Halitosis: Bad Breath!

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What is halitosis?

Halitosis is the medical term for bad breath. Dental reports in the United States say there are about 40 million Americans who have bad breath. In the Philippines, as in other regions in Asia, the incidence, conservatively speaking, may be as high as 50%-60%. This is a rough guesstimate, and the figure, of course, varies in different subgroups in the community. Halitosis, as a general rule, is less among those who live in the city, compared to rural areas, those who are more affluent, higher in socio-economic status, those who are more educated or professional, and those in the younger generation. Obviously, the financially handicapped could ill afford the luxury of toothpaste, dental floss, mouthwash, regular dental check-up and proper dental care. They may also be not as well-nourished, and as healthy, as those who can afford.

What causes halitosis?

There are a variety of causes of bad breath. Eating food that causes foul breath (like garlic, onion, etc), poor dental hygiene, decayed tooth or infection of the gums or oral cavity, diseases like diabetes, esophageal diverticulum, esophageal reflux, sinusitis, emphysema, etc. But the commonest underlying cause is poor dental hygiene where care of the teeth and mouth is neglected. There are people who do not brush their teeth at all and go to bed at night with food particles stuck in between their teeth. They may gargle and rinse their mouth with water (or water and salt) after each meal, or even use mouthwash, but the food caught in between their teeth (especially meat and fish) rot and stink like dead animals on the street. This is putrefaction and the foul smelling odor is from the sulfur compounds produced by the decaying meat, which usually results in bacterial infection (and more bad odor), and this makes the cycle a vicious one.

What are the types of bad breath?

Transitory halitosis is caused by food like onions and garlic and generally lasts from one day to day and a half. Some people develop halitosis after drinking pop or eating sweets, like dessert. The individual "oral metabolism" may have something to do with this observation. The other form of bad breath is the Chronic halitosis, which does not diminish or improve with time. It is permanently present until the cause is abolished. The bad odor comes from the bacteria in the mouth (between the teeth and on the tongue) which produce the foul smelling volatile sulfur compounds (VSC) in the form of hydrogen sulfides.

Can tooth infection cause infection in the heart?

Yes, tooth infection can cause the bacteria in the mouth to circulate in the blood stream to infect the heart valve, causing bacterial endocarditis, most especially in people who may have had rheumatic heart disease when they were young. This condition affects and weakens the heart valves, making them susceptible to infection. And those with artificial heart valves are even more prone to infection originating from tooth decay or infection in the mouth.

Does infected tonsils cause bad breath?

Yes, any infection in the oral cavity (in the teeth, gum, tongue, tonsils, any part of the mouth and throat) will cause halitosis.

Does eating bagoong, patis, century egg or durian cause bad breath?

Yes, but only if one does not do proper oral hygiene after eating any of these, or any other food items. If one brushes the teeth, does dental floss, gurgles with mouthwash, and maybe chews minted gum, after eating these food items, there should not be halitosis at all post-ingestion.

If, inspite of proper oral hygiene, bad breath is still present, what can it be due to?

If there is no tooth decay or any infection in the mouth or throat, the bad breath may be coming from sinusitis, emphysema or from the stomach (as in esophageal reflex, where the controlling valve between the stomach and the food pipe is not closing ---airtight---properly). A dental, or even medical, evaluation may be needed to ascertain the specific cause of this persistent halitosis.

Can mouthwash eliminate bad breath?

No, mouthwash alone cannot do the trick. First, the food particles that can rot must be removed from in-between the teeth immediately after each meal (by dental flossing, since tooth pick alone will not do the job). Then, brushing the teeth using toothpaste (that contains fluoride and other ingredients like Poly (methylvinylether) maleic acid coplymer and triclosan) for added tooth protection, is essential at least 3 times a day, after each meal. Mouthwash can be used as a last step in this routine as an added regimen. A study made on 15 mouthwashes showed that most masked the bad breath for a few minutes, only a few were still effective after a few hours. Most of the products sold over-the-counter do not eliminate halitosis.

What are the dental problems caused by bacteria?

Besides bad breath, the other problems caused by germs in our mouth include cavities, gum problems, plaques and tartar formation. Therefore, the routine regimen of dental flossing (to eliminate food particles that will rot and harbor bacteria), tongue-scraping, toothbrushing (to scrub food elements, juices and stains from the teeth, and protecting the teeth and gums with those ingredients in the toothpaste), and gurgling (with mouthwash that contain bacteria killing, and plaque-and-tartar preventing ingredients), and visiting your dentist at least every 6 months will not only eliminate bad breath but lead to a healthier dental and oral state.

Can mouth containing alcohol cause cancer?

Yes, according to a 1991 study in the Journal of the American Dental Association, which stated that mouthwashes "containing more than 25% alcohol could increase the risk of oral and pharyngeal (throat) cancer by 50%". Fortunately, most, if not all, mouthwashes in the market contain less than 15% alcohol.

How effective are breath-freshener capsules?

If taken as directed, and as a part of the comprehensive regimen we have discussed above, these breath-freshener capsules could be of help, especially for those with gastrointestinal reflux.

How about chewing gum?

Not by itself, but if added to the daily oral hygiene regimen we recommended, chewing (sugar-free) gum can be of help achieving a fresher and kissable breath.

Do people know they have bad breath?

It is odd but most people with chronic halitosis do not know they have it. Their own sense of smell is so conditioned to the bad breath in their mouth to the point that they do not even perceive or know they have halitosis. And their friends and relatives (including most spouse) will not even tell them, "to spare" them from the embarrassment (which actually leads to more embarrassment because of the persistence of this very offensive problem.) So, the next time you see your lover or friend, or relative, beg him or her to be candid with you. This honesty might change your reputation and love life forever.

©2003Raoul R. Diez, M.A.O.D.