Bad breath can cause emotional distress

HALITOSIS is the medical term for bad breath and describes noticeably unpleasant odours exhaled in breathing. Although not a serious medical condition, it can make a person feel awkward in social situations, cause emotional distress, and lower a person’s self-esteem. The 2002 article entitled Microbiology and Treatment of Halitosis by Loesche and Kazor, stated that 85 to 90% of bad breath originates in the mouth itself and can be serious enough to cause personal embarrassment. It is assumed that the most common location for mouth-related halitosis is the tongue. Fedorowicz et al, in their article mouthrinses for the treatment of halitosis, indicated that accumulation of halitosis–causing bacteria and food residues at the back and in the furrows of the tongue are broken down into volatile sulphur compounds and are considered to be the major causes of bad breath. Dr Katz, an expert on halitosis, argues that everyone has the same bacteria in the mouth, and the bacteria that people have in their mouths needs to be there. “These bacteria assist humans in digestion by breaking down proteins found in specific foods. But, for some people, the bacteria reacts differently with these proteins and the resulting factor is known as volatile sulfur compounds (VSC). These sulfur compounds produce the odour”, Dr Katz pointed out. One thing about halitosis is that nobody dares to disclose the condition to sufferer (s). Despite the fact that breaking such news can be a delicate subject, one of the basic things to undertand about halitosis is that it is not a uniform, consistent condition. It can vary in several ways including but not limited to intensity, type and the occurrence of associated symptoms. Many people are not aware that they suffer from halitosis. This is assumed so because most people with halitosis walk around unaware that they offend those around them. The aim of this article is to provide useful and easy to undertand information that will help sufferers in particular and the general public about halitosis and what they can do about it.Causes Bad breath (malodour) can be caused by a variety of things including diet, medication, poor oral hygiene, and diseases or conditions such as diabetes, gastroesophgeal reflux disorder (GERD), lactose intolerance, gum disease, and more. According to http://en.wikipedia.org/wiki/halitosis entry, large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleaned, and bacterial population can thrive on remnants of food deposits and dead epithelial cells. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria (bacteria that do not live or grow in the presence of oxygen), which flourish under a continually-forming tongue coating of food debris, dead cells and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield putrescent smell that is overpowering and pervasive.Other parts of the mouth that may contribute to the overall odour, but not as common as the back of the tongue, in their order of descending prevalence include inter-dental and subgingival niches, faulty dental work, food-impaction areas in between the teeth, abscesses, and unclean dentures. Additionally, smoking, alcohol consumption, or not brushing or flossing teeth properly or on a regular basis can cause halitosis. Certain medical conditions such as gum infections, local infection in the respiratory tract, diabetes, sinus infection, throat infection (pharyngitis or tonsollitis), liver disease, or kidney disorders can also cause halitosis to flare up. Halitosis treatmentThe causes of the problems can range from dysfunctional conditions of the various organs like the lungs or the kidneys, to dental issues like gum diseases, dry socket and faulty dental work. Thus, treatment for bad breath depends on the cause. The 2009 Cochrane Review asserted that halitosis is malodour that originates from the mouth and that eating certain foods such as garlic, unions, fish and cheese is the major contributor to halitosis. Basically, all the food eaten bigins to be broken down in the mouth. As foods are digested and absorbed into the bloodstream, they are eventually carried to the lungs and given off in the breath. When eating, World Health Organization advises to consume fibrous fruits which help stimulate salivary glands into producing more saliva. The concept here is that fibrous fruits such as oranges or lemons encourage the production of saliva, whch help wash away bacteria and small food particles that may lead to halitosis. Thus, people who drink a lot of alcohol or coffee, should replace those beverages with water instead. Like saliva, water keeps the mouth evenly and regularly moist and can help to keep the mouth free of bacteria causing food particles. This will help reduce the chance of developing halitosis.There are many products on the market that can help with halitosis treatment. These products include oral rinse such as TheraBreath, toothpaste/toothbrushes and many others. The most effective way to fight halitosis is by performing regular and proper oral hygiene where gentle cleaning of the tongue surface twice daily, using a tongue brush or tongue cleaner /scraper to wipe off the bacterial biofilm, debris and mucus, is the most effective way to keep bad breath under control. According to http://www.badbreath-halitosis.info, the cure of halitosis is complex, but at the same time it is simple. What needs to be done is to prevent the bacteria from creating the odorous sulfide compounds (VSCs) by adding oxygen to the environment they live in (tongue/throat). By adding oxygen, (gargling mouth rinse such as TheraBreath after toothbrushing with fluoridated toothpaste), end result is the formation of a Sulfate, which has no odour or taste. Halitosis can be an embarrassing and frustrating condition that often times prevents the sufferer from participating in social gatherings. The good news however is that many easy halitosis treatments are available. So patients with the condition should seek halitosis treatment from medical/dental professional, and stop suffering in silence. There is no reason that the sufferer should allow halitosis to dectate his/her life. Since most causes of bad breath are due to inadequate oral hygiene and are rarely life-threatening, they are more or less preventable. Malodour of dental origin can be treated by dentists, but if the mouth is healthy and the odour is not of oral origin, the suffurer can be referred to a medical doctor or a specialist to determine the odour source and treatment plan. Keeping oral hygiene is a must do job. It is not only a matter of health but also it is a social thing. Thus, it is important that sufferers of halitosis follow the above solutions and preventive measures if they wish to be more confident and secure in knowing that bad breath will not drive anyone away.Frank Rwema, MDPH (Lond)LT COLOral Health SpecialistDepartment of Preventive DentistryRwanda Military Hospital