Halitosis: Bad Breath (Halitosis)

Halitosis is the term used to describe a foul mouth or breath odor. The foul odor thereby also occurs when exhaling through the nose. Another name for halitosis is foetor ex ore stink, musty smell , which refers exclusively to the foul-smelling air exhaled from the mouth. It is estimated that about 50% of the population suffers from chronic (persistent) halitosis. Classification

  • True halitosis
    – Physiological halitosis
    – Pathological halitosis
  • Pseudo-Halitosis
  • Halitophobia

In pseudo-halitosis, bad breath is perceived only by the sufferer, but not by outsiders. Through objective examinations, the patient learns that there is no bad breath. Halitophobia Halitophobia is when a patient is demonstrably not suffering from bad breath and yet cannot be convinced that his or her breath smells normal.

Symptoms Complaints

  • Foul odor from mouth and/or nose
  • Unpleasant taste in the mouth
  • Mental stress

Risk factors

Modifiable by behavior or preventable risk factors are:

  • Tongue coating
  • Poor oral hygiene
  • Smoking
  • Mouth breathing as it leads to dry mouth
  • Snoring can also lead to dry mouth

Diseases

Causes

The causes of physiological halitosis are found directly in the mouth. The foul odor comes from the back of the tongue or from consumed food and stimulants, such as garlic or alcohol. Pathologic halitosis can have both oral (affecting the mouth) and extraoral (outside the mouth) causes. Oral causes

  • Tongue coating
  • Infections gingivitis (inflammation of the gums), stomatitis (inflammation of the mucous membrane), periodontitis (inflammation of the periodontium).
  • Xerostomia (dry mouth)
  • Candidiasis (thrush; fungal disease)
  • Caries (tooth decay)
  • Open root canals
  • Unkempt dentures
  • Poor oral hygiene
  • Pathological processes within the oral cavity e.g. abscesses, tumors.
  • Pemphigus (blistering skin disease).
  • Gum changes e.g. necrosis (death of tissue), gingival fibromatosis (benign proliferation of connective tissue).

Extraoral causes

In 85-90% of all cases, the cause of bad breath is bacterial degradation of organic material in the oral cavity. The bacteria metabolize mainly proteins and secrete as a metabolic end product foul-smelling sulfur compounds e.g. hydrogen sulfide (H2S), cadaverine and methyl mercaptan. Up to 41% of the cause of bad breath is found on the tongue, where up to 60% of all bacteria present in the oral cavity are located. The next most frequent cause is gingivitis (inflammation of the gums), with a frequency of 31%, and periodontitis, which is the cause of bad breath in 28% of patients.Smokers also have a typical bad breath, called smoker’s breath, which is caused by the components of tobacco. Furthermore, smokers have a high risk of developing periodontitis, which also causes bad breath. Medication causes

Some medications cause bad breath directly or indirectly by producing xerostomia (dry mouth). The following medications can inhibit saliva production, leading to bad breath:

  • Antiadiposita, anorectics (appetite suppressants).
  • Antiarrhythmics for cardiac arrhythmias.
  • Antiepileptic drugs, sedatives tranquilizers.
  • Antidepressants for depression
  • Antihistamines for allergies
  • Antihypertensives blood pressure lowering medikanente
  • Antiparkinsonian drugs for Parkinson’s disease
  • Anxiolytics, ataractics anxiety-relieving
  • Diuretics diuretic
  • Hypnotics soporific
  • Muscle relaxants muscle spasmolytic
  • Neuroleptics among others for psychoses
  • Spasmolytics antispasmodic

Furthermore, the use of sulfur-containing drugs, for example, disulfiram or dimethyl sulfoxide can lead to bad breath.

Diagnostics

Diagnostics are composed of the following procedures.

  • Organoleptic measurement
  • Instrumental measurement

Organoleptic measurement

Here, bad breath is assessed by the attending physician. The patient speaks the letter A, while the doctor checks at a distance further and further away from the patient, whether a bad breath is perceivable or not. If the bad breath is perceptible at a distance of ten centimeters, it is called grade I halitosis. If the doctor can also perceive something at a distance of 30 centimeters, it is grade II, and if bad breath can be detected at a distance of one meter, it is grade III. This form of measurement is very subjective and should be performed by specially trained personnel. If you want to test yourself whether you suffer from bad breath, the following quick test will help. Lick the back of your hand, then wait five seconds and smell it. If you detect an unpleasant odor, you probably suffer from bad breath. Instrumental measurement

Sulfide monitors Halimeter

Sulfide monitors are the most common devices used for halitosis diagnosis and are also known as halimeters. A plastic straw is used to draw some air from the patient’s mouth, holding the air for a short time. Usually, an average of three measurements is taken. The measurement can be repeated with air from the nose if necessary. Gas chromatograph

A gas chromatograph measures the quantity and quality of sulfur compounds responsible for bad breath. For this purpose, the patient breathes into a plastic bag, the contents of which are analyzed by the device. Electronic nose

An electronic nose is a device capable of analyzing scents. These devices have only recently found application in halitosis diagnostics.

Therapy

The therapy of halitosis is based on the following pillars.

  • Secondary prevention, that is, reduction of risk factors.
  • Drug therapy
  • Other therapy

Reduction of risk factors

Good oral hygiene is an optimal condition to prevent bad breath or eliminate existing bad breath. Particular emphasis should be placed on daily tongue cleaning. Furthermore, the interdental spaces, where food residues often accumulate from which the bacteria produce the unpleasant sulfur compounds should be removed by means of dental floss or interdental brushes (interdental brushes). Dentures, whether partial or complete, must be cleaned thoroughly every day. The mucous membrane in the mouth is constantly renewed and normally the old flakes of skin can be removed without any problems. In the case of denture wearers, the old flakes of skin accumulate on the denture, which in time, if the denture is not cleaned daily, results in a very unpleasant mouth odor. Smokers who suffer from the above-mentioned smoker’s breath can find relief with the help of smoking cessation.

Drug therapy

Mouth rinses

Numerous mouth rinses can be used to alleviate bad breath. Preparations with the following active ingredients have proven to be effective against halitosis and against the bacteria, respectively:

  • Chlorhexidine digluconate
  • amine fluoride, stannous fluoride
  • Triclosan
  • Hydrogen peroxide
  • Cetyl pyridine chloride (CPC)
  • Essential oils
  • Metal salt solutions e.g. zinc chloride

Toothpastes

Regular brushing with toothpaste also reduces bad breath. Toothpastes with the addition of zinc or stannous fluoride are particularly effective.

Other therapy

Periodontal therapy

Patients suffering from periodontal diseases such as gingivitis (inflammation of the gums) or periodontitis (inflammation of the periodontium) can use periodontal therapy to reduce the number of bacteria living in the mouth, which thus indirectly leads to a reduction in bad breath.

Diseases

If a non-oral disease is determined to be the cause of bad breath, the first step is to treat it causally and then wait to see how it progresses.