Bad Breath

Bad Breath Treatments and Effective Solutions from The Devon Clinic CIC

Having bad breath translates into people pulling away from you. Solve your bad breath issues and regain your social king/queen status.

Nutritional Therapy Allergy Testing
Hypnotherapy

The Devon Clinic CIC  is pleased to offer Bad Breath treatments from the following local practitioner(s):

 

Devon Allergy Clinic at New Devon Clinic  Devon Allergy Clinic  Chris Fleet (Dip.Hyp. Adv D. hyp, GQHP) at New Devon Clinic  Chris Fleet (Dip.Hyp. Adv D. hyp, GQHP)

More About Bad Breath

In most cases (85–90%), bad breath originates in the mouth itself. The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity, smoking, and alcohol consumption. Because the mouth is exposed to less oxygen and is inactive during the night, the odour is usually worse upon awakening (“morning breath”). Bad breath may be transient, often disappearing following eating, brushing one’s teeth, flossing, or rinsing with specialized mouthwash.

Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees. It can negatively affect the individual’s personal, social, and business relationships, leading to poor self-esteem and increased stress.

Listerine introduced the term halitosis in 1921, combining the Latin halitus, meaning ‘breath’, with the Greek suffix osis often used to describe a medical condition, e.g., “cirrhosis of the liver”. Bad breath is not, however, a modern affliction. Records mentioning bad breath have been discovered dating to 1550 B.C. A mouthwash of wine and herbs was one recommended way of solving the problem

The most common location for mouth-related halitosis is the tongue. Tongue bacteria produce malodorous compounds and fatty acids, and account for 80 to 90 percent of all cases of mouth-related bad breath. Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells, and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the “rotten egg” smell of volatile sulphur compounds (VSCs) such as hydrogen sulphide, methyl mercaptan, Allyl methyl sulphide, and dimethyl sulphide.

The most widely-known reason to clean the tongue is for the control of bad breath. Methods used against bad breath, such as mints, mouth sprays, mouthwash or gum, may only temporarily mask the odours created by the bacteria on the tongue, but cannot cure bad breath because they do not remove the source of the bad breath.

To prevent the for mentioned sulphur-containing compounds, the bacteria on the tongue must be removed. Most who clean their tongue use a tongue cleaner such as a scraper, or a toothbrush. Specially designed tongue cleaners are far more effective at collecting and removing bacterial coatings than toothbrushes which merely move the accumulations around the mouth.

In the average mouth, there can be found over 600 types of bacteria. Several of these have been found, in a laboratory setting, to produce high levels of odour. These odours are mainly produced by the breakdown of proteins into amino acids, which create detectable foul gases.

An example; the breaking down of cysteine and methionine produce hydrogen sulphide and methyl mercaptan, respectively. Volatile sulphur compounds have been statistically shown to associate with oral malodour levels, and generally decrease following treatment.

There are other parts of the mouth that contribute to odour, but these are not as common as the tongue; inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses, and unclean dentures. Oral based lesions cause by viral infections may also contribute to bad breath.

There is some controversy over the role of periodontal diseases in causing bad breath. Whereas bacteria growing below the gum line (subgingival dental plaque) have a foul smell upon removal, several studies reported no statistical correlation between malodour and periodontal parameters.

The second major source of bad breath is the nose. In this occurrence, the air exiting the nostrils has a pungent door that differs from the oral odour. Nasal odour may be due to sinus infections or foreign bodies.

In general, putrefaction from the tonsils is considered a minor cause of bad breath, contributing to some 3–5% of cases. Approximately 7% of the population suffer from small bits of calcified matter in tonsillar crypts called tonsilloliths that smell extremely foul when released and can cause bad breath.

The Cardia, the valve between the stomach and the oesophagus, may not close properly due to Hiatal Hernia or GERD, allowing acid to enter the oesophagus and gases escape to the mouth. A Zenker’s diverticulum may also result in halitosis due to moulding food retained in the oesophagus.

The stomach is considered by most a very uncommon source of bad breath (except in belching). The oesophagus is a collapsed tube, and continuous flow of gas or putrid substances from the stomach indicates a health problem—such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the oesophagus—which will demonstrate more serious manifestations than just foul odour.

In the case of allyl methyl sulphide (by-product of garlic’s digestion), odour does not come from the stomach, since it does not get metabolized there.

There are a few systemic (non-oral) medical conditions that may cause foul breath odour, but these are extremely infrequent in the general population. Such conditions are:

  • Fetor hepaticas: A rare type of bad breath caused by chronic liver failure.
  • Lower respiratory tract infections (bronchial and lung infections).
  • Renal infections and renal failure.
  • Trimethylaminuria (“fish odour syndrome”).
  • Diabetes mellitus.

 

Metabolic dysfunction.

Individuals afflicted by the above conditions often show additional, more diagnostically conclusive symptoms than bad breath. People troubled by bad breath should not conclude that they suffer from these conditions or disease.

Some one quarter of the patients seeking professional advice on bad breath suffer from a highly exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of Olfactory Reference Syndrome. These patients are sure that they have bad breath, although many have not asked anyone for an objective opinion. Halitophobia may severely affect the lives of some 0.5–1.0% of the adult population.

Scientists have long thought that smelling one’s own breath odour is often difficult due to acclimatization, although many people with bad breath can detect it in others.

Researchers have suggested that self-evaluation of halitosis is not so easy because of the preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of a bad taste (metallic, sour, faecal, etc.), however bad taste is considered a poor indicator.

For these reasons, the simplest and most effective way to know whether one has bad breath is to ask a trusted adult family member or very close friend (“confidant”). If the confidant confirms that there is a breath problem, he or she can help determine whether it is coming from the mouth or the nose, and whether a treatment is effective or not.

A populist home method is to lick the back of your wrist, allow the saliva to dry, and smell the wrist. These methods result in overestimation and should be avoided. A far better way would be to lightly scrape the back of your tongue with a plastic spoon and before it dries, smell it. Home tests that use a chemical reaction are now available, but few studies show how they do this. Since breath odour changes during the day depending on many factors, testing multiple times may be required.

If bad breath is persistent, and all other medical and dental factors have been ruled out, specialized testing and treatment is required. Hundreds of dental offices and commercial breath clinics now claim to diagnose and treat bad breath. They often use some of several laboratory methods for diagnosis of bad breath:

  1. Heliometer: portable sulphide monitor used in the testing of levels of sulphur emissions (hydrogen sulphide) in the mouth. When used correctly, this device is very effective at determining levels of certain VSC-producing bacteria. However, it has drawbacks in clinical trials. For example, other common sulphides (mercaptan) are not recorded easily and can be misrepresented in results. Certain foods such as garlic and onions produce sulphur in the breath for 48 hours and can result in false readings. The Heliometer is also very sensitive to alcohol, so you should avoid drinking alcohol or alcohol-containing mouthwashes for at least 12 hours prior to the test. This analogue machine will lose sensitivity over time and requires periodic recalibration to remain accurate.
  2. Gas Chromatography: portable machines, such as the Oral Chroma, are currently being introduced. This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulphide, methyl mercaptan, and dimethyl sulphide). It is accurate in measuring the sulphur components of the breath and produces visual results in graph form via computer interface.
  3. BANA Test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
  4. β-Galactosidase Test: salivary levels of this enzyme were found to be correlated with oral malodour.

Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odour carried out by trained experts (“organoleptic measurements”). The level of odour is usually assessed on a six-point intensity scale.

At the current time, chronic halitosis is not very well understood by most physicians and dentists, so effective treatment is not always easy to find. Six strategies may be suggested:

  1. Gently cleaning the tongue surface twice daily is the most effective way to keep bad breath in control; that can be achieved using a tongue cleaner or tongue brush/scraper to wipe off the bacterial biofilm, debris, and mucus. An inverted teaspoon may also do the job; a toothbrush should be avoided, as the bristles only spread the bacteria in the mouth, and grip the tongue, causing a gagging reflex. Scraping or otherwise damaging the tongue should be avoided, and scraping of the V-shaped row of taste buds found at the extreme back of the tongue should also be avoided. Brushing a small amount of antibacterial mouth rinse or tongue gel onto the tongue surface will further inhibit bacterial action.
  2. Eating a healthy breakfast with rough foods helps clean the very back of the tongue.
  3. Chewing gum: Since dry-mouth can increase bacterial build up and cause or worsen bad breath, chewing sugarless gum can help with the production of saliva, and thereby help to reduce bad breath. Chewing may help particularly when the mouth is dry, or when one cannot perform oral hygiene procedures after meals (especially those meals rich in protein). This aids in provision of saliva, which washes away oral bacteria, has antibacterial properties and promotes mechanical activity which helps cleanse the mouth. Some chewing gums contain special anti-odour ingredients. Chewing on fennel seeds, cinnamon sticks, mastic gum, or fresh parsley are common folk remedies.
  4. Gargling right before bedtime with an effective mouthwash. Several types of commercial mouthwashes have been shown to reduce malodour for hours in peer-reviewed scientific studies. Mouthwashes may contain active ingredients that are inactivated by the soap present in most toothpastes. Thus, it is recommended to refrain from using mouthwash directly after tooth brushing with paste.
  5. Maintaining proper oral hygiene, including daily tongue cleaning, brushing, flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gum line. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist).

Before discussing them, it is important to note that there has not been a single documented medical case of successfully cured chronic halitosis using any of the currently available mouthwashes. Mouthwashes often contain antibacterial agents including Cetylpyridinium chloride, chlorhexidine, zinc gluconate, essential oils, and chlorine dioxide. Zinc and chlorhexidine provide strong synergistic effect. They may also contain alcohol, which is a drying agent.

Other solutions rely on odour eliminators like oxidizers to eliminate existing bad breath on a short-term basis.

A relatively new approach for home-care of bad breath is by oil-containing mouthwashes. The use of essential oils has been studied, was found effective and is being used in several commercial mouthwashes, as well as the use of two-phase (oil: water) mouthwashes, which have been found to be effective in reducing oral malodour. Also, advances in oral science has made advice websites available worldwide.

Per traditional Ayurvedic medicine, chewing areca nut and betel leaf is an excellent remedy against bad breath. In South Asia, it was a custom to chew areca or betel nut and betel leaf among lovers because of the breath-freshening and stimulant drug properties of the mixture. Both the nut and the leaf are mild stimulants and can be addictive with repeated use. The betel nut will also cause tooth decay and dye one’s teeth bright red when chewed. Both areca nut and the betel leaf chewing however are recognised risk factors for squamous cell carcinoma. Their use is not recommended.

Bad breath often evokes a reaction characteristic of disgust among those who interact with bad breath sufferers. This is a natural defensive reaction designed to protect the body from potential sources of disease: The major chemical compounds of bad breath are the same as those emitted by rotting food (Putrescine), feces (Skatole), and even dead bodies (Cadaverine), all potential sources of disease and infection.

When the brain detects these compounds, it protects the body by forcing physical recoil (which moves the body away), scrunching up the nose (which constricts the nasal passages, and prevents further intake of noxious odours), and by causing gagging (which stops anything being swallowed). It may also produce nausea and vomiting, which ejects anything that has already been swallowed. Although these reactions are involuntary, they are often misinterpreted as a personal judgement on the sufferer, and can severely damage personal relationships.

Bad Breath is also sometimes known as:

  • Halitosis
  • Gum-Disease

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