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Halitosis

CAUSES OF HALITOSIS

The majority of bad breath problems begin in the oral cavity.
  • Bad breath that is of oral cavity origin can be traced to a sulfur compound produced by bacteria. Dead and dying bacterial cells release this sulfur compound which gives the breath an unpleasant odor.
  • Bacterial plaque and food debris accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices. Large amounts of sulfur compounds can be produced in this area, making it a frequent site of origin for bad breath.
  • The tooth attracts bacteria containing plaque and if not cleaned regularly and thoroughly, this can result in large accumulations of bacteria which result in bad breath.
  • People who have gingivitis or periodontitis(Gum Disease) often experience bad breath because of bacteria accumulating in areas that are not cleaned easily, such as deep pockets around teeth.
  • Xerostomia(dry mouth) can significantly increase the potential for halitosis.  There are many causes of Xerostomia - ask us for an assesment.
  • Fortunately, treatment is very effective for people who have bad breath of mouth origin.
Other reasons (other than the mouth) for bad breath are:
  • Infections, especially in the sinuses or lungs
  • diabetes mellitus (acetone smell to the breath)
  • kidney failure (can produce a fishy odor)
  • gastrointestinal disorders
  • malfunction of the liver
  • disorders of metabolism (foul, fishy odor that comes and goes and may be difficult to diagnose)
  • fasting (when the body is not provided with fuel in the form of food, fat and protein will begin to be broken down; the result is bad odor from the waste products of this metabolism)

TREATMENT:

  • Treatment begins with a complete oral examination and health history.
  • Periodontal disease and /or cavities should be treated and repaired.
  • Oral infections must be eliminated or impacted teeth may need to be removed.
  • Good oral hygiene must be stressed, including cleaning the teeth and tongue. Once the oral infection is treated and cured, mouthrinses, toothpastes, and other oral hygiene products may have some effectiveness in managing oral odor.  Ask us for a product that may be helpful to you.

Please feel encouraged to seek treatment because of the high success rate in managing the problem.

Halitosis - Organoleptic Olfactory Test

Doing your own sniff test for halitosis isn’t very reliable… for two reasons. First, your oral cavity is connected to your nose which filters out background smells like your breath. Second, thanks to advertising, you could have halitophobia, an exaggerated needless fear of bad breath.

If you’re in doubt, ask us… your mouth experts!

Frequently asked Questions about Halitosis:

1. What is Chronic Bad Breath?

Chronic bad breath and bad taste problems are most often caused by the overpopulation of certain types of bacteria naturally present in the mouth.  These bacteria are found specifically on the base of the tongue, the rough surface of the tongue and in between the teeth.  The bacteria feed on the protein in saliva and tissues producing large amounts of volatile sulfur compounds (VSC's).  It is generally these sulfur compounds that mix with mouth air to form bad breath.  In addition, the following conditions may also contribute to bad breath problems:

  • stress
  • hunger
  • certain foods
  • systemic diseases and conditions
  • alcohol, tobacco and medications
  • dental diseases and conditions
  • hormonal changes and metabolic disorders

2. What is Dry Mouth?

Oral dryness can be the result of insufficient production of saliva.  More often, we find that the dry and pasty feeling described by our clients is a response of the tongue and tissues of the mouth to an increased VSC production.  Once the oral bacteria are reduced and their by-products eliminated, the sensation disappears and there is no longer a complaint of oral dryness.

3. Is all Bad Breath the same?

The odour of the breath depends on the type of VSC's that the bacteria produce.  For example, hydrogen sulfide smells like stale cooked eggs while methyl mercaptan has a penetrating pungent odour.  Both of these gases are usually present in bad breath along with other compounds also produced by the bacteria.  The blending of all gaseous compounds is what determines the kind of bad breath that is present at any given time.  In addition, many physical and medical conditions can add their own distinctive odours to the mix.

4. For the past few months I have been getting lumps in the pockets of my tonsils.  They get sore and make my breath smell bad.  When I breathe through my nose, I can smell this myself.  After a few weeks the lumps get big enough to fall out.  It's ok for a few more weeks until the problem starts again.  Could I have a bacterial infection of some sort?

You most likely have tonsilloliths.  These cauliflower-like lumps are a combination of bacteria, food debris, dead cells and mucus.  This material accumulates in small pockets in the tonsils and eventually the action of the throat muscles forces some of it out.  The odour from the tonsilloliths is unpleasant.
 
We have had considerable success in treating tonsilloliths with antimicrobial rinses such as chlorhexidine or with a mixture of antibiotics.  The number of lumps present, the size and the frequency that they appear can all be reduced dramatically but it is rare that we can remove them completely.  Many patients say that they may experience one or two very small lumps once every 4 to 6 months.
 
Although surgical procedures are not recommended except when the tonsil appears enlarged, inflamed and infected, a tonsillectomy (surgical removal of tonsils) is the most effective way to prevent the formation of tonsilloliths.  Your doctor can advise you if a tonsillectomy should be considered.

5. What is Trimethylaminuria (TMAU) or the fish-odour syndrome?

Trimethylamine (TMA) is a byproduct formed as a result of the body's conversion of the nutrient 'choline' into essential compounds for use by the nervous system and other body systems.  This byproduct, composed of methyl and amines, is a highly odourous chemical but under normal functioning the body deodorizes this chemical prior to elimination.  A gene releases an enzyme called flavin mono-oxidase which is responsible for making the byproduct odourless.  This enzyme adds oxygen to the chemical, converting it to Trimethyl-N-oxide and thereby neutralising the odour.
 
The chemical is excreted through all pores in the body, including the skin, mouth and nose.  In some individuals the body fails to oxidize this chemical, giving the person a very unpleasant odour.  This condition is called Trimethylaminuria or TMAU.


 
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chronic oral infections and your general health
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