Bad Breath
What are the causes of bad breath?
Bad breath is a health problem that affects many people. The offensive odor coming from the mouth is unpleasant to anyone in close contact. It can lead to many problems even marriage difficulties.
Every human being has bad breath. A cavity may have millions of anaerobic bacteria that act on food protein and putrifies them. This forms offensive gases like hydrogen sulfide for example resulting in a bad odor. Not keeping proper oral hygiene will cause bad breath. Regular brushing, cleaning the tongue and gargling are enough. Even after all this however, some individuals still suffer from offensive smells because of various causes that need diagnosing and proper treatment.
Common causes of bad breath.
Poor oral hygiene:
Not upholding proper oral hygiene, the mouth becomes infested with bacteria that produce offensive gases by degrading food debris. Not cleaning your mouth after every meal will result in bad breath. Eating snacks between meals can also produce bad breath. Bad breath is common to everyone on waking. Sleeping produces less saliva. Saliva contains antibacterial properties that help in keeping a clean mouth. Saliva also contains oxygen molecules for aerobic activity. Reducing the quantity during sleep makes conditions suitable for anaerobic bacteria.
Food habits:
A bad smell is degrading protein by bacteria and therefore all food products rich in protein strengthens bad breath. Foods like meat, fish, milk products, eggs, cakes, nuts, pears can cause bad breath. Some foods can produce a particular smell that may be unpleasant. Raw onions are an example. The old saying that an apple a day keeps the doctor away, but a raw onion a day keeps everyone away is true. Cleaning properly though lessens smells irrespective of the food. Small snacks taken between meals can also produce bad smells.
Biofilm:
Biofilm is a thin sticky coating on the tongue and oral mucosa. It is thick on the posterior of the tongue gathering millions of gram-negative bacteria. This thick coating on the tongue is always indicative of bad breath. Even a thin biofilm can make anaerobic conditions suitable for bacterial growth.
Dental caries:
This is destructive causing decalcification with destruction of enamel and dentin resulting in cavities in the teeth. The lactobacilli are responsible for producing these. Accumulating food particles inside, the anaerobic bacteria decay them producing bad smells. Normal brushing does not remove food debris easily, decaying them quickly. In school-going children and in those who do not uphold proper oral hygiene, cavities are commonplace. Calcium and vitamin shortage can also predispose caries.
Gingivitis:
The gum is a mucus membrane that has supporting connective tissue covering the tooth bearing borders of the jaw. The main role of the gum is in providing protection. Gingivitis is an inflammation of the gum. When gum tissue becomes infected, swelling and pain occurs. If the infection then spreads towards the peridontal area a continuous discharge called pyorrhoea happens. The infection can go deeper producing alveolar abscess with discharging of pus. It may even reach the bone causing osteomyelitis. All these conditions can produce offensive smells.
Retraction of the Gum:
When gums retract from the teeth developing a gap, food particles will lodge there and cause bad breath.
Dental plaques and tartar deposits:
In the gaps between the teeth and gum plaques and tartar pile up, providing shelter for food debris and bacteria causing bad breath.
Ulcerative lesions and coatings:
Nearly every ulcerative lesion of the mouth is vulnerable, resulting in bad breath. Bacteria, viruses, food allergies or autoimmune disorders may be causing these lesions. Apthous ulcers are the most common among ulcerative lesions. Others include herpes, fungal infections, infectious mononucleosis, diphtheria and scarlet fever among others. Cancerous ulcers are bad, producing severe bad breath. All fungal infections produce a white coating (candidiasis). Leucoplakia is a white thick patch that forms on the mucus membrane of the mouth and tongue. It is commonly a precancerous condition. Associating offensive breath with these conditions is general.
Salivary Gland Diseases:
Saliva is useful in supplying oxygen to every part of the oral cavity. As seen earlier a thin film of coating called biofilm provides an anaerobic condition in the mouth. Saliva wets these layers making an aerobic condition that is unfavourable to bacteria. Any condition that reduces producing saliva can increase bacteria. Obstructing the salivary duct by stones or tumours is a problem. Associating cancer of the salivary gland with offensive odor is possible. In suppurative parotitis, purulent discharge into the mouth results in bad breath.
Tonsillitis:
Tonsils are a pair of lymphoid tissues placed in the lateral wall of oropharynx. Tonsillitis is an inflammation of the tonsils. In both chronic and severe tonsillitis bad breath occurs. Quinsy or peritonsillar abscess also produces bad breath.
Tonsillar plaques and tonsillar fluid:
When bad breath persists even after keeping to proper oral hygiene there is a possibility of this condition happening. Fluid secreting from the folds of the tonsil is offensive. Sometimes excreting cheesy materials from the throat occurs. These form inside the tonsillar crypts which contain thousands of bacteria. In such cases tonsillectomy provides notable relief from bad breath.
Pharyngitis and pharyngial abscess:
Pharynx is a fibro muscular tube forming the upper part of the digestive and respiratory tract. Bacteria and viruses mainly cause inflammation of the pharynx, pharyngitis. Bad breath is present in pharyngitis with other signs like cough and throat irritation. Abscesses in the wall of the pharynx happen, producing offensive discharge of pus into the throat.
Dentures:
Denture users may have a bad smell because of small food debris lodging between them. Proper brushing may be impossible in denture users especially those using the fixed kind.
Tobacco:
Tobacco chewing and bad breath. Tobacco irritates the mucus membrane, causing ulcers and coatings. Gingivitis and pyorrhoea are common to tobacco chewers. Tartar deposits happen on the teeth especially close to the gums. Tobacco chewers have gastric acidity with eructations, resulting in offensive smells.
Smoking:
Smoking always causes a bad smell, sometimes producing lesions in the mouth and lungs causing bad breath. Smoking directly increases carbon dioxide in the oral cavity reducing oxygen levels, causing favourable conditions for bacteria. Smoking reduces appetite and thirst therefore acid peptic disease is common to chain-smokers.
Lesions of the nose and ear:
Bad breath occasionally happens in sinusitis (infection of paranasal sinuses). With postnasal dripping, bad breath is common because of the presence of protein in the discharge. Degrading of these proteins by the bacteria occurs. Infection of the middle ear with discharging of pus into the throat through the eustachian tube (the passage from the middle ear to the throat) can also cause offensive odours. Chronic rhinitis (infection of the mucus membrane in the nose) and foreign bodies in the nose also produce bad smells in the expired air.
Diabetes mellitus:
Nearly every diabetic patient suffers from bad breath. Coated tongue, ulcers, coating of the mouth, increasing sugar level in tissues among others are responsible for bad breath. Bacterial growth in diabetic patients is faster than in normal people.
Fevers:
Bad breath is commonplace in nearly type of fever. Even a severe fever can produce bad breath. Typhoid produces severe bad breath. Other infectious diseases like Tuberculosis, AIDS and others produce bad smells also.
Fasting and dehydration:
A dry mouth favors bacteria. Any condition that produces mouth dryness makes the breath offensive. Even though food particles produce bad breath, fasting can also produce the same result. Reducing saliva during fasting also favors bacteria. Help keep your mouth clean by chewing and swallowing.
Bedridden patients:
Bedridden patients suffer from offensive breath because of a thick coating on their tongues. Limiting the intake of water in these patients does not help. Regurgitation of food only irritates the condition. They talk less thus reducing aeration in the oral cavity that helps anaerobic bacteria in becoming active.
Diseases of the stomach and oesophagus:
Eructation of gas and food produce unpleasant smells. Abnormality in the work of the lower sphincter can allow food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis, gastric ulcer and cancers of the stomach.
Intestinal diseases:
Bad breath is common in anyone suffering from ulcerative lesions of the intestine such as ulcerative colitis and diseases like malabsorption, intestinal tuberculosis and peritonitis.
Diseases of the Lung:
Lung diseases like lung abscess, chronic bronchitis, pneumonia, tuberculosis, lung cancer and bronchiectasis can produce bad odours.
Liver disorders:
Liver diseases like hepatitis or cirrhosis can cause bad breath. Gallbladder diseases with vomiting also causes unpleasant odor.
Psychiatric patients:
Bad breath is common in psychotic patients because of poor hygiene, irregular food habits and reduced water intake.
Somatisation disorder:
A psychiatric disorder characterised by the presence of a physical symptom that suggests a medical illness. These patients present with physical complaints like pain, nausea, difficultly breathing and bad smells among others. Diagnosing this condition means detailed examinations and many investigations. Managing this disorder must use a psychological approach because it is a psychiatric disorder.
[ POINTS COVERED IN THIS ARTICLE ARE FOR GENERAL INFORMATION ONLY. ANYONE EXPERIENCING BAD BREATH SHOULD CONSULT A QUALIFIED DOCTOR ]