Halitosis

Factors contributing to the overgrowth of halitosis-causing bacteria include reduced salivary flow (e.g., due to parotid disease, Sjögren's syndrome or the use of anticholinergic drugs), salivary stagnation and increased salivary pH.

What is halitosis?

The term halitosis, or simply bad breath, refers to the unpleasant odor emitted when breathing through the mouth; it is a disorder that can affect anyone, although the problem occurs more frequently with increasing age.

From a social point of view, it is a problem that can cause great embarrassment in those affected, to the point of jeopardizing interpersonal relationships for fear of inducing discomfort in their interlocutor; there is also a disorder in which the patient is constantly afraid of suffering from bad breath, despite the unfoundedness of the thought (halitophobia).

It is estimated that 50% of the population suffers from halitosis more or less systematically and the most common cause is undoubtedly insufficient oral hygiene (probably around 90% of cases), but in certain situations there are different reasons that should be addressed with the help of a physician.

Halitosis can be effectively treated if the cause is correctly diagnosed, which is pursued by means of a detailed clinical examination. In many cases, the patient's treatment simply consists of regular oral hygiene and periodic dental hygiene.

Causes

The possible causes of bad breath are many and varied. In most cases, up to 90 %, the bad odor originates directly in the mouth, very often due to the accumulation of food residues that are transformed by the metabolism of the bacteria responsible for plaque, present due to insufficient oral hygiene on the teeth and tongue. It is also possible that the cause is a reduced hydration of the oral mucosa (xerostomia, i.e. dry mouth).

When the cause is not in the mouth, various diseases can cause halitosis:

• Respiratory diseases (tonsillitis, bronchitis and sinusitis, for example)
• Digestive diseases (gastroesophageal reflux)
• Systemic diseases (diabetes, hepatic or renal dysfunction)

More rarely, the cause of the disorder must be sought in certain specific substances:

• Food:
  • Dairy products (milk, cheese, yogurt, ice cream)
  • Onions and garlic
  • Sugar (because it can act as a stimulus for bacterial proliferation)
  • Coffee (due to its acid pH)
  • Medications:
• Nitrates
• Chemotherapy

There are also a number of concomitant causes that can aggravate the problem:

• Low salivation
• Poor oral hygiene
• Undetected caries
• Presence of food residues in the mouth
• Local infections (e.g., aphthous ulcers)
• Inhalation through the mouth (i.e. breathing without the aid of the nose)
• Stress
• Smoking
• Alcohol

Generally, when halitosis is caused by the consumption of certain foods, the disorder is temporary and, when the consumption of the food is suspended, the unpleasant symptom disappears.

A special case of breath disorders is Low-carbohydrate diets which, by inducing a state of ketosis, are responsible for the typical fruity breath.

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When bad breath starts in the mouth

In almost 90% of cases, bad breath is due to causes that are also related to oral caries, such as the presence of decaying food, dead cells of the oral mucosa and microscopic traces of blood on the oral structures. As a result of a complex series of chemical reactions that occur between bacteria and these substrates present mainly on the back of the tongue, the unpleasant odor originates.

In fact, the surface of the tongue (along with the grooves of the gums) serves as an ideal habitat for the proliferation of bacteria that metabolize food residues and release volatile sulfur compounds responsible for bad odor.

Other bacterial settlements that may be responsible for malodor are found in interdental spaces, imperfect dental restorations, abscesses and poorly sanitized dentures / dental prostheses, but also in the vicinity of caries andgingival inflammations such as periodontitis, triggering a dangerous vicious circle that can lead to worsening of both halitosis and oral disorders.

Treatment of halitosis

Once the diagnosis of halitosis has been made and the cause identified, specific therapy can be prescribed to address and possibly resolve it.

Apart from this, the following remedies are recommended to treat a bad breath problem:

1. Practice proper oral hygiene, including the use of a toothbrush, toothpaste, dental floss and Mouthwash; teeth should be brushed at least twice a day for two minutes, after main meals, but waiting about 30 minutes after finishing them to prevent the combination of acids from food and the rubbing of the toothbrush from damaging the enamel.
2. Perform thorough brushing of the upper surface of the tongue to remove food microparticles that may be at the origin of the development of halitosis.
3. Rinse and gargle with mint-flavored mouthwashes formulated with chlorhexidine or cetylpyridinium chloride, as they contribute to the reduction of the load of microorganisms causing bad breath.
4. Use licorice root, chewing gum or candies of mint, anise, orange, etc., which have a refreshing effect on the oral cavity and keep the breath fresh for some time.
5. Have regular check-ups with a dentist (at least twice a year), with possible dental cleanings and removal of tartar.
6. Smoking cessation.
7. Avoid alcohol abuse.
8. Follow a light, healthy and balanced diet, avoiding overly spicy and spicy foods (such as garlic and onions); reduce consumption of foods and beverages rich in sugar.
9. Avoid dehydration by drinking at least 1.5 - 2 liters of water per day.
10. Dentures should be brushed and cleaned once a day.