By: Dr. Abhishek Kumar Pandey, Asstt. Editor-ICN
LUCKNOW: Oral malodor, also called halitosis or bad breath. Halitosis originates from the Latin word ‘Halitus’ which means pathologic alterations of ones breath. It is defined as an unpleasant or offensive odor in the breath of an individual. It can ruin ones personality and confidence, causing social, emotional and psychological anxiety.
It is universally experienced condition that has a variety of etiologic factors and is extremely common and majority of adult population have had it at some point in time. Halitosis may be physiological, pathological, and sometimes psychological also.
Physiologic Halitosis– It is defined as an offensive odor in the breath of an individual with no detectable and underlying systemic cause.
Pathologic Halitosis– Defined as an offensive odor in the breath of an individual with different causes originating from various locations of the body, such as oral cavity, upper respiratory tract and lungs.
Where does it come from?
The etiology of oral malodor is multifactorial. The unpleasant smell of breath mainly originates from volatile sulphide compounds, especially hydrogen sulfide (H2S), methylmercaptan (CH3SH), and dimethyl sulfide [(CH3)2S]. Nonsulfur-containing compounds such as cadaverine, putrescine, indole, skatole, and volatile fatty acids such as butyric or propionic acid have also been implicated in the foul smell of oral malodour. Most of these compounds result from the proteolytic degradation by oral microorganisms of peptides present in saliva, shed epithelium, food debris, gingival crevicular fluid (GCF), interdental plaque, postnasal drip, and blood.
Causes of Halitosis– Halitosis can be subdivided into intra-oral and extra-oral halitosis, depending on the place where it originates.
Some of the intra-oral causes that can cause halitosis are deep carious lesions with food impaction and putrefaction, extraction/ healing wounds filled with a blood clot, crowding of teeth, acrylic dentures especially when kept in mouth at night or not regularly cleaned, periodontal infections, gingivitis, plaque coating on the dorsum of the tongue, restorative crowns which are not well adapted, cysts with fistula draining into the mouth, oral cancer and ulcerations. Oral malodor may be aggravated by a reduction in salivary flow (patients with xerostomia).
Extra- oral causes includes-
1). Otolarynx and respiratory diseases- Halitosis is a very common complaint among ENT patients. The main causes of halitosis related to the oronasal cavity are acute viral or bacterial pharyngitis, chronic/ purulent tonsillitis, retropharyngeal abscesses, and deep crypts of the tonsils, caseous retention, chronic / purulent sinusitis, postnasal drip, and cancer of the pharynx, foreign body in nasal or sinusal cavity.
2). Digestive diseases related to halitosis– Many digestive diseases are traditionally associated with halitosis.Reflux esophagitis, hiatal hernia, Zencker diverticulum, achalasia are associated. Actually, steatorrhea or other malabsorption syndromes, which cause excessive flatulence, are the most important causes of halitosis concerning gastrointestinal diseases.
3).Other causes– Renal impairment is normally a result of a chronic glomerulonephritis, which damage the glomerular function, leading to an increased urea level in the blood. Breathed air is described as ammonium-like breath and generally is accompanied by complaints of dysgeusia (salty taste).
Diabetes can result in accumulation of ketone bodies, which are breathed out producing a very characteristic Halitus, moreover, diabetes causes dry mouth.
Trimethylaminuria or “fish odor syndrome” is a genetic metabolic disorder characterized by a failure in the oxidation route from trimethylamine to trimethylamine N-oxide in the liver. High levels of TMA in urine and others body fluids confer that typical unpleasant, intermittent characteristic fishy odor to the breath.
Tumor lesions in any part of the body also produce volatile gases due to the necrosis process. These gases are expired in the breathed air causing halitosis and that is the reason why halitosis can indicate the presence of serious diseases.
Radiation therapy, Sjogren’s syndrome, and certain types of carcinomas such as leukemia can also contribute to oral malodour.
Specific character of breath odor –
- A “rotten eggs” smell is indicative of VSCs.
- A sweet odor, as that of “dead mice” has been associated with liver insufficiency; besides VSCs, aliphatic acids accumulate.
- The smell of “rotten apples” has been associated with unbalanced insulin-dependent diabetes, which leads to the accumulation of ketones.
- A “fish odor” can suggest kidney insufficiency characterized by uremia and accumulation of dimethylamine and trimethylamine.
Treatment of Oral Malodour
Oral malodor is a multifactorial problem that requires a well-defined approach to diagnosis and treatment. The ultimate goal of treatment for oral malodor should be directed at eliminating or at least reducing the causative microorganisms and associated substrates. Following general treatment strategies can be applied:
- Mechanical reduction of intraoral nutrients and microorganisms: Tongue cleaning, interdental cleaning and tooth brushing are essential mechanical means of dental plaque control.
- Chemical reduction of oral microbial load: Mouthwashes have been used as chemical approach to combat oral malodor. Antibacterial components in oral rinses such as cetylpyridinium chloride, chlorhexidine, triclosan, essential oils, quaternary ammonium compounds, benzalkonium chloride and hydrogen peroxide have been considered along with mechanical approaches to reduce oral malodour.
- Masking the malodor: Mouth sprays and lozenges containing volatiles with a pleasant odor.
PREVENTION–
1). Avoid foods like onion, garlic, spices.
2). Avoid habit that may worsen breath odor such as alcohol, smoking.
3). Brush your teeth regularly after meals and keep oral hygiene good.
4). Rinse at least twice daily with chlorhexidine, triclosan mouthwashes.
5). Clean your tongue with tongue scrapper regularly.
6). Keep your mouth as moist as possible.
7). Dentures should be kept out at night in hypochlorite or chlorhexidine.
Breath malodor has important socioeconomic consequences and can reveal important diseases. Therefore, halitosis must be treated as a serious condition. A multifactorial and a rational approach are essential for good results. A proper diagnosis and determination of the etiology allows initiation of proper etiologic treatment. Management of oral malodor is therefore dependent on diagnosing the foul breath as physiological or pathological and therapy should then be appropriately and specifically directed to the cause of the oral malodor to totally eliminate the condition.
