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Halitosis
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Halitosis can be caused by a a variety of factors and conditions, some of which are behaviors that can be avoided to reduce bad breath. Halitosis is caused by mainly volatile sulfur compounds as a result of bacterial breakdown of protein and can be quantitatively and qualitatively measured in the expired oral breath. In eighty to ninety percent of cases, bad breath originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth on the posterior third of the dorsal surface of the tongue. In the remaining ten to twenty percent of cases, chronic bad breath is caused by systemic disorders such as hepatic, pancreatic and nephritic insufficiencies, trimethylaminuria, upper and lower respiratory tract infection, medication and cases where gastric content may generate oral malodour. The methods of detecting or diagnosing halitosis are organoleptic or human sense of smell, sulfide monitoring and gas chromatography. All of these methods have limitations and disadvantages.
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Halitosis (bad breath) is a condition that typically originates in the mouth. It is most often caused by the combination of bacteria, food particles and dead cells that can accumulate in the mouth. Poor dental hygiene and a lack of saliva, which helps to wash away germs, often contribute to the problem.
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Halitosis most often results from fermentation of food particles by anaerobic gram-negative bacteria in the mouth, producing such volatile sulfur compounds as hydrogen sulfide and methyl mercaptan. Causative bacteria may be present in areas of gingival or periodontal disease, particularly when ulceration or necrosis is present. In patients with healthy periodontal tissue, these bacteria deposit on the dorsal posterior tongue. Factors contributing to the overgrowth of causative bacteria include decreased salivary flow (eg, due to parotid disease or Sjögren's syndrome), salivary stagnation, and increased salivary pH.
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Halitosis treatment depends on the cause. There are four recognized stages of periodontal disease. The first two (early gingivitis and advanced gingivitis) are treated by professional teeth cleaning. As the disease advances bone loss occurs causing periodontitis, which may require surgery or tooth extraction.
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Halitosis (... known as bad breath) most often is caused by volatile sulfur compound producing bacteria in the oral cavity (85%). Such bacteria exist on the gums, teeth, tonsils, adenoids, and tongue. Other (less common) causes of bad breath also include reflux, sinus infections, pneumonia, bronchitis, kidney failure, metabolic dysfunction, cancer, etc. The most recalcitrant cause of halitosis (in people with excellent oral hygiene) is due to bacterial overgrowth in the back part of the tongue (lingual tonsils). Adenoids is another location often neglected as a cause of halitosis.
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Halitosis can be diagnosed by smell. Additionally, a dentist or physician may collect a patient’s medical history to help identify potential causes of the odor. For some types of oral causes (e.g., some cases of gum disease), a periodontist may be recommended. If non-oral causes are suspected, a patient may be referred for additional testing.
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Halitosis