What is Halitosis?
Halitosis, commonly known as “bad breath,” is a condition that causes an unpleasant smell from the mouth. This term is a combination of the Latin word ‘halitus,’ meaning breath, and the Greek word ‘osis,’ which refers to a pathological process. Understandably, this condition can be a significant concern for individuals as it can cause social embarrassment and may lead them to become isolated or sometimes even stigmatized. Often, people may not realize they have bad breath until a dentist or doctor notices it during a regular checkup. As more people are becoming aware of the importance of dental hygiene, they are seeking medical help to solve this troubling issue.
What Causes Halitosis?
Halitosis, commonly known as bad breath, falls into two categories: genuine and delusional.
Delusional bad breath means that the individual believes they have bad breath, but nobody else detects it, including doctors. This type can take two forms:
- Pseudo halitosis: the person perceives a foul smell from their mouth that others cannot detect. There has been an increase in this condition, perhaps due to the many advertisements for oral health products.
- Halitophobia: the person with this condition is anxious about having bad breath, even after treatment. Nearly 1% of adults have this condition, which often requires counseling. These individuals believe other parts of their bodies such as armpits or feet also smell bad.
Then there’s genuine bad breath, which can be either physiological (naturally occurring) or pathological (caused by a disease or disorder).
Most bad breath cases (about 80-85%) are due to causes inside the mouth, such as gum disease, Sjogren syndrome (a disease that causes dry mouth), tooth cavities, misaligned teeth, poorly fitting dentures, an overgrowth of yeast in the mouth, and cancers or infections of the mouth or teeth. All of these conditions can allow too many microorganisms to grow in the mouth, causing the bad breath.
If there’s a drop in the oxygen levels in saliva, the acidity level of the saliva goes down, leading to a creation of substances called diamines that cause a foul smell.
Bad breath can also come from outside the mouth:
- Respiratory system: The nose, sinuses, tonsils, and throat can cause bad breath. This could be due to a foreign object in the nose, infections like streptococcus, cancer, pneumonia, or lung diseases like cystic fibrosis. The bacteria Pseudomonas aeruginosa, which is present in some respiratory diseases, produces a substance that causes bad breath.
- Digestive system: Digestive causes account for most cases of bad breath originating outside the mouth. Conditions like acid reflux, stomach ulcers, stomach cancer, and blockages in the bowels can all lead to bad breath. Certain gut bacteria like Enterococcus faecalis and Helicobacter pylori can also cause bad breath.
- Metabolic or hormonal disorders: Some conditions like diabetes can give the breath a fruity smell, while kidney disease can make the breath smell like ammonia. Other health issues like cystic fibrosis, leukemia, liver failure, and menstrual cycles can also alter the smell of the breath.
Lastly, some bad breath can be traced back to certain medications. Drugs like disulfiram, acetaminophen, some antihistamines, alcohol, and several others can all contribute to bad breath.
Risk Factors and Frequency for Halitosis
There isn’t a lot of clear information on halitosis, or bad breath, because there’s no generally accepted way to classify what counts as bad odor and how bad it has to be to be a problem. This makes it difficult to hold scientific studies on the subject because different cultures and societies have different standards for what’s considered bad breath. It’s also a sensitive topic, which means people might not want to admit they have it in a study.
Finding out how many people have halitosis can be a challenge due to these issues, but some studies suggest that as many as half of all people might have it. The rate can vary a lot, though, depending on the details of the study.
- Reports suggest that 6 to 23% of people in China and around half of people in the United States might have halitosis.
- In India, some studies suggest that 21.7% of male dental students and 35.3% of female dental students have halitosis.
- Bad breath tends to become more common as people get older.
- After tooth decay and gum disease, halitosis is the third most common reason people go to the dentist.
- One study lists halitosis as one of the 100 most distressing conditions for humans.
Signs and Symptoms of Halitosis
If someone is experiencing bad breath, doctors need to take a detailed history. This involves figuring out whether there might be temporary causes related to diet, smoking habits, or medication use. Doctors also need information about past and current diseases that could be connected to bad breath, like infections in the upper or lower respiratory tracts, stomach issues such as indigestion or heartburn, as well as symptoms like fever and weight loss. It’s also important to check if the patient has a family history of chronic diseases like hypertension or diabetes.
After they’ve gathered this information, a thorough check of the gums is needed. If there’s any suspicion of problems outside the mouth, more tests may be required. These can be done using either direct or indirect gum health checks.
Testing for Halitosis
If you’re worried about having bad breath, rest assured that doctors can diagnose the condition accurately. They can differentiate between someone who simply perceives themselves as having bad breath (pseudo-halitosis) and those with an excessive fear of having bad breath (halitophobia). There are several testing methods used which include the organoleptic (smell) test, gas chromatography, sulfide monitoring, BANA tests, and more.
The Organoleptic Method
Most doctors use the organoleptic test first. The doctor will use a plastic tube. One end is placed in the patient’s mouth and the doctor inhales slightly from the other end to detect any odor. The odor is then rated on a scale from 0 to 5, where 0 means no detectable odor and 5 signifies a very strong malodor (bad smell). This test is straightforward, affordable, and doesn’t require any special equipment.
Gas Chromatography
For a more specific analysis, a doctor might use gas chromatography. This technique can identify tiny amounts of sulfur-containing substances that cause bad breath in saliva or other oral fluids. However, it’s primarily used for academic and research purposes due to its high cost, requirement of high expertise, and inability to detect non-sulfur causing bad breath molecules.
Portable Sulfide Monitor
Doctors can use a portable device which the patient breathes into for five minutes. This tool is designed to detect sulfur-containing molecules. However, like gas chromatography, it cannot detect non-sulfur containing molecules.
Benzoyl-DL-Arginine-Alpha-Naphthylamide (BANA) Test
The BANA test can identify specific types of bacteria often associated with bad breath. It’s user-friendly and yields results quickly.
Ammonia Monitoring
This test measures the amount of ammonia produced in the mouth using a special pump and disposable tube. The reading obtained shows the quantity of ammonia.
Ninhydrin Technique
A simple method that involves adding isopropanol to the patient’s sample to detect amines and polyamines, chemicals that can cause bad breath.
Salivary Incubation Test
In this test, a patient’s saliva sample is stored under specific conditions for a few hours, and then checked for the presence of odor. This test is known to be more sensitive than the organoleptic test but does require more time.
Other Methods
Quantifying Beta-Galactosidase activity test examines an enzyme that contributes to bad breath, while Polymerase chain reaction (PCR) is a rapid and specific test for detecting volatile sulfur compounds causing bad breath.
All these aforementioned methods aim to accurately assess whether or not a person genuinely has bad breath and to evaluate the severity of the condition.
Treatment Options for Halitosis
If you’re dealing with bad breath, also known as halitosis, the first thing your doctor will do is check to make sure it’s not a symptom of something else. Things like poor oral hygiene, tooth decay, or even certain diseases can cause bad breath. In some cases, it could be due to an improperly fitted dental prosthesis, dentures, or even serious conditions like tuberculosis or cancer. Once the cause is found, your doctor will plan your treatment accordingly.
Bad breath is often caused by poor dental hygiene. One of the ways you can address this is by being vigilant about cleaning your teeth and tongue. A thin layer of bacteria, which scientists call “tongue biofilm,” can gather on your tongue and cause a foul smell. You can remove this biofilm using a tongue scraper, which tends to work better than a toothbrush. Flossing is also important to remove food particles and plaque that can get trapped between teeth and cause bad breath.
Another common solution to bad breath is using mouthwashes that contain antibacterial agents like chlorhexidine, zinc, triclosan, or cetylpyridinium chloride. These substances work in different ways to control the bacteria that cause bad breath. Although chlorhexidine is particularly effective, it can sometimes stain your teeth, which some people find bothersome. Many mouthwashes contain a mix of these agents and other ingredients, such as essential oils.
There are other measures you can take to help with bad breath. One study found that tea tree oil can help control bad breath caused by a specific type of bacteria. Light therapy, which uses light waves to kill bacteria, has been found to reduce bad breath in some cases. Using flavored toothpaste or chewing gum can mask bad breath temporarily. It’s also a good idea to avoid smoking or drinking alcohol, eat less of foods like onions and garlic that can cause bad breath, and drink plenty of fluids to keep your mouth hydrated.
If bad breath isn’t linked to any oral causes, your doctor will run tests to find the underlying issue. The bad breath could be due to a respiratory infection, acid reflux, or swollen and infected adenoids (a type of immune cell found in your throat). These conditions can be treated with antibiotics, antacids, or even surgery, respectively.
What else can Halitosis be?
The list includes several medical conditions that share potential symptoms. These include:
- Diabetes mellitus
- Fever
- Dehydration
- Internal hemorrhage
- Liver failure
- Renal failure (Kidney failure)
- Tuberculosis
Preventing Halitosis
It is crucial to explain to the patient the importance of maintaining good dental health. While many people think that poor teeth cleaning habits only lead to bad breath, toothaches, and unsightly stains, there are serious consequences that are overlooked. Among these, the links between poor oral health and severe medical conditions like heart diseases, including a heart attack, stroke or inflammation of the heart’s lining triggered by gum disease, are a significant concern.
Besides these, gum disease can also lead to respiratory infections like pneumonia or chronic obstructive pulmonary disease (COPD), early childbirth or slowed growth of a baby in the womb, erectile dysfunction, complications in managing diabetes, kidney diseases, infertility, or even pancreatic cancer.
So, maintaining good dental hygiene is not just about having a beautiful smile, it is also about protecting your overall health.