Family doctor

Overview:

• Bad breath is also known as halitosis
• Some degree of bad breath is common in most people at various times
• It is particularly common after waking due to bacteria present in plaque, and after eating some foods such as onion or garlic
• Halitosis can sometimes signal a serious underlying medical disorder
• Most bad breath can be cured by improved dental hygiene measures

What is it?

Bad breath is also called halitosis and most people have suffered from it at some stage.

It is particularly common after waking (morning breath) and eating some foods which can cause bad breath such as garlic, onion, pastrami, and curries.

Bad breath at other times can be concerning and some sufferers may be unaware they have an odour problem and may need to be gently told.

Halitosis is more common in the morning because the mouth dries out during sleep and this creates a more fertile breeding ground for bacteria in plaque on the teeth and the back of the tongue. The bacteria produces a number of odours including volatile sulfur compounds which are believed to be the major cause of bad breath.

Bad breath is also more common among the elderly because of reduced saliva production.

Some medications can cause bad breath because of a dry mouth such as antidepressants, blood pressure treatments, diuretics, and antihistamines.

Most cases of halitosis are not serious and relate to dental hygiene such as gum disease and periodontal disease. However, about 10 percent of sufferers may have an underlying medical condition.

If the bad breath is coming from the mouth then it is likely to be purely a dental concern, but if the breath seems to be coming from inside the body or from the nose then it is possible another condition is causing it and a medical check up is advised.

Some medical causes include:

• Tonsillitis
• Sinusitis
• Bronchitis
• Pneumonia
• An object in the nose
• Respiratory infections
• Oral thrush
• Cancer such as pharyngeal or oral tumours, leukaemia, stomach and pulmonary cancer
• Gastroesophageal reflux
• Hiatal hernia
• Liver disease such as cirrhosis (this produces a rotten egg smell)
• Kidney disease
• Diabetic ketosis (acetone breath)
• Gallbladder dysfunction
• Tuberculosis

Another disorder called trimethylaminuria which affects up to one percent of the population produces a fish-odour all over the body and on the breath. It is a genetic disorder which prevents the proper metabolism of choline. There is no cure but sufferers are encouraged to avoid foods high in choline such as broccoli, beans, eggs, and liver.

What can be done?

The main treatment of bad breath involves improving oral hygiene with more regular brushing and flossing of teeth, and the use of a mouth wash.

People are also advised to clean the back of their tongue. This can be done with a toothbrush but if the gagging reflex prevents this, a mouth wash can be used. Making an "aahh" sound while gargling helps to ensure the mouth wash reaches the more inaccessible areas of the tongue.

Avoid dehydration by drinking plenty of water, and a dry mouth can also be treated with the use of artificial saliva.

Persistent or severe cases of halitosis can be treated with antimicrobial drug treatment.

New therapies are also under investigation.

Getting help

A dental examination is advisable for straight forward cases of halitosis. Bad breath which originates from outside the mouth should be investigated by a doctor.