Bad breath or halitosis is a common condition observed to be present in around 30% of the population. Usually, it is not noticed by the individual suffering from bad breath and is brought to their attention by their friends or family. While bad breath is generally of no major medical concern, it can cause significant distress to the individual. In addition there are some serious diseases like cancers of the oral cavity which can present with bad breath and should not be ignored.
Causes of Bad Breath
Physiologic bad breath:
This is the common form noted in normal individuals in the mornings. This occurs due to the action of bacteria on the tiny food particles between the teeth and on the surface of the tongue. It resolves with cleansing the mouth and brushing teeth. It can also be observed in relation to certain food and drinks. Garlic and onions are infamous for causing bad breath along with smoking tobacco.
Pathologic bad breath:
There are multiple conditions which can lead to bad breath.
- Dry mouth
- Excessively coated tongue with white fungus
- Infections affecting the gums
- Tonsillar inflammation and abscess
- Poor oral hygiene
- Dental cavities
- Frequent lung infections
- Zenker’s diverticulum (pouching of the food pipe in the region of the neck with collection of food material)
- Gastrocolic fistulae (an abnormal connection between the stomach and the colon containing faeces, with malodorous burping)
- Some medical conditions can cause bad odours due to certain chemicals produced in the body which is released out as vapours like Diabetic ketoacidosis, Severe kidney or Liver disease
- Tumors or cancer in any part of the mouth, throat or larynx.
Subjective bad breath or pseudo-halitosis:
This when a person perceives to have bad breath when there is no observable presence of malodour. This is associated with excessive concern over having bad breath and is usually psychological.
Clinical Features of Bad Breath
Apart from the presence of notable bad odor from the mouth, the individual may experience various other symptoms depending on the underlying cause
- Pain and bleeding of gums
- Dryness in the mouth
- Pain in the mouth and throat, hoarseness of voice, in case of tumors
- Swelling in the neck and difficulty swallowing in case of a Zenker’s diverticulitis
- Symptoms of kidney and liver disease
Diagnostic Tests for Bad Breath
It is recommended to meet with a primary care physician or a dentist to evaluate the underlying cause of the bad breath. The following tests can be done to identify if the bad breath is due to a serious condition requiring specialist care
Physical exam: A thorough examination of the mouth, teeth and gums is done. The throat and nose is also examined. Subjective tests assessing the severity of the bad breath is made by the physician.
Imaging studies: X ray of the head and neck, chest may be done to look for any mass or chronic lung disease. A CT scan may be needed to further assess for tumors
Treatment of Bad Breath
- Apart from treating the underlying disease, the following measures can help with improvement in isolated bad breath
- Drinking plenty of fluids to maintain hydration
- Maintenance of oral hygiene which involves brushing twice a day, cleaning the tongue and flossing daily
- Chewing gums free of sugar which can stimulate production of saliva
- Mouth gargling using a mouthwash such as chlorhexidine before bed time
- Bad breath-aetiology, differential diagnosis and therapy. Ther Umsch. 2008 Feb;65(2):83
- Clinical assessment of bad breath: current concepts. J Am Dent Assoc. 1996;127(4):475.