WHAT IS HALITOSIS?
Halitosis, more commonly known as bad breath, can cause a lot of anxiety. We spend a lot of money on breath mints, gum, mouthwash, and other items in the effort to combat bad breath, but these temporary fixes do not address the root of the problem.
Practicing good oral hygiene by brushing your teeth at least twice per day and flossing at least once per day is usually enough to combat bad breath. However, if your halitosis persists, you should consider booking a dentist appointment. In some cases, there is no apparent cause for persistent bad breath, which may require further investigation.
Symptoms
The primary symptom of halitosis is a persistent, unpleasant odor on the breath. You can check for it by smelling your own breath or asking a trusted person for their assessment.
Diagnosing the Cause of Bad Breath
A healthcare professional will diagnose the root cause of halitosis through a comprehensive review of your health, habits, and specialized tests.
1. Common Causes
Most cases of bad breath are linked to oral health and lifestyle factors.
- Oral Hygiene: Bacteria buildup on the tongue, teeth, and gums is the most frequent cause. If your breath still smells after brushing teeth, it may indicate that bacteria are trapped in areas that brushing alone cannot reach.
- Gum Disease: Inflamed or infected gums can release odors. Noticing bad breath when flossing can be a sign of gingivitis or periodontitis.
- Diet: Certain foods (like garlic and onions) and habits like not eating (fasting) can cause temporary bad breath as the body breaks down fats for energy, a process that releases ketones.
- Medical Conditions: Issues like sinus infections, acid reflux, or more serious conditions like liver or kidney disease can also be culprits.
2. Is Halitosis Genetic or Hereditary?
Yes, for some individuals, chronic bad breath is genetic.
Recent research has identified that a mutation in the SELENBP1 gene can cause severe, persistent halitosis. This gene is responsible for creating a protein that breaks down smelly sulfur compounds in the body, particularly methanethiol (which has a boiled cabbage odor).
- Genetic Predisposition: If you have this genetic mutation, your body cannot effectively process these sulfur compounds, leading to a buildup that is released through your breath.
- Hereditary Link: This condition answers the question, “is bad breath hereditary?“—it can be passed down through families. This explains why some people suffer from halitosis despite excellent oral hygiene.
The Diagnostic Process
- Medical History & Physical Exam: A dentist or doctor will examine your mouth, teeth, and gums and ask about your diet, hygiene habits, and medications.
- Specialized Breath Tests: Devices like a halimeter can measure the levels of volatile sulfur compounds (VSCs) in your breath to objectively identify the severity of the issue.
- Further Medical Testing: If a more serious underlying condition is suspected, blood work or other tests may be ordered to check for systemic issues.
HALITOSIS CAUSES AND VOLATILE SULFUR COMPOUNDS
Halitosis is a multifaceted condition that can be caused by a variety of factors. Some cases of halitosis are temporary and result from eating odorous foods. However, according to the Canadian Dental Association, as many as 85% of halitosis cases are caused by the oral cavity.
In some cases, halitosis may have a genetic cause, such as a gene mutation affecting sulfur metabolism. Studying families with hereditary halitosis has helped researchers gain a better understanding of the genetic basis of the condition. These studies have shown that sulfur-based compounds, especially methanethiol, are key contributors to chronic bad breath.
Other causes of halitosis include:
ORAL PATHOLOGY
Oral pathology refers to diseases and other problems originating in your mouth and jawbone. Oral pathology conditions that cause halitosis can include:
- Food remnants and epithelial cells form a coating that sticks to your tongue. This coating can be difficult to remove, and as a result, the food particles degrade and cause unpleasant odours.
- Reduced salivary flow during sleep, which causes odours.
- Poor oral hygiene results in food and other particulates being left on the teeth and gums. This results in halitosis, plaque, tartar buildup, and gum disease.
- Insufficient denture cleaning, which allows food and other particles to build up on the surface of your dentures, where they break down and cause odours.
- Gum diseases, including gingivitis and periodontitis.
- Stomatitis (inflammation and soreness in the mouth), tooth extraction wounds, crowded teeth, recurrent oral ulcers, pericoronitis (swollen tissue around the wisdom teeth), and implantitis (swollen tissue around dental implants).
GASTROINTESTINAL PATHOLOGY
Halitosis can be caused by a variety of gastrointestinal issues, including:
- Intestinal obstructions
- Stomach infections. Infections that are the result of H. pylori bacteria may also cause halitosis, but there is currently no research to support a strong correlation.
ENT (EAR, NOSE, AND THROAT) AND PULMONARY PATHOLOGY
ENT and pulmonary pathology refer to diseases of the ears, nose, throat and pulmonary systems. According to the Canadian Dental Association diseases and other problems with these systems account for as many as 10% of all halitosis cases. These halitosis cases can result from:
- Acute tonsillitis. The same bacteria that causes tonsillitis can cause halitosis.
- Post-nasal drip, foreign bodies in the nasal passage, and atrophic rhinitis. Malfunctioning mucus glands can contribute to the development of halitosis.
- Acute bacterial rhinosinusitis, a respiratory infection caused by bacteria.
- Bronchiectasis, lung abscesses, and endobronchial chronic disorders.
In some cases, sulfur compounds produced in the body are transported in the blood. As the blood reaches the lungs, smelly sulfur compounds leave the bloodstream and are exhaled, contributing to halitosis.
METABOLIC DISORDERS
Halitosis can be a side effect of some metabolic disorders, including:
- Diabetes mellitus and ketoacidosis (both of which are types of diabetes), which can produce a sweet-smelling odour.
- Trimethylaminuria is a condition that prevents the body from breaking down trimethylamine and causes the breath to take on a fishy odour.
- Kidney failure, and cirrhosis of the liver.
Certain metabolic disorders can lead to high levels of sulfur compounds, such as methanethiol and dimethyl sulfide, in the blood and breath. This is often due to low levels of the protein responsible for breaking down these compounds, such as SELENBP1.
Researchers can measure high amounts of these and other volatile sulfur compounds in affected individuals, which often results in an unpleasant boiled cabbage smell characteristic of some forms of halitosis.
HEPATHOLOGY AND ENDOCRINOLOGY
Halitosis can be a side effect of liver diseases and problems.
- Tyrosinemia, which is a hereditary disease, can cause halitosis with a cabbage-like odour.
- Reduced liver function can also cause your breath to take on a sweet odour similar to excrement.
CERTAIN MEDICATIONS
Halitosis can be a side effect of some medications.
- Medications that cause dry mouth can lead to halitosis.
- Bisphosphonates, a class of medications used to treat osteoporosis-related bone loss, can cause halitosis.
HALITOSIS TREATMENTS
Though halitosis can be caused by a wide variety of factors, there are a number of ways to treat or manage the condition, both at home and at the dentist’s office.
Advances in applied sciences are helping to translate genetic and biochemical research into new treatment options for halitosis.
TREATING HALITOSIS AND IMPROVING ORAL HYGIENE AT HOME
Depending on the cause of your halitosis, you may be able to treat it effectively on your own. Home treatments for halitosis can include:
- Practising good oral hygiene. Ensuring you floss your teeth at least once a day and brush at least twice a day with fluoride toothpaste helps remove all food particles, plaque, and other debris from your teeth and gums. You may also want to select a toothpaste that contains zinc or triclosan.
- Adding tongue scraping to your regular oral hygiene routine, so that you can remove food and other particles from your tongue before they cause unpleasant odours.
- Watch what you are eating and drinking, and avoid odorous foods such as onions and garlic.
- Drinking lots of water to ensure your mouth stays hydrated.
- Rinsing your mouth with an antiseptic mouthwash at least once per day.
- Skip the after-dinner mints and choose sugarless gum instead. The bacteria in our mouths love sugar, which they use to produce acid. This, in turn, can lead to various conditions, including halitosis, gum disease, and tooth decay.
- Staying away from tobacco. Smoking causes a large variety of serious health problems ,such as cancer. It can also cause halitosis and damage your gums.
TREATING HALITOSIS AT THE DENTIST’S OFFICE
If you are finding that your halitosis persists even after you have tried at-home remedies, it is time to make an appointment with both your dentist and your doctor.
Halitosis can be caused by cavities, gum disease, and a variety of other medical conditions, and may be a sign that a more serious problem is at hand. Your dentist and your doctor are better equipped to help you diagnose the root causes of your halitosis, and will be able to rule out any serious problems that may be contributing factors.