Posted by Ramesh Venkatraman
Halitosis more commonly known as bad breath, is a term derived from the combination of the latin prefix - "halitus" (breath) and the greek suffix "osis" (condition). Halitosis is very common with almost everyone having suffered from it at least transiently. For example all of us suffer from oral malodor on awakening which is very common and is generally not regarded as halitosis. It becomes a problem only when it is long standing, and is a cause for societal embarrassment.
Poor oral hygiene is the single most common cause of oral malodor - most likely due to the accumulation of food debris and bacterial accumulation on the tongue surface and between teeth. Additional factors (that will require more aggressive treatment interventions) include infection/inflammation of the gums gingivitis/periodontitis. Xerostomia, a condition characterized by a lack of saliva in the mouth and dryness can also cause malodor - most people would have experienced a transient form of xerostomia during illnesses or when they have suffered from mouth ulcers.
Broadly, oral malodor can be categorized under 3 main causes:
Oral disease and malodor:
In the absence of any systemic disease, the most common cause of oral malodor is poor oral hygiene. In some people, oral malodor may persist in spite of good oral habits, then the most likely source is the tongue and a lack of tongue cleaning.
Diagnosis and assessment of malodor: Clinical assessment of oral malodor is usually subjective and is basically arrived at by smelling the exhaled air from the mouth and nose and then comparing the two:
Halitosis more commonly known as bad breath, is a term derived from the combination of the latin prefix - "halitus" (breath) and the greek suffix "osis" (condition). Halitosis is very common with almost everyone having suffered from it at least transiently. For example all of us suffer from oral malodor on awakening which is very common and is generally not regarded as halitosis. It becomes a problem only when it is long standing, and is a cause for societal embarrassment.
Poor oral hygiene is the single most common cause of oral malodor - most likely due to the accumulation of food debris and bacterial accumulation on the tongue surface and between teeth. Additional factors (that will require more aggressive treatment interventions) include infection/inflammation of the gums gingivitis/periodontitis. Xerostomia, a condition characterized by a lack of saliva in the mouth and dryness can also cause malodor - most people would have experienced a transient form of xerostomia during illnesses or when they have suffered from mouth ulcers.
Broadly, oral malodor can be categorized under 3 main causes:
- Oral malodor due to oral disease, respiratory disease, and volatile foodstuffs (the last being transient in nature).
- Systemic causes i.e. an internal disease/disorder whose symptoms manifest as oral malodor
- Certain drugs (including alcohol) that may be the cause of oral malodor.
Oral disease and malodor:
- Food impaction, i.e. food particles stuck between teeth that can putrefy, decompose and cause malodor
- Acute gingivitis - infection of the gums
- Periodontitis
- Xerostomia - dryness of the mouth due to a lack of saliva
- Oral ulceration
- Oral malignancy
- Sinusitis
- Tonsilitis
- Malignancy
- Bronchiectasis
- Presence of foreign body in the respiratory passage
- Garlic
- Onions
- Spiced foods
In the absence of any systemic disease, the most common cause of oral malodor is poor oral hygiene. In some people, oral malodor may persist in spite of good oral habits, then the most likely source is the tongue and a lack of tongue cleaning.
Diagnosis and assessment of malodor: Clinical assessment of oral malodor is usually subjective and is basically arrived at by smelling the exhaled air from the mouth and nose and then comparing the two:
- Odor coming from the nose but not from the mouth could likely indicate a problem with either the nasal passage or the sinuses
- Odor detected from the mouth but not from the nose could be of oral or pharyngeal origin
- In rare case when the oral and nasal odor are of similar intensity it could indicate a systemic cause that calls for more detailed analysis and diagnosis of underlying problems, if any.
- Brushing and Inter-dental cleaning: Effective brushing and interdental cleaning (flossing) can significantly reduce malodor particularly in people with oral malodor due to poor oral hygiene and any related oral diseases
- Tongue scraping and cleaning: If oral malodor persists even when oral hygiene is good, then the most likely source could be the tongue. Gentle, regular tongue scraping and cleaning can significantly reduce malodor.
- Mouthwashes and mouth rinsing: Although a variety of mouthwashes are available in the market, a plan oil-water mouth rinse should suffice in most cases. Commercial mouth washes containing chlorhexidine while effective cannot be used too frequently as they tend to cause a burning sensation of the oral mucosa. Mouthwashes containing Triclosan may be a better alternative but Triclosan is effective only in the presence of a suitable delivery agent.
- Chewing gum: Studies have shown that 70% of people with oral malodor choose to use chewing gum to reduce odor. However, chewing gums only mask the odor and and they have only a short-term effect on malodor.
- Gum massage: Regular massage of the gums also helps in improving blood circulation to the gums, and in squeezing out any residual bacteria - You can do this by gently pressing the gums between forefinger and thumb - ensure that your fingernails are clean and cut cleanly and evenly.
- Oil pulling: Regular oil pulling or gargling with gingely oil - also called sesame oil or til oil is recommended in Ayurveda for strong teeth and gums - simply pour 15 ml of sesame oil into your mouth and swish it around, pulling the oil between your teeth for a bout 5 minutes and then spit it out - rinse and clean your mouth with warm water.
