Symptoms
Bad breath manifests itself in foul-smelling breath. The bad odor is also a psychosocial problem and can lower self-esteem, lead to feelings of shame, and make it difficult to communicate with others.
Causes
True, chronic bad breath originates from the oral cavity and mainly from the coating on the tongue in over 80 to 90% of cases. Odor-causing bacteria form volatile sulfur compounds and other substances by decomposing organic substances (food residues, cells, salivary proteins, plaque). These are, for example, hydrogen sulfide H
2
S, methanethiol CH
3
SH, diamines, nitrogen compounds, short-chain fatty acids, indoles and ketones. Plaque, oral cavity diseases such as gingivitis, and interdental spaces may play a role. Less commonly, oral gout is triggered by acute and chronic diseases, for example, respiratory diseases such as sore throat, streptococcal angina, tonsillitis, hoarseness, acute bronchitis, sinusitis, or rhinitis. Other possible causes include: Diabetes mellitus, heart failure, esophageal diverticula, carcinoma, GERD, Helicobacter pylori, possibly parasitic diseases in children, liver and kidney diseases, genetic and metabolic diseases. In some cases, no cause can be determined or patients just imagine smelling bad from the mouth (pseudohalitosis). Transient acute halitosis is not considered true halitosis requiring treatment, such as physiologic halitosis after sleeping, after dieting, an alcohol breath, halitosis after consuming certain foods such as onions, garlic, radishes, cabbage, arugula, durian fruit, betel nut, a smoker’s breath, or halitosis after ingesting intoxicants or medications (e.g., disulfiram, chloral hydrate, phenothiazines).
Risk factors
Risk factors include poor oral hygiene, oral cavity disease, plaque, dry mouth, and wearing braces.
Diagnosis
Diagnosis involves medical or dental treatment to clarify the possible causes. Bad breath can be classified organoleptically into different degrees of severity by trained professionals by smelling. There are also special measuring devices, for example, gas chromatographs or the halimeters, which can objectively measure the odor, for example, hydrogen sulfide.
Treatment
Acute, transient bad breath can usually be removed quickly by brushing the teeth, rinsing the mouth, or eating something. Treatment of chronic bad breath involves treating underlying conditions, maintaining good oral hygiene, and using antibacterial products. Deodorants mask the odor for a short time. Oral care product manufacturers offer combined systems that include, for example, a tongue gel, mouth rinse, and tongue cleaner. These methods are considered effective, but have not been optimally studied scientifically. Good oral hygiene:
- Good and regular oral hygiene reduces the number of bacteria that cause bad breath and removes food particles. In addition to normal dental care with a toothbrush, good interdental cleaning with an interdental brush, flossing, and tongue cleaning with a tongue cleaner or a toothbrush and tongue gel or toothpaste is recommended. In some circumstances, professional dental cleaning or treatment by the dentist or dental hygienist may be necessary to address acute discomfort and disease of the teeth or oral cavity.
Antibacterial oral care products:
- Antibacterial oral care products, for example, mouthwashes and toothpastes, reduce bacterial flora even in places that are not reached by mechanical cleaning methods. Substances used include disinfectants, chlorhexidine, triclosan, alcohols, cetylpyridinium chloride, chlorine compounds, oxidizing agents, hydrogen peroxide, essential oils, and tea tree oil. Oral care products also often contain substances that mask or neutralize odor in the short term. Possible adverse effects include local irritation, allergic reactions, taste changes, bad taste, and discoloration of the teeth and tongue. Chlorhexidine should only be used for a maximum of 10 days in the short term, as it can reversibly discolor the teeth.Strong mouthwash is considered a risk factor for the development of black hair tongue.
Deodorants:
- Deodorants in the form of chewing gum, candies, toothpastes, sprays and rinses mask the odor in the short term or neutralize the odor compounds, but usually do not eliminate the cause. For example, essential oils, menthol, peppermint oil, fennel fruit for chewing, metal salts (zinc, tin, magnesium, sodium), baking soda and chlorophyllin are used. Deodorants are often combined with antibacterial agents.
Probiotics lozenges:
- Probiotics lozenges provide the mucous membrane of the oral cavity with “good” bacteria, which settle and multiply. The treatment is considered well tolerated.
Other measures:
- Drink enough fluids, treat an existing dry mouth, stimulate salivation with chewing gum, discontinue triggering drugs, stop smoking, eat a “solid” breakfast.
