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Bad Breath (Halitosis)

What is Halitosis?

Halitosis (Bad Breath) is the unpleasant smell on breath which comes from either the mouth or the nose that disturbs the person and the people around him.

As bad breath affects negatively the interpersonal communication, it leads to problems concerning social pressure, psychosocial stress and self-confidence. Even social and personal isolation can be seen due to these problems.

Patients consult physicians about bad breath noticing themselves or as a result of warnings from people around them.
Bad breath is the most common cause for consulting dentists following tooth decays and periodontal diseases.

Within the last 35 years, the accumulation of knowledge about bad breath has gradually increased, the direct measurement of volatile sulfur compounds that are produced by germs in the saliva and breath has been improved, and the reasons and the sources of the smell has been revealed. 

Does everyone get bad breath?

Bad breath is seen frequently and in every age. At least 50% of the adults, in a period of their lives, have bad breath that cannot be accepted socially, especially in the morning after waking up.

Recent researches have shown that bad breath is relatively 3 times more common among men than women. Moreover, it is 3 times more common among adults aged 20 and older than the youth.

Few patients see a dentist although the density of halitosis has been reported as such a high ratio as 50%. The situation, in which people facing halitosis problem are not completely aware of this situation, is called ‘bad breath paradox’. In addition, it is stated that approximately 50% of men and 60% of women  use cosmetic mouth spray.

Does halitosis increase with age?

Severe halitosis is seen among middle-aged people especially in the mornings. Bad breath increases depending on prostheses that are used, the loss of saliva fluidity, and systemic diseases in advanced ages.

What are the causes of bad breath?

The reasons for bad breath can be either pathological or physiological or both in some cases. 80-90% of pathological halitosis originates inside the mouth and 10-20% are exogenous.

Gingival and oromucosal diseases, fungus and infections, tongue and tongue base (rust), reflux and postnasal (nasal) drainage, implants and prostheses that are in bad condition, dental cavities and poor-quality fillings, decrease in the amount of saliva and dryness of the mouth, oral cancer, cleft palate, and tonsil diseases make up the reasons that originate inside the mouth.

Where does this bad breath come from although my oral and dental health is in good condition?

The easiest way to make distinction between in-mouth and external reasons is to compare mouth smell with nose smell because when the external reasons of halitosis is thought, the first organ that comes to mind is nose. Nasal flaring is the essential breathing style that must be preferred. Mouth breathing that has an important part in halitosis etiology occurs as a result of nasal congestion.

You should consult a physician for further evaluation if the smell stems from the nose or it has medical reasons. We know that one of the most commonly seen reasons among anatomical ones of nasal congestion is nasal septal deviation. In a patient with nasal septal deviation, other nasal pathologies connected to this are more persistent and they are seen more frequently. If there are no mouth related  reasons explaining the pathology, the fact that septum deviation can cause halitosis due to mouth breathing must be brought to mind.

Physiological reasons of bad breath are hunger, menstruation, smoking, poor oral hygiene, food remains, high-protein foods, odoriferous foods such as onion, garlic, and turnip, coffee, alcohol and some spices.

Should I be concerned about halitosis?

Since bad breath can be the symptom of upper and lower respiratory tract diseases, gastorintestinal (stomach-intestine), oesophageal, hepatic diseases, autoimmune system and blood diseases, chronic kidney failure, leucemia, AIDS, and metabolic diseases, it must be taken seriously; if it is not mouth related, you must absolutely see a physician.

Does my breath smell bad due to smoking?

Smoking is a reason for halitosis directly or indirectly due to periodontal diseases it causes. Cigarette smoke contains volatile sulfur compounds (VSC). Excessive smoking leads to hairy tongue that causes the accumulation of tobacco smell and food remains. Bad breath due to smoking continues for only 24 hours. It is stated that the back of the tongue is the first source that is responsible for the formation of VSC and the cleaning of the rust in there decreases the formation of VSC. It is observed that the longest effectiveness is provided with the cleaning of the rust on the tongue.

My breath smells bad. What should I do?

Halitosis treatment depends on paying attention to oral hygiene, brushing the teeth and the tongue, interdental cleaning, and having the gingivitis treated. Patient that have bad breath should be encouraged to decrease smoking, should abstain harmful foods, eat at regular intervals, and visit their dentists once every six months.

Why should I brush my tongue?

While many products are used to remove the plaque from the teeth, the tongue that keeps millions of bacteria which causes halitosis on itself has been neglected.

The back of the tongue is covered with a layer of bacteria. Swallowing and having a soft diet do not remove this layer. As a result, a white-grey layer that is "rich" in microorganisms remains intact.

Hydrogen sulfide and methylmercaptan that are formed during the putrefaction of this layer are directly linked to halitosis. For this reason, brushing the tongue must be cared about as much as brushing the teeth.

Plastic tongue scrapers and small brushes are designed for the scraping of the tongue. These provide convenience especially for patients who have vomiting reflex. The tongue is sticked out as much as possible, the tongue scraper is placed on the farthest part of the tongue and it is pulled frontward by applying force. Patients with halitosis must repeat this process a few times in a day.

My child has bad breath. What should I do?

Children of different ages have specific breath odor. For example, in children aged between 2-5, specific halitosis that progresses depending on bacteria and food remains, which frequently root on the tonsil crypts (, is observed.
Firstly, you must certainly consult a pedodontist. If halitosis still cannot be eliminated although the necessary diagnosis and treatment, you should ask for appointment from a pediatrician.

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