Bad breath is a common health problem which greatly affects the day
to day activities of so many people. The offensive odor from the mouth
is unpleasant to those who come in close contact with bad breathers.
The
problem will be doubled by psychological trauma leading to depression.
The sufferers from this problem will be isolated from the society. This
can even lead to marital disharmony.
Literally speaking
all human beings are bad breathes. Oral cavity contains millions of
anaerobic bacteria like fusobacterium and actinomyces which acts on the
protein of food materials and purifies them.
This process
results in the formation of offensive gases like hydrogen
sulphide,methyl mescaptan,cadaverin,skatol,putrescine etc. causing 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 suffer from
offensive smell due to various causes which has to be diagnosed and
treated properly.
Here are some common causes of bad breath.
1) Poor oral hygiene:
If
oral hygiene is not maintained properly the mouth becomes the seat for
millions of bacteria which produce offensive gases by degrading the food
debris.
Bad breath is severe in those who do not brush
their teeth regularly and clean their mouth after every food. Snacks
taken in between meals can also produce bad breath because of improper
cleaning.
Bad breath is common in almost all people in the
morning on waking. During sleep there is less production of saliva
.Saliva has got some antibacterial properties which help to keep the
mouth clean.
Saliva contains oxygen molecules which is
needed to make oral cavity aerobic. So the reduction in it's quantity
during sleep makes a favorable condition for anaerobic bacteria.
2) Food habits:
The
main cause of bad smell is due to degradation of protein by the
bacteria and hence all food products rich in protein favors bad breath.
Meat,fish,milk products, eggs,cakes,nuts,pear etc can cause bad breath.
Some food articles can produce particular type of smell which may be
unpleasant.
Raw onion can produce 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 bad smell.
However
if proper cleaning is done smell can be reduced irrespective of the
nature of food. Irregularity in timing of food can also produce bad
breath. Small food articles taken in between the meals can also produce
bad smell.
3) Bio-film:
There is
formation of a thin sticky coating called bio-film 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. Even a thin bio-film
can make anaerobic condition favorable for bacterial proliferation.
4) Dental cavities:
This
is a destructive process causing destruction of enamel and dentine
resulting in cavitation of the tooth. These are produced mainly by the
lactobacilli .
Food particles are deposited inside these
cavities and are putrefied by the anaerobic bacteria producing bad
smell. Normal brushing will not remove the food debris easily.
Cavities
are common in school going children and in those who do not maintain
proper oral hygiene .Calcium and vitamin deficiency can also predispose
cavities.
5) Gingivitis:
Gum is a
mucus membrane with supporting connective tissue covering the tooth
bearing borders of the jaw .The main function of gum is protection
.Gingivitis is the inflammation of the gum. Due to various causes gum
tissue get infected resulting in swelling,pain and discharge.
If
the condition become worse the infection spread towards periodontal
area leading to continuous discharge called pyorrhea. Some times the
infection goes deep producing alveolar abscess with discharge of pus.
Infection can even reach the bone causing osteomyelitis. All these
conditions can produce offensive smell.
6) Gum retraction:
When the gums retract from the teeth a gap is developed which will lodge food particles and cause bad breath.
7) Dental plaques and tartar deposits:
Plaques
and tartar is deposited mainly in the gaps between the teeth and gum.
This will provide shelter for the food debris and bacteria causing bad
breath.
8) 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.
Apthous ulcer is the commonest
among ulcerative lesions. Others are herpes,fungal infections,
angina,infectious mononucleosis,scarlet fever,diphtheria,drug reactions
etc.
Cancerous ulcers produce severe bad breath. All
fungal infections produce white coating(candidiasis). Leucoplakia is a
white thick patch on the mucus membrane of the mouth & tongue. It is
considered as a precancerous condition. Offensive breath is associated
with these conditions.
9) 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 bio-film 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.
Some times the salivary duct is obstructed by stones or tumors.Cancer
of the salivary gland is associated with offensive odor.
10) Tonsillitis:
Tonsils
are a pair of lymphoid tissue situated in the lateral wall of
oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath
is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar
abscess can also produce bad breath.
11) Tonsillar plaques & Tonsillar fluid:
If
bad breath persists even after maintaining proper oral hygiene there is
possibility of this condition. Serous fluid secreted from the folds of
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.
12) Pharyngitis and pharyngial abscess:
Pharynx
is a fibromuscular tube which forms the upper part of the digestive
& respiratory tract. 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 pharynx can also produce
offensive discharge of pus in to the throat.
13) Dentures:
Denture
users may complain about bad smell due to lodgement of small food
debris in between. Proper brushing may not be possible in denture users
especially fixed dentures.
14) Tobacco:
Tobacco
chewing is associated with bad breath. The smell of tobacco itself is
unpleasant for others. Tobacco can irritate the mucus membrane and cause
ulcers and coatings. Gingivitis and pyorrhea 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 offensive smell.
15) Smoking:
Smokers always have bad smell. It can also produce lesions in the mouth & lungs causing bad breath.
Smoking
increases carbon dioxide in the oral cavity & reduces oxygen
level,causing a favorable condition for bacteria. Smoking reduces
appetite & thirst hence acid peptic disease is common in chain
smokers.
16) Lesions in the nose & ear:
Bad
breath is occasionally seen in sinusitis(infection of para nasal
sinuses). In 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 discharge
of pus in to the throat through the Eustachian tube(passage from middle
ear to the throat)can also cause offensive odor.
Chronic
rhinitis(infection of mucus membrane of nose) and foreign bodies in the
nose can also produce bad smell in the expired air.
17) Diabetes mellitus:
Mostly
all diabetic patients suffer from bad breath. Coated tongue,ulcers
& coatings in the mouth ,increased sugar level in tissues are
responsible for bad breath.Bacterial growth in diabetic patient is very
faster than non diabetic individuals.
18) Fevers:
Bad
breath is common in almost all fevers. Even an acute fever can produce
bad breath. Severe bad breath is seen in typhoid .Other infectious
diseases like Tuberculosis and AIDS produce bad smell.
19) Fasting & dehydration:
Dry
mouth favors bacterial activity. So any condition which produce 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.
20) Bedridden patients:
Bedridden
patients suffer from offensive breath due to 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.
21) Diseases of stomach & esophagus:
Eructation
of gas and food produce unpleasant smell. Abnormality in the function
of lower sphincter can allow the food to regurgitate upwards causing bad
breath. Bad breath is also common in gastritis,gastric ulcer and cancer
of stomach.
22) Intestinal diseases:
Bad
breath is common in patients suffering from ulcerative lesions of
intestine like ulcerative colitis. Other diseases are malabsorption
syndrome, intestinal tuberculosis, peritonitis etc.
23) Diseases of lungs:
Lung
diseases like pneumonia, lung abscess,chronic bronchitis,tuberculosis,
lung cancer etc can produce bad odor during expiration.
24) Liver disorders:
Liver
diseases like hepatitis, cirrhosis,can cause bad breath.Gall bladder
diseases with vomiting also causes unpleasant odor.
25) Psychiatric patients:
Bad breath is common in psychotic patients due to poor hygiene,irregular food habits,less water intake and etc.
26) Somatisation disorder:
This
is a psychiatric disorder characterized by the presence of a physical
symptom that suggest a medical illness .These patients come with
physical complaints like pain,nausea difficult respiration, bad smell
etc.
This condition is diagnosed after detailed
examination of the patient with all investigations.Since this is a
psychiatric disorder it has to be managed with a psychological approach.
[ THE POINTS MENTIONED IN THIS ARTICLE ARE FOR
GENERAL INFORMATION ONLY. ANY PERSON THAT NEEDS TO TREAT BAD BREATH
SHOULD CONSULT A QUALIFIED DOCTOR ]