Bad breath may be a common ill-health which greatly affects the day to day activities of so many people. The offensive odour from the mouth is unpleasant to those that are available close contact with bad breathers. the matter is going to be doubled by psychological trauma resulting in depression. The sufferers from this problem will be isolated from society. this will even cause marital disharmony.
Literally speaking all human beings are bad breathers. the mouth contains millions of anaerobic bacteria like Fusobacterium and Actinomyces which acts on the protein of food materials and putrifies them. This process leads to the formation of offensive gases like hydrogen sulphide, methyl mercaptan, cadaverine, skatol, putrescine etc causing bad odour. If oral hygiene isn’t maintained properly all will suffer from bad breath. Most folks control this by regular brushing, tongue cleaning and gargling. Even after maintaining cleanliness within the mouth, some individuals suffer from offensive smell thanks to various causes which has got to be diagnosed and treated properly.
Some common causes of bad breath.
- Poor oral hygiene:
If oral hygiene isn’t maintained properly the mouth becomes the seat for many bacteria that produce offensive gases by degrading the food debris. Bad breath is severe in those that don’t brush their teeth regularly and clean their mouth after every food. Snacks took in between meals also can produce bad breath due to improper cleaning.
Bad breath is common in most people within the morning on waking. During sleep, there’s less production of saliva. Saliva possesses some antibacterial properties which help to stay the mouth clean. Saliva contains oxygen molecules which is required to form mouth aerobic. therefore the reduction in its quantity during sleep makes a favourable condition for anaerobic bacteria.
- Food habits:
The main explanation for bad smell is thanks to the degradation of protein by the bacteria and hence all food products rich in protein favours bad breath. Meat, fish, milk products, eggs, cakes, nuts, pear and it can cause bad breath. Some food articles can produce a particular sort of smell which can be unpleasant. Raw onion can produce a typical bad smell. it’s said that an apple each day keeps the doctor away, a raw onion each day keeps everybody away. Eating groundnuts also can produce bad smells. However, if proper cleaning is completed smell are often reduced regardless of the character of the food. Irregularity in the timing of food also can produce bad breath. Small food articles are taken in between the meals also can produce bad smells.
There is a formation of a skinny sticky coating called biofilm on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where many gram-negative bacteriae are seen. The thick coating on the tongue is usually related to bad breath. Even a thin biofilm can make anaerobic conditions favourable for bacterial proliferation.
- Dental caries:
This is a destructive process causing decalcification with the destruction of enamel and dentine leading to cavitation of the tooth. These are produced mainly by the lactobacilli. Food particles are deposited inside these cavities and are putrified by the anaerobic bacteria producing bad smell. Normal brushing won’t remove the food debris easily and hence they’re putrified completely. Caries is common in schoolgoing children and in those that do not maintain proper oral hygiene. Calcium and vitamin deficiency also can predispose caries.
Gum may be a mucus membrane with supporting animal tissue covering the tooth-bearing borders of the jaw. The main function of gum is protection. Gingivitis is the inflammation of the gum. Due to various causes gum tissue gets infected leading to swelling, pain and discharge. If the condition goes to pot the infection spread towards peridontal area resulting in continuous discharge called pyorrhoea. Some times the infection goes deep producing alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis. All these conditions can produce offensive smells.
- Gum retraction:
When the gums retract from the teeth a niche is developed which can lodge food particles and cause bad breath.
- Dental plaques and tartar deposits:
Plaques and tartar are deposited mainly within the gaps between the teeth and gum. this may provide shelter for the food debris and bacteria causing bad breath.
- Ulcerative lesions& coatings:
Almost all ulcerative lesions of the mouth are related to bad breath. These lesions could also be caused by bacteria, viruses, food allergies or thanks to autoimmune disorders. Aphthous ulcer is that the commonest among ulcerative lesions. Others are herpes, fungal infections, vincents angina, infectious mononucleosis, scarlet fever, diphtheria, drug reactions and etc. Cancerous ulcers produce severe bad breath. All fungal infections produce a white coating(candidiasis). Leucoplakia may be a white thick patch on the mucus membrane of the mouth & tongue. it’s considered as a precancerous condition. Offensive breath is related to these conditions.
- Diseases of the salivary glands:
Saliva is extremely useful to provide oxygen to all or any parts of the mouth. Even a skinny film of coating called biofilm can provide an anaerobic condition within the mouth. Saliva can wet these layers and make an aerobic condition which is unfavourable for the bacteria. Any condition which reduces the assembly of saliva can increase bacterial activity. Some times the duct is obstructed by stones or tumours. Cancer of the exocrine gland is related to offensive odour. In suppurative parotitis, purulent discharge into the mouth causes bad breath.
Tonsils are a pair of lymphatic tissue situated within the lateral wall of oropharynx. Inflammation of the tonsil is named tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or quinsy also can produce bad breath.
- Tonsillar plaques & tonsillar fluid:
If bad breath persists even after maintaining proper oral hygiene there’s a possibility of this condition. Serous fluid secreted from the folds of the tonsil is extremely offensive. Some patients complain that they hawk some cheesy materials from the throat; which are very offensive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteriae. In such conditions, tonsillectomy gives noticeable relief from bad breath.
- Pharyngitis& pharyngial abscess:
Pharynx may be a fibromuscular tube that forms the upper a part of the digestive & tract. Inflammation of the pharynx is named pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis alongside other signs like cough and throat irritation. Abscesses within the wall of pharynx also can produce an offensive discharge of pus into the throat.
Denture users may complain about bad smell thanks to the lodgement of small food debris in between. Proper brushing might not be possible in denture users especially fixed dentures.
Tobacco chewing is related to bad breath. The smell of tobacco itself is unpleasant for others. Tobacco can irritate the mucus membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. of these causes offensive smell.
Smokers always have bad smell. It also can produce lesions within the mouth & lungs causing bad breath.Smoking increases CO2 within the mouth & reduces oxygen level,causing a favourable condition for bacteria. Smoking reduses appetite & thirst hence acid peptic disease is common in chain smokers.
- Lesions within the nose & ear:
Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). just in case of post nasal dripping bad breath are common thanks to the presence of protein within the discharges. These proteins are degraded by the bacteria. Infection within the tympanic cavity with the discharge of pus into the throat through the eustachian tube(passage from the tympanic cavity to the throat)can also cause an offensive odour. Chronic rhinitis(infection of the mucus membrane of the nose) and foreign bodies within the nose also can produce bad smell within the expired air.
- Diabetes mellitus:
Mostly all diabetic patients suffer from bad breath. Coated tongue, ulcers &coatings within the mouth, increased sugar level in tissues etc are liable for bad breath. Bacterial growth in diabetic patients is extremely faster than non-diabetic individuals.
Bad breath is common in most fevers. Even an acute fever can produce bad breath. Severe bad breath is seen in typhoid. Other infectious diseases like Tuberculosis, AIDS etc produce bad smell.
- Fasting & dehydration:
Dry mouth favours bacterial activity. So any condition which produces dryness within the mouth makes the breath offensive. Even though the food particles are known to supply bad breath, fasting also can produce an equivalent. Production of saliva is additionally reduced during fasting. Chewing and swallowing also help to stay the mouth clean.
- 20) Bedridden patients:
Bedridden patients suffer from offensive breath thanks to a thick coating on the tongue. water intake is additionally limited in these patients. Regurgitation of food aggravates the condition. Since they talk less aeration within the mouth is reduced which favours anaerobic bacteria to become active.
- 21) Diseases of stomach & esophagus:
Eructation of gas and food produce an unpleasant smell. The abnormality within the function of the lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is additionally common in gastritis, gastric ulcer and cancer of the stomach.
- 22) Intestinal diseases:
Bad breath is common in patients affected by ulcerative lesions of intestine like ulcerative colitis…Other diseases are syndrome intestinal tuberculosis, peritonitis etc..
* Diseases of lungs:
Lung diseases like pneumonia, lung abscess, chronic bronchitis, bronchiectasis, tuberculosis, carcinoma etc can produce bad odour during expiration.
- 24) Liver disorders:
Liver diseases like hepatitis, cirrhosis, can cause bad breath. Gall bladder diseases with vomiting also cause an unpleasant odour.
- 25) Psychiatric patients:
Bad breath is common in psychotic patients thanks to poor hygiene, irregular food habits, less water intake and etc.
- 26) Somatisation disorder:
This is a psychiatric disorder characterized by the presence of a physical symptom that suggests a medical illness. These patients accompany physical complaints like pain, nausea difficult respiration, bad smell etc. This condition is diagnosed after a detailed examination of the patient with all investigations. Since this is often a psychiatric disorder it’s to be managed with a psychological approach