Halitosis – Causes, Diagnosis, Prevention and Treatment

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Halitosis, more commonly known as bad breath is a condition in which significant foul odors are exhaled from the mouth when breathing. In general, halitosis is typically caused by poor or improper oral hygiene. On the other hand, it can also be caused by other things such as gum disease, dry mouth, viral infections, and food particles among many others.

The most common causes of halitosis originate from the mouth, specifically from the tongue and throat. This is because the food debris decays and produce VSCs or volatile sulfur compounds which are the main culprits of the unpleasant ‘rotten eggs’ smell. Halitosis can also be caused by smoking, alcohol consumption, side effects of medications, tooth decay, systemic diseases such as diabetes and periodontal diseases.

On the other hand, there are also some rare cases of delusional halitosis or Halitophobia in which an individual is suffering from having bad breath but, but in reality is not. This condition may also be a symptom of Olfactory Reference Syndrome. People with this condition have an exaggerated fear of bad breath although most of them haven’t actually asked someone for an objective opinion. Reportedly, halitophobia affects around .5 to 1% of adults.

Diagnosing Halitosis

Halitosis or bad breath can normally be reduced or eliminated by proper oral hygiene. However, there is also such a thing as persistent or chronic bad breath and it is typically the case for people who practice proper oral hygiene and have ruled out dental and medical factors, but still have bad breath. In this context, specialized testing is required which can be done in breath clinics.

Even though bad breath examinations and instruments are widely utilized in clinics, the gold standard or the most vital measurement of halitosis is still via sniffing and taking the score of the types and levels of odor. These measurements are called organoleptic measurements and its level of odor is typically evaluated on a 6-point severity scale.

Halimeter – a halimeter is a portable tool used for monitoring sulfur emissions in the mouth’s exhaled air, particularly hydrogen sulfide. If utilized correctly, this tool is actually very helpful in determining the amount of volatile sulfur compounds present in the mouth. On the other hand, it is not very effective in monitoring other sulfides such as mercapatan and may be misrepresented in actual test results.

Specific foods like onions and garlic are also capable of producing sulfur that can take as long as 2 days to be completely removed so they can produce inaccurate results. In addition, the halimeter is likewise sensitive to alcohol so in the event that you are scheduled for a halimeter test, you should refrain from consuming alcohol, as well as mouthwashes with alcohol content for 12 hours or more before the testing.

BANA Test – this test can detect the levels of saliva responsible for enzymes that can indicate the presence of specific bacteria that causes halitosis.

Gas Chromatography – these are portable devices made to measure digitally the molecular levels of the 3 primary volatile sulfur compounds namely hydrogen sulfide, dimethyl sulfide and mercapatan present in your mouth’s exhaled air. Once measurement is done, it presents a graph containing visual results through a PC interface.

β-galactosidase Test – this test is designed to test the levels of the β-galactosidase enzyme associated with halitosis.
Treatment or Prevention of Halitosis

Proper oral hygiene – It is recommended by dentists that you brush your teeth at least twice daily with a good fluoride toothpaste for cleaning food particles, as well as plaque. You should preferably brush your teeth after every meal whenever possible and always brush your tongue.

You should likewise use a new toothbrush every 2-3 months and use an interdental cleaner or dental floss once a day to remove plaque and food particles in between the teeth. In addition, if you wear dentures, remove them at night and clean them thoroughly so it is ready to go when you wear it the next morning.

Visit your dentist as often as you can – if you have relatively healthy teeth, it is recommended that you visit your dentist twice a year at least. During your visit, your dentist will usually do an oral exam and then clean your teeth. In the oral exam, the dentist will be able to see if you have dry mouth, infections or periodontal diseases that may cause halitosis.

Chew gum – chewing gum or eating candy, if possible the sugarless kind, can help in stimulating saliva production which generally aids in washing away bacteria and food particles in your mouth which will lessen the chances of bad breath. Chewing gum will also be very beneficial in the event that you cannot brush your teeth after meals since it aids in producing saliva.

In addition, some chewing gums have anti-odor ingredients such as menthol and spearmint to help freshen your breath. Alternatively, you can also try common folk remedies for bad breath such as chewing fresh parsley, mastic gum, cinnamon sticks, betel nuts or fennel seeds.

Start a food log – it is important to start and maintain a log of all the foods you eat throughout the day so you can start to determine if certain foods can worsen bad breath. Likewise, a list of the medications you are taking is useful. You can bring these to your next dentist appointment for review.

Other things you can consider to prevent halitosis include quitting smoking, regulating alcohol intake, drinking plenty of water to moisturize your mouth and stimulate saliva production and gargling before going to bed at night.

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