First appearance of the term halitosis was in 1921, defined by the Listerine Company. Halitosis, oral malodor, breath odor, or simply bad breath are the terms used to describe the same clinical condition, which refers to unpleasant smell exhaled while breathing. Bad breath disease may be presented in various forms depending on the severity of the clinical condition. Chronic halitosis, a more serious problem of bad breath, is not well defined among doctors and has no effective treatment alternatives, which directly attack and eliminate the problem.
Most of the products introduced to treat the disease are quite controversial, as they are helpful in some cases, while in others they can provide only partial treatment or have no effect at all. A fairly small number of clinics access the problem on microbiological level in order to determine the actual cause of the problem, usually represented by a specific type of bacteria, which is the only way to achieve essential success in treating the problem. All other alternatives attacking the symptoms rather than eliminating causes fail to treat halitosis or result only in a short-term improvement of the condition.
Different types of halitosis are distinguished based on the causes of the problem. The most common cases include transient bad breath, initiated due to oral dryness, ketosis, oral disbacterios, and consumption of certain types of foods, such as onions, coffee, garlic, etc. Transient halitosis is also often cause by lack of appropriate oral care and smoking. Chronic halitosis is a more severe condition and more widespread of bad breath. Chronic bad breath is primarily caused by excess of certain types of oral bacteria existing in human’s mouth environment. This case can be severely worsened by dry mouth syndrome.
Currently, causes of appearance of halitosis are not clearly defined and fully discovered, however, in most cases bad breath is known to be the outcome of trapping food particles in mouth, which get involved in contact with mouth flora. Bacteria overpopulation, triggered by the contact with specific oral conditions, leads to emergence of halitosis problem. Currently, around 450 types of bacteria are discovered to exist in human mouth. The typical location of excess bacteria gathering due to genetic overpopulation is the rear portion of the tongue, where there is less normal mouth activity, which usually regulates the amount of the bacteria.
The specialties of tongue structure, such as rough surface, creates a perfect environment for existence and expanse of anaerobic bacteria, appearing under a continuously renewing tongue cover composed of dead cells, huge amount of dead and living bacteria, and waste produced by processed food particles. Anaerobic respiration of a combination of these microorganisms and environment of the tongue surface may lead to various bad breath phenomena. The result is usually the putrescence smell caused by polyamines, and the smell of “rotten egg” caused by volatile sulfur compounds.
The latter includes hydrogen sulfide, methyl and di-methyl sulfide. These microelements combined with the mouth air result in bad smell of breath upon exhalation. Among other causes of chronic halitosis are intestinal parasitic infections, kidney failure, gum disease, sinusitis, gastro esophageal reflux disorder, hormonal changes, and different prescription drugs consumed during a long period of time. Different causes of halitosis can be divided by the area of influence, and include factors affecting the mouth, airways, esophagus, and stomach.
Most commonly bad breath appears due to the protein breakdown by bacteria in oral environment. Factors targeting the mouth and resulting in different conditions of halitosis include the following. Dental decay appears due to “the irreversible solubilization of tooth mineral by acid produced by certain bacteria that adhere to the tooth surface in bacterial communities known as dental plaque” (Thivierge). Gum disease, or periodontal disease, considers of the consequences being halitosis.
Stagnation of food between teeth may lead to halitosis as a result of these food particles being processed by oral bacteria. Dryness of mouth favors the microbiological processes causing bad breath. Bacterial activity on the rear part of the tongue resulting from postnasal drip creates bad smell environment in the mouth. Infections of tonsil and throat, as well as catarrh may be the motivators of halitosis. Events attacking airways that are possible reasons for bad breath include sinusitis, the bacterial, allergic, or viral inflammation of nasal sinuses.
Other causes include polyps, dryness of oral environment, presence of a foreign body, hindered air distribution or mucus flow. Some physical illnesses, such as bronchitis and pneumonia, also as a result provoke halitosis. Amplification of the bronchi of the lungs followed after bronchi infection also result in bad breath upon exhale. Activities targeting esophagus and stomach that result in halitosis include food stagnation. Inflammation of the lining of the stomach, or gastritis, includes halitosis as one of the side effects.
There are three serious diseases, resulting in different bad breathing smells: kidney failure generates ammonia smell of breath, liver failure has a fishy breath smell as one of the side effects, and unpleasant fruity smell is caused by diabetic coma. Many cases of appearance of halitosis in healthy organisms appear due to the poor digestion function, as well as hormonal changes in the organism, such as menopausal symptoms, may force inadequate activity of certain functions triggering of the disorders mentioned above and resulting in bad breath.
The process of habituation to own organism’s processes makes it almost impossible for a person to feel whether he/she has a bad breath problem, however, in cases with severe halitosis symptoms a person may experience an effect of bad taste as a side effect of halitosis, such as sour, fecal, or metal tastes pertaining fresh food. Bad taste symptom depends on the severity of halitosis and oral dryness. The most common and primitive methods of determining of halitosis include extraction of a small portion of saliva and smelling it after it dries.
Also, collection with a dental floss of substance located on the rear portion of the tongue will provide specific smell after dying up. In case of severe symptoms of halitosis, which undermine the assumption of all the primary medical and dental factors as motivators of bad breath, specialized testing procedures are undertaken followed by complicated treatment actions targeting the cause rather than the symptom elimination. A recently developed technique to test the presence of halitosis is known as Halimeter.
It used a portable sulfide monitor to determine the level of sulfur emissions in mouth air. In proper appliance this method is effective indicator of bacteria producing volatile sulfur compounds. However, it has several drawbacks as it is very sensetive to alcohol and cannot differentiate sulfides originated from different sources. Therefore, the presence of alcohol in organism may generate false results as for sulfides levels, as well as consumption of garlic or onion with 48 hours of test will result in higher sulfide levels and false halitosis indications.
The three major volatile sulfur compounds, which include hydrogen sulfide, methyl mercaptan, and diethyl sulfide, can be determined by new gas chromatography devices. These digital appliances determine molecular levels of sulfurs with great accuracy and provide greater reliability as for diagnosing symptoms and causes of halitosis. Treatment procedures and methods of halitosis can be divided into five categories: physiologic halitosis, oral pathologic, pseudo-halitosis, extra-oral pathologic halitosis, and halitophobia.
The first three categories should be accessed with dental practice techniques; extra-oral pathologic halitosis is a responsibility of a physician, while haliohobia should be treated by a psychologist of psychiatrist. The primary action to target physiological halitosis is tongue cleaning. Such procedure yields high effectiveness of reduction of halitosis problem, because most if the bacteria influencing processes favorable for halitosis appearance are located on the tongue.
Tongue cleaning should be assessed carefully using an appropriate tool (usually tongue cleaning brushes), as an excessive effort and usage of regular tooth brush may lead to damage of the tongue surface. In addition to tongue cleaning, halitosis should be undermined with regular oral hygiene procedures, including teeth brushing and mouth rinsing. Mouthwashes with ingredients of chlorhexidine, zinc, and hydrogen per-oxide demonstrate the highest efficiency of preventing halitosis.