Bad breath is a common health problem which greatly
affects the day today 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 wil 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 ect 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.
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 inbetween
meals can also produce bad breath because of improper cleaning.
Badbreath
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 flavors bad breath. Meat,fish,milk products,
eggs,cakes,nuts,pear and ect 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) Biofilm:
There
is formation of a thin sticky coating called biofilm on the tongue and
oral mucosa. This coating is thick on the posterior aspect of the
tongue where millions of gram negative bacteriae are seen .The thick
coating on the tongue is always associated with badbreath. Even a thin
biofilm can make anaerobic condition favourable for bacterial
proliferation.
4) Dental caries:
This is a destructive
process causing declassification with destruction of enamel and dentine
resulting in cavitisation of the tooth. These are produced mainly by the
lactobacilli . Food particles are deposited inside these cavities and
are putrified by the anaerobic bacteria producing bad smell. Normal
brushing will not remove the food debris easily and hence they are
putrified completely. Caries are common in school going children and in
those who do not maintain proper oral hygiene .Calcium and vitamin
deficiency can also predispose caries.
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 peridontal area
leading to continuous discharge called pyorrhoea. 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& 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,vincents angina,infectious
mononucleosis,scarlet fever,diphtheria,drug reactions and ect.
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 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. Some times the
salivary duct is obstructed by stones or tumors.Cancer of the salivary
gland is associated with offensive odor. In superlative parotitis
purulent discharge in to the mouth causes bad breath.
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 hygeine there is
possibility of this condition. Serous fluid secreated from the folds of
tonsil is very offenssive. Some patients complain that they hawk some
cheesy materials from the throat;which are very offenssive in nature.
These are formed inside the tonsillar crypts which contain thousands of
bacteriae. In such conditions tonsillectomy gives noticiable relief from
bad breath.
12) Pharyngitis& pharyngial abscess:
Pharynx
is a fibromuscular tube which forms the upper part of the digestive
& respiratory tract. Inflmmation 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 unpleasent
for others. Tobacco can irritate the mucus 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 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 favourable 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 ect 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 , AIDS ect 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 offenssive 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
ulceration collitis..Other diseases are malabsorption syndrome
intestinal tuberculosis, peritonitis ect.
23) Diseases of lungs:
Lung
diseases like pneumonia, lung abscess,chronic
bronchitis,bronchiectasis,tuberculosis, lung cancer ect 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 ect.
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
ect. 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 IS FOR GENERAL INFORMATION. ANY
PERSON HAVING BAD BREATH SHOULD CONSULT A QUALIFIED DOCTOR ]