Halitosis (bad breath)
Summary/Definition
Persistent bad breath, also known as halitosis, is a very common symptom that affects about half of the population. This symptom manifests itself as an unpleasant odour that originates in the mouth or related organs and is then released through the oral cavity. Bad breath is caused by the presence of gases called volatile sulphur compounds, which are produced by the breakdown of proteins by bacteria in the oral cavity. These decomposed proteins are mainly food particles in the teeth, as well as saliva and shed cells of the oral mucosa. Bad breath not only causes psychological problems but can also limit social interaction.
Halitosis can be divided into two types: true and perceived. The former includes physiological bad breath, which is temporary and reversible and is caused by physiological phenomena such as fasting, menstruation or morning breath. There is also pathological halitosis, which is characterized by the persistent presence of volatile sulphur compounds as a result of putrefactive action of bacteria. Causes of physiological bad breath include nervousness of the person, starvation and old age. The causes of pathological bad breath include excessive plaque or tartar, dental caries, gum disease, dry mouth, etc. Non-oral causes of halitosis include foreign bodies in the nasal cavity, systemic diseases such as diabetes and renal failure, and gastrointestinal diseases including reflux esophagitis.
Perceived halitosis is characterized by the absence of objective bad breath, but it is believed that bad breath can come from other organs such as the nose and ears in addition to the mouth. Perceived halitosis includes pseudogynosis (imaginary bad breath) and halitophobia (fear of bad breath).
Symptoms
Persistent bad breath that causes discomfort to the individual and can be sensed by others can cause psychological problems and lead to social isolation.
Diagnostics
The first step in diagnosing this condition is to see a specialist. The specialist will assess the degree of bad breath, collect information about medications taken, oral hygiene habits, and any diseases of related organs such as the digestive or respiratory systems. A dental examination, saliva analysis, dental caries and dentures assessment will be required to determine the cause of the bad breath.
Treatment and course of the disease
As the causes of bad breath can be both intra-oral and extra-oral, effective treatment requires a comprehensive approach. If the source of the odour is in the oral cavity, it can be treated physically, by thoroughly cleaning the teeth and mucous membranes, and chemically, by using products containing zinc chloride or chlorhexidine. If bad breath is caused by problems outside the mouth, appropriate treatment should be given. Symptoms such as obsession with bad breath, depression, anxiety and phobias may be present in imaginary halitosis syndrome. It is therefore important to reduce the subjective discomfort associated with bad breath and to encourage a healthy mindset and awareness of one’s physical condition. If dry mouth and reduced salivation are present, artificial saliva or salivary stimulants such as pilocarpine may be used. However, it should be remembered that prolonged use of pilocarpine can cause complications such as glaucoma or asthma. Therefore, the duration of use of such medications should be limited – it is advisable to use them for short periods only.
