Dental specialties

Oral health considerations

Halitosis: Recommendations to avoid bad breath

Halitosis or bad breath is an unpleasant condition that generates shame and social problems. The causes and treatments of this problem can be diverse.

Halitosis, bad breath or oral odor are all synonymous with the same condition, a common oral problem that affects 25% of the general population. Halitosis has a great social repercussion since it causes embarrassment to most patients and affects their daily life. The causes of this problem can vary, as can its treatments.

Halitosis, causes and recommendations to avoid bad breath

Halitosis, bad breath or bad oral odor are all synonyms of the same condition.
Halitosis is a common condition that affects 25% of the general population. It has a great social impact. Most patients are ashamed and affect their daily lives.
Halitosis can have multiple causes, being those of intraoral origin the most common. In about 85% of all cases of halitosis the problem is in the mouth, with gingivitis, periodontitis and saburral tongue (accumulation of whitish substance on the back of the mouth) as the main causes.
People with healthy gums can also suffer halitosis, this is caused by food impaction, bacteria, white blood cells and desquamated epithelial cells that accumulate mainly on the dorsum of the tongue.
The tongue has the highest amount of bacterial load than any oral tissue and makes the greatest contribution to the total number of bacteria present in saliva. The back of the tongue is the main place where the components that cause bad odor are produced.
Microbial degradation in the oral cavity is the main cause of bad odor. Due to this process, volatile sulfur compounds are formed. These compounds are mainly produced by anaerobic bacteria present in the mouth. Most of these microorganisms present in halitosis are related to periodontitis.
Poor oral hygiene, presence of plaque, decay, accumulation and putrefaction of food remains and poorly sanitized prostheses contribute to this microbial degradation and therefore bad breath.
Peri-implantitis (infection of an implant), pericoronitis (typical infection around a wisdom tooth), recurrent oral ulcerations, and herpetic gingivitis are also described as causing bad breath.
Another possible cause of halitosis is xerostomia or dry mouth. It has multiple causes such as systemic diseases (Sjogren's Syndrome, Diabetes ...) or as a side effect of many medications such as antihypertensives or antidepressants. These patients usually have a larger volume of plaque on their teeth and tongue, which causes a bad odour. This is due to the lack of saliva and therefore to the lack of its antimicrobial activity. This condition in turn increases the frequency of caries.
Only 10% of the causes of halitosis are extraoral causes such as sinusitis, nasal obstruction or nasopharyngeal problems. It is very important to know that the halitosis of extraoral cause can be the sign of an underlying systemic disease . Therefore it could be necessary in these cases to organize consultations with other medical specialists to be able to treat it.
Contrary to what many people believe, in less than 2% of cases halitosis is caused by stomach problems .

Morning bad breath

It is not proper halitosis but is a temporary physiological state. This is due to the decreased production of saliva during the night, which increases the formation of anaerobic bacteria causing the typical morning bad breath. The problem disappears as soon as routine hygiene measures are taken.

Inadequate oral hygiene

Poor oral hygiene will end up developing a presence of plaque, cavities, accumulation and putrefaction of food remains that contribute to this microbial degradation and therefore bad breath. Poorly sanitized prostheses are also a common cause of halitosis

Gum disease

Persistent bad breath or bad taste in the mouth can also be one of the warning signs of gum disease, caused by bacteria that builds up in plaque.

Dry mouth or xerostomia

Another possible cause of halitosis is xerostomia or dry mouth, caused when the flow of saliva decreases. Without enough saliva, the food remains are not removed, which usually generates a greater volume of plaque on the teeth and on the tongue, and its consequent bad smell. This condition in turn increases the frequency of cavities.
Xerostomia can be caused by systemic diseases (Sjögren's syndrome, diabetes ...), by problems in the salivary glands, by side effect of many medications such as antihypertensive or antidepressant or by having continuous breathing through the mouth. If you suffer from dry mouth, your dentist may suggest using sugar-free candies, increasing your fluid intake, or even prescribing artificial saliva.

Food

What we eat affects our breath, especially foods like garlic or onion. If you don't brush and floss daily, food debris can remain in your mouth, collecting bacteria, which can cause halitosis. People who are dieting can develop unpleasant breath from eating infrequently.

Other oral problems causing halitosis

Peri-implantitis (infection of an implant), pericoronitis (typical infection around a wisdom tooth), recurrent oral ulcerations and herpetic gingivitis are also described as causes of bad breath.

Tobacco

Tobacco can cause bad breath, reduce oxygenation of tissues and irritate them, in addition to staining teeth and damaging general health. In addition to all this, smokers are more likely to suffer from periodontitis or gum disease and have a higher risk of developing oral cancer.

Morning breath

It is not generally halitosis, as it is a temporary state. This is due to the decrease in saliva production during the night, which increases the formation of anaerobic bacteria, causing the typical bad morning breath. The problem disappears as soon as routine hygiene measures are carried out.

Extraoral medical conditions

Only 10% of the causes of halitosis are extraoral, such as sinus or lung infections, bronchitis, diabetes and some liver or kidney diseases. It is very important to know that extraoral halitosis can be the sign of an underlying systemic disease. Therefore it might be necessary in these cases to organize consultations with other medical specialists in order to treat it.
If you are concerned about what is causing your bad breath, make an appointment with your dentist. Regular check-ups help detect problems such as gum disease or dry mouth. If your dentist determines that your mouth is healthy, you may be referred to your primary care physician or a halitosis specialist. Halitosis can also be the sign of a medical disorder.

Treatment and recommendations

Dentists and periodontists are the first professionals to detect and address this problem, since the individuals themselves usually do not detect their own bad breath, being commonly warned by relatives, partners or friends.
In most cases halitosis can be treated by maintaining correct dental and lingual hygiene (through the use of tongue scrapers) and with the use of antiseptic mouth rinses such as chlorhexidine. Chlorhexidine is the most effective product against plaque. Toothpastes, which contain fluorides, zinc or triclosan, also seem to have a beneficial effect in reducing oral bad odor for a limited period of time.

Proper dental hygiene to combat bad breath

It is recommended to visit your periodontist for check ups and eventual treatment.

In our clinic we have a specialized department in Halitosis with which we can solve your bad breath problems.

  • You should brush your teeth three times a day: when waking up in the morning, after the midday meal, and immediately before going to bed at night.
  • After the dental hygiene, you should brush, with the brush without toothpaste, also the cheeks and the tongue, trying to get there as far back as possible. This operation can be carried out more easily using a tongue cleaner or scraper (sold at any pharmacy) instead of the brush.
  • In case of eating out, you should clean as indicated when you have the possibility to do so. If there is no other way, you can, exceptionally, do without the midday cleaning, but you should not stop practicing the morning and the night.
  • You should avoid having a dry mouth. If you have an occasional tendency to dry mouth, you can correct it by chewing sugar-free dental gum.
  • It is also convenient to practice a professional oral cleaning every six months approximately.

Specialized treatment against halitosis

In our clinic we have a department specialized in halitosis with which we can solve your bad breath problems. For the treatment of halitosis, it is important to make a correct diagnosis of the origin of bad breath, for which samples of bacteria, saliva and breath (exhaled air) are collected, as well as personal medical data that could influence a pathology that leads to halitosis.

These samples are analyzed using different technologies that will allow the doctor to know the type of bacteria that exists and the origin of bad breath. Based on these results, the specialist will draw up a treatment plan that may include the use of different drugs, and where necessary, dental treatment or complementary surgery (rhinosinusal, tonsil, gastric, etc.). It is recommended to visit your periodontist for check-ups and eventual treatment.

Share it
Follow us

In our YouTube channel, world's most viewed dental channel, you will find numerous 3D videos with detailed explanations of more than 55 different treatments and subtitled in 15 different languages.

Project of Clínica Médico Dental Pardiñas where we answer FAQs about oral health matters