
the use of a tongue gel and a supragingival rinse which contain chlorine
dioxide or zinc chloride should become part of an individual's home care.
Chlorine dioxide and zinc chloride are the two most effective agents in
fighting bad breath by neutralizing VSC's.
In diagnosing the
mouth as the source of chronic bad breath, the patient must be part of the
diagnostic process. An individual can easily determine if the source of
their bad breath is the mouth by flossing under their gums and smelling the
residue. In assessing the tongue as a source of malodor, an effective test
is to lick one's wrist, wait a few seconds until the area dries, and then
smell the area. With both tests the answer will be immediately obvious.
Bad breath is hardly
America's most critical health issue, but as discussed is often a symptom
of a more serious oral health problem. The best way to treat bad breath is
to practice good oral hygiene. For instance, studies have shown that
individuals who floss have significantly less mouth odor than those who do
not. Cleaning the back of the tongue should also become part of all
patients' home care routine. Brushing and flossing alone, however, will not
eliminate bacteria in the mouth. As such, toothpastes and mouthrinses that
contain chlorine dioxide and zinc chloride should be added to the home care
regiment in fighting bacteria that cause halitosis to develop.
My staff and I are
always available to answer any questions about halitosis or any other
matter.
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