BAD BREATH
Causes of bad breath?
Bad breath is a common health problem that severely affects the daily activities of many people. The offensive odor that emerges from the mouth is unpleasant for those who are in close contact with people who have bad breath. The problem will be coupled with psychological trauma leading to depression. People who suffer from this problem are isolated from society. It can even lead to marital discord.
Literally speaking, all human beings are bad breathers. The oral cavity contains millions of anaerobic bacteria such as Fusobacterium and Actinomyces that act on the proteins in food and putrify them. This process leads to the formation of offensive gases such as hydrogen sulfide, methylmecaptan, cadaverine, skatol, putrescine, etc., which cause bad odors. If oral hygiene is not maintained properly, everyone will suffer from bad breath. Most of us control this problem by regular brushing, tongue cleaning and gargling. Even after keeping the mouth clean, some people suffer from an unpleasant odor due to a variety of causes that must be diagnosed and treated properly.
Some common causes of bad breath.
1) Poor oral hygiene:
If oral hygiene is not maintained properly, the mouth becomes home to millions of bacteria that produce offensive gases by breaking down food debris. Bad breath is serious for those who do not brush regularly and do not clean their mouths after each meal. Snacks eaten between meals can also produce bad breath due to inadequate cleaning.
Bad breath is common in almost everyone in the morning when they wake up. During sleep, less saliva is produced. Saliva has antibacterial properties that help keep the mouth clean. Saliva contains oxygen molecules that are necessary to make the oral cavity aerobic. Therefore, reducing its amount during sleep creates favorable conditions for anaerobic bacteria.
2) Eating habits:
The main cause of bad odor is due to the degradation of proteins by bacteria and therefore all food products rich in protein promote bad breath. Meat, fish, dairy products, eggs, cakes, nuts, pears, etc. can cause bad breath. Some food products can produce a particular type of odor that can be unpleasant. Raw onions can produce a typical bad smell. They say an apple a day keeps the doctor away, a raw onion a day keeps everyone away. Eating peanuts can also produce a bad smell. However, with proper cleaning, the odor can be reduced, regardless of the nature of the food. Irregularity in the timing of eating can also produce bad breath. Small food items eaten between meals can also produce bad odor.
3) Biofilm:
A thin sticky coating called biofilm forms on the tongue and oral mucosa. This coating is thick on the back of the tongue, where millions of gram-negative bacteria can be seen. The thick coating on the tongue is always associated with bad breath. Even a thin biofilm can make anaerobic conditions favorable for bacterial growth.
4) Dental Caries:
This is a destructive process causing decalcification with destruction of enamel and dentin, resulting in cavitation of the tooth. These cavities are mainly produced by lactobacilli. Food particles are deposited inside these cavities and are putrefied by anaerobic bacteria which produce a bad odor. Normal brushing does not easily remove the food debris, which then putrefies completely. Cavities are common in school children and in those who do not have good oral hygiene. Calcium and vitamin deficiencies can also predispose to cavities.
5) Gingivitis:
The gum is a mucous membrane with supporting connective tissue that covers the edges of the jaw bearing the teeth. The main function of the gum is protection. Gingivitis is the inflammation of the gums. For various reasons, the gum tissue becomes infected, resulting in swelling, pain and discharge. If the situation worsens, the infection spreads to the peridontal area, causing a continuous discharge called pyorrhea. Sometimes the infection is deep and produces an alveolar abscess with pus discharge.
The infection can even reach the bone and cause osteomyelitis. All these conditions can produce a foul odor.
6) Retracted gums:
When the gums recede from the teeth, a space develops that will house food particles and cause bad breath.
7) Dental plaque and tartar deposits:
Plaque and tartar are deposited primarily in the spaces between the teeth and gums. They serve as a shelter for food debris and bacteria that cause bad breath.
8) Ulcerative lesions & coatings :
Almost all ulcerative lesions in the mouth are associated with bad breath. These lesions can be caused by bacteria, viruses, food allergies or autoimmune disorders. Apinous ulcer is the most common ulcerative lesion. Others are herpes, fungal infections, angina, infectious mononucleosis, scarlet fever, diphtheria, drug reactions, etc. Cancerous ulcers produce strong bad breath. All fungal infections produce a white coating (candidiasis). Leukoplakia is a thick white spot on the mucous membrane of the mouth and tongue. It is considered a pre-cancerous condition. Fetid breath is associated with these conditions.
9) Salivary gland diseases:
Saliva is very useful in supplying oxygen to all parts of the oral cavity. Even a thin coating called biofilm can create an anaerobic condition in the mouth. Saliva can wet these layers and create an aerobic condition unfavorable to bacteria. Any condition that reduces saliva production can increase bacterial activity. Sometimes the salivary duct is blocked by stones or tumors. Cancer of the salivary gland is associated with an unpleasant smell. In the case of suppurative parotitis, a purulent discharge in the mouth causes bad breath.
10) Tonsillitis:
The tonsils are a pair of lymphoid tissues located in the lateral wall of the oropharynx. The inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quacking or peritonsillar abscess can also cause bad breath.
11) Tonsil Plaques and Tonsil Fluid:
If bad breath persists even after good oral hygiene, this condition is possible. The serous fluid secreted by the folds of the tonsil is very offensive. Some patients complain of having a cheesy odor coming from their throat that is very offensive in nature. This material forms inside the tonsil crypts which contain thousands of bacteria. Under these conditions, tonsillectomy provides significant relief from bad breath.
12) Pharyngitis and pharyngeal abscess:
The pharynx is a fibromuscular tube that forms the upper part of the digestive and respiratory system. Inflammation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis, along with other signs such as coughing and throat irritation. Abscesses in the lining of the pharynx can also produce an offensive discharge of pus into the throat.
13) Dentures:
Denture users may complain of a bad odor due to the presence of small food debris between the teeth. Proper brushing may not be possible in denture users, especially fixed dentures.
14) Tobacco:
Chewing tobacco is associated with bad breath. The smell of tobacco itself is unpleasant to others. Tobacco can irritate the mucosa and cause ulcers and coatings. Gingivitis and pyorrhea are common among tobacco chewers. Tartar is deposited on the teeth, mainly near the gums. Tobacco chewers have stomach acidity with belching. All this causes offensive odors.
15) Smoking:
Smokers always have a bad smell. Smoking increases carbon dioxide in the oral cavity and reduces oxygen levels, which creates favorable conditions for bacteria. Smoking reduces appetite and thirst, hence the frequency of acidic gastrointestinal disease in chain smokers.
16) Nose and ear injuries:
Bad breath is sometimes observed in cases of sinusitis (infection of the para-nasal sinuses). In case of post-nasal drip, bad breath is common due to the presence of proteins in the drip. These proteins are broken down by bacteria. A middle ear infection with pus flowing down the throat through the eustachian tube (passage from the middle ear to the throat) can also cause an unpleasant odor. Chronic rhinitis (infection of the nasal mucosa) and the presence of foreign bodies in the nose can also produce a bad smell in the exhaled air.
17) Diabetes mellitus:
Most patients with diabetes suffer from bad breath. Coated tongue, ulcers and coatings in the mouth, increased sugar levels in the tissues, etc. are responsible for bad breath. Bacterial growth in diabetic patients is very rapid compared to non-diabetic individuals.
18) Fevers:
Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. Other infectious diseases such as tuberculosis, AIDS, etc. produce bad breath.
19) Fasting and dehydration:
Dry mouth promotes bacterial activity. Thus, any condition that produces dryness in the mouth makes the breath offensive. Although food particles are known to produce bad breath, fasting can also produce the same thing. Saliva production is also reduced during fasting. Chewing and swallowing also help keep the mouth clean.
20) Bedridden patients:
Bedridden patients suffer from offensive breath due to a thick coating on the tongue. Water intake is also limited in these patients. Regurgitation of food aggravates the situation. As they speak less, the aeration of the oral cavity is reduced, which promotes the activity of anaerobic bacteria.
21) Stomach and esophageal diseases:
Belching of gas and food produces an unpleasant odor. An abnormality in the function of the lower sphincter may allow food to regurgitate upward, causing bad breath. Bad breath is also common in gastritis, gastric ulcers and stomach cancer.
22) Intestinal diseases:
Bad breath is common in patients with ulcerative lesions of the intestine such as ulcerative colitis, malabsorption syndrome, intestinal tuberculosis or peritonitis.
23) Lung diseases:
Lung diseases such as pneumonia, lung abscess, chronic bronchitis, bronchiectasis, tuberculosis, lung cancer, etc. may produce a bad smell during exhalation.
24) Liver disorders:
Liver diseases such as hepatitis, cirrhosis, can cause bad breath, gallbladder diseases with vomiting can also cause unpleasant smell.
25) Psychiatric patients:
Bad breath is common in psychotic patients due to poor hygiene, irregular eating habits, reduced water consumption, etc.
26) Somatization disorder:
This is a psychiatric disorder characterized by the presence of a physical symptom that suggests a medical illness. These patients complain of pain, nausea, difficulty breathing, bad odor, etc. This disorder is diagnosed after a detailed examination of the patient and all necessary investigations, but as it is a psychiatric disorder, it must be managed by a psychological approach.
[THE POINTS MENTIONED IN THIS ARTICLE ARE GIVEN AS GENERAL INFORMATION. ANYONE WITH BAD BREATH SHOULD CONSULT A QUALIFIED PHYSICIAN].
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