Bad breath is a common health problem that greatly affects the day-to-day activities of a good number of people. It could make one feel uncomfortable around other people, and it can severely affect your self-confidence in social situations. The offensive odor from the mouth is unpleasant to those who come in close contact with bad breathers thus can be a barrier to communication.
The reaction bad breathers receive from others can be a source of worry and embarrassment. This hostile reception can further impact facilitate psychological trauma leading to depression. Sometimes, Sufferers from this problem are kept in isolation from society. This can even lead to marital disharmony.
Literally speaking all humans at some point have bad breath. Yes, we do. The reason is Oral cavity contains millions of anaerobic bacteria like Fusobacterium and actinomyces which acts on the protein of food materials and putrify them.
This process results in the formation of offensive gases like hydrogen sulfide, methyl, mescaptan, cadaverine, skatol, putrescine, etc causing a bad odor. If oral hygiene is not maintained properly all will suffer from bad breath. Most of us control this by regular brushing, tongue cleaning, and gargling. Even after maintaining cleanliness in the mouth some individuals still emit offensive smells due to various causes which requires diagnosis and proper treatment
Some common causes of bad breath
Poor oral hygiene – if oral hygiene is not maintained properly the mouth becomes a comfort zone for millions of bacteria that produce offensive gases by degrading food debris. Bad breath is common among those who do not brush their teeth regularly and clean their mouth after every food. Dentists recommend brushing your teeth twice a day with alcohol-free toothpaste for two minutes each time.
Ensure you clean your mouth after taking Snacks in-between meals to prevent the production of bad breath. Regular teeth washing can help remove food and plaque in the mouth — a sticky white film that forms on your teeth and contains bacteria.
The claim all humans are bad breathers can be backed by the odor the mouth releases upon waking up in the morning. During sleep, there is less production of saliva. Saliva has got some antibacterial properties that help to keep the mouth clean. Saliva contains oxygen molecules that are needed to make the oral cavity aerobic. So the reduction in its quantity during sleep creates a favorable space for anaerobic bacteria.
Food habits – The main cause of the bad smell is due to the degradation of protein by the bacteria and hence all food products rich in protein favors bad breath. For example, Meat, fish, milk products, eggs, cakes, nuts, pear, and other foods that belong to this class can cause bad breath.
Some food articles can produce a particular type of smell that may be unpleasant. Raw onion can produce a typical bad smell. It is said that an apple a day keeps the doctor away, a raw onion a day keeps everybody away. Eating groundnuts can also produce a bad smell. However, if proper cleaning is done, the smell can be reduced irrespective of the nature of food. Irregularity in the timing of food can also produce bad breath. Small food articles taken in between the meals can also produce a bad smell. So make sure you control your eating habits and do proper mouth cleaning when you eat(especially snacks) in between meals.
Alcohol consumption – Drinking alcohol, particularly in excess causes a decrease in saliva production – thus encouraging bacteria to settle within the oral cavity terrain. Alcohol consumption is another culprit of bad breath. The more often you drink, the more likely you are to experience bad breath. Therefore avoid alcohol if you can or drink less.
Read more about Alcohol and its Effect
Biofilm – This is the formation of a thin sticky coating on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram-negative bacteria are seen. The thick coating on the tongue is always associated with bad breath. Furthermore, a thin biofilm can make anaerobic conditions favorable for bacterial proliferation.
Dental caries – Dental caries, which can also be called tooth decay, is one of the most common and widespread persistent diseases in the present day that is also preventable. When you eat certain foods, the bacteria on your teeth break them down and produce acids that can seriously harm your tooth’s tough tissues, thus causing dental caries. Normal brushing will not remove the food debris easily and hence they are putrified completely. Caries is common in school-going children and in those who do not maintain proper oral hygiene. Calcium and vitamin deficiency can also predispose to caries.
Gingivitis – Gum is a mucous membrane with supporting connective tissue that covers the tooth-bearing boundaries of the jaw. The primary role of the gum is protection. Gingivitis is the inflammation of the gum(base of your teeth) caused by infected gum tissues which can become Painful, irritated, red, and swelling. If the situation deteriorates, the infection spreads to the periodontal region, resulting in continuous discharge called pyorrhoea.
Gum Recession – Gum Recession is what happens when gum tissue is recessed and lowers its position on the tooth, exposing the roots of the teeth which further causes bad breath
Dental plaques and tartar deposits – Plaques and tartar are deposited mainly in the gaps between the teeth and gum. This will provide shelter for the food debris and bacteria causing bad breath.
Ulcerative lesions and coatings – Almost all ulcerative lesions of the mouth are associated with bad breath. These lesions may be caused by bacteria, viruses, food allergies, or due to autoimmune disorders. Aphthous ulcer is the commonest among ulcerative lesions. Others are herpes, fungal infections, vincents angina, infectious mononucleosis, scarlet fever, diphtheria, drug reactions and etc.
Cancerous ulcers produce severe bad breath. All fungal infections produce a white coating(candidiasis). Leucoplakia is a white thick patch on the mucous membrane of the mouth & tongue. It is considered a precancerous condition. Offensive breath is associated with these conditions.
Diseases of the salivary glands – Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin film of coating called biofilm can provide an anaerobic condition in the mouth. Saliva can wet these layers and make an aerobic condition which is unfavorable for the bacteria.
Any condition which reduces the production of saliva can increase bacterial activity. Sometimes the salivary duct is obstructed by stones or tumors. Cancer of the salivary gland is associated with an offensive odor. In suppurative parotitis purulent, discharge into the mouth causes bad breath.
Tonsillitis – is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. Tonsillitis signs and symptoms include swollen tonsils, sore throat, swallowing trouble, and tender lymph nodes on the neck sides which can cause bad breath. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.
Tonsillar plaques and tonsillar fluid – This is a possible condition that persists even after maintaining proper oral hygiene. Serous fluid secreted from the folds of the tonsil is very offensive. Some patients complain that they hawk some cheesy materials from the throat; which are very offensive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteria. In such conditions, tonsillectomy gives noticeable relief from bad breath.
Pharyngitis and pharyngeal abscess – The pharynx is a fibromuscular tube that forms the upper part of the digestive & respiratory tract. The inflammation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis along with other signs like cough and throat irritation. Abscesses in the wall of the pharynx can also produce an offensive discharge of pus into the throat.
Dentures –Denture users may complain about bad smells due to the lodgement of small food debris in between. Proper brushing may not be possible in denture users especially fixed dentures.
Tobacco – Tobacco chewing is associated with bad breath. The smell of tobacco itself is unpleasant for others. Tobacco can irritate the mucous membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. All these causes an unpleasant smell.
Smoking – Smokers always have a bad smell. It can also produce lesions in the mouth and lungs causing bad breath. Smoking increases carbon dioxide in the oral cavity and reduces oxygen levels, causing a favorable condition for bacteria. Smoking reduces appetite & thirst hence the acid peptic disease is common in chain smokers.
Lesions in the nose and ear – Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In the case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with the discharge of pus in to the throat through the eustachian tube(passage from the middle ear to the throat)can also cause a foul odor. Chronic rhinitis(infection of the mucus membrane of the nose) and foreign bodies in the nose can also produce a bad smell in the expired air.
Diabetes mellitus – Mostly all diabetic patients suffer from bad breath. Coated tongue, ulcers, and coatings in the mouth increase the sugar level in tissues, etc are responsible for bad breath. Bacterial growth in diabetic patients is very faster than in nondiabetic individuals.
Fevers – Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. A severe bad breath is seen in typhoid. Other infectious diseases like Tuberculosis, AIDS, etc produce a bad smell.
Fasting and dehydration – Dry mouth favors bacterial activity. So any condition which produces dryness in the mouth makes the breath offensive. Even though the food particles are known to produce bad breath, fasting can also produce the same. Production of saliva is also reduced during fasting. Chewing and swallowing also helps to keep the mouth clean.
Bedridden patients – Bedridden patients suffer from bad breath due to the thick coating on the tongue. water intake is also limited in these patients. Regurgitation of food aggravates the condition. Since they talk less aeration in the oral cavity is reduced which favors anaerobic bacteria to become active.
Diseases of stomach and esophagus – Eructation of gas and food produces an unpleasant smell. Abnormality in the function of the lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis, gastric ulcer, and cancer of the stomach.
Intestinal diseases – Bad breath is common in patients suffering from ulcerative lesions of the intestine like ulcerative colitis. Other diseases are malabsorption syndrome intestinal tuberculosis, peritonitis, etc.
Diseases of lungs – Lung diseases like pneumonia, lung abscess, chronic bronchitis, bronchiectasis, tuberculosis, lung cancer, etc can produce a bad odor during expiration.
Liver disorders – Liver diseases like hepatitis, cirrhosis, can cause bad breath. Gall bladder diseases with vomiting also cause an unpleasant odor.
How to manage bad breath
Oral hygiene – Mouth should be kept clean every time to reduce bacterial action. After food gargling with lukewarm water is very essential. Even after small food articles like snacks, sweets, biscuits cleaning with water is needed. Brushing should be done twice daily. It is said that early morning brushing is for beauty and bedtime brushing is for good health.
Brushing techniques – Normal brushing techniques should be followed for better results. Many people brush vigorously causing damage to the gums. Brushing after every food and drink can damage the enamel. Bristles of the tooth brush should be smooth but hard enough to remove the food particles from the gaps. The direction of brushing is the most important thing. The upper teeth should be brushed in a downward direction and the lower in an upward direction. This is applicable to both inner and outer surfaces. Next comes the crown of the teeth; here brushing is done in anterior and posterior direction keeping the brush in the same direction. This is applicable to both the upper and lower set of teeth.
Tongue cleaning – White or yellowish coating on the tongue can cause bad breath. This is better marked in the morning and should be removed twice daily with the help of a tongue cleaner. Tongue cleaner must be used gently without damaging the taste buds on the tongue.
