What is causing bad breath?
Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. Halitosis is not infectious. About 2.4% of the adult population suffers from bad breath.
Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:
• Dental factors – such as periodontitis (infection around the teeth) or poor oral hygiene.
• Dry mouth – caused by medicines, alcohol, stress or a medical condition.
• Smoking – which starves the mouth of oxygen.
Less common causes of halitosis include:
• Acid and bile reflux from the stomach
• Post-nasal discharge – for example, due to chronic sinusitis
• Kidney failure, various carcinomas, metabolic dysfunctions, and biochemical disorders, together account for only a very small percentage of halitosis suffers
• Foods – such as onions, garlic or cauliflower, which induce certain odours. However, these effects are only shortlived.
What are the features of halitosis?
• A white coating on the tongue especially at the back of the tongue
• Dry mouth
• Build up around teeth
• Post-nasal drip, or mucous
• Morning bad breath and a burning tongue
• Thick saliva and a constant need to clear your throat
• Constant sour, bitter metallic taste.
Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.
What to do if you develop bad breath?
If you develop bad breath maintain good oral hygiene for three days. If the problem persists, make an appointment with your doctor to get a further assessment and advice on managing the problem.
When to seek further help?
If you develop any of the following symptoms, you should visit your dentist to discuss your symptoms:
• Pus coming from your gums
• A bad taste in your mouth that won’t go away
• Loose teeth caused by infected gums
• Any abscesses that develop – these can be under your teeth and will usually be very painful.
If you develop any of the following symptoms with your mouth problems, you should contact your doctor as soon as possible:
• Any difficulty talking or swallowing.
• Swollen lymph glands in your neck
• A fever (a temperature over 38⁰C).
How to treat halitosis?
There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis.
Gentle but effective tongue cleaning may also be required. A variety of tongue brushes and scrapers have been produced in recent years. The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue, keeping in mind that the hardest to reach back portion smells the worst.
People with chronic sinusitis may find the regular use of a saline nasal spray helpful. A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help. Speak to your dentist, doctor or chemist to identify the cause of your halitosis and to find the most effective treatment for you.
Where to get help?
Your doctor, your dentist and your local chemist.
Dr Ash Mina
Principal Scientist | NSW Health Pathology
Ph.D., M.Sc.(Clin Biochem), B.Sc.(Hons), Grad Dip (Biochem
Nutrition), Grad Dip (Micro), MACMSR, MAIMS.
Institute of Clinical Pathology and Medical Research (ICPMR),
Senior clinical lejjcturer, Faculty of Medicine, Sydney University.
Address: Locked Bag 9001, Westmead NSW 2145.