Halitosis

What are the symptoms of this condition?

The primary symptom is an unpleasant or offensive odour to the breath. There may also be a metallic or acidic taste in the mouth. Whitish deposits may be seen at the back of the mouth or on the tonsils, and the tongue may be covered in a thin, white coating.

What is the cause of the condition?

The cause of offensive breath mainly seems to lie in the activities of certain bacteria that live within the mouth.

To give a better understanding of how bad breath can be tackled, a brief description must be given of the bacteria found in the mouth.

Bacteria can be divided into two large families: those that can live in air (known as 'aerobes') and those bacteria that are poisoned by air, specifically by the oxygen in the atmosphere. This last group of bacteria are known as 'anaerobes'. Anaerobic bacteria must live in an environment where fresh, oxygenated air cannot be found. In the mouth this type of environment can be found deep inside the microscopic folds of the tongue. Here the anaerobic bacteria live and are tolerated by the body because they assist in digestion.

The process of digestion commences as soon as food is taken into the mouth. Saliva contains chemicals which start to break down certain types of food. This is aided by the anaerobic bacteria on the tongue, which act on proteins found in food. Proteins are not confined to food; they are also found in blood, mucous and phlegm. The anaerobic bacteria help to keep the mouth clean by digesting and removing any traces of blood or phlegm inside the mouth.

As the proteins are digested, they are broken up into their chemical components; substances called amino acids. Two of these amino acids (cysteine and methionine) contain large amounts of sulphur, and it is the sulphur from the amino acids, released mainly in the form of hydrogen sulphide and other sulphur compounds, that is responsible for the unpleasant breath odour. Collectively, these sulphur compounds are referred to as 'volatile sulphur compounds' or VSCs.

Gum disease may make this VSC problem worse. Normally, the gums wrap closely around the base of the tooth. If the gums are inflamed, perhaps due to plaque on the teeth, they start to separate away, leaving a tiny pocket between the gum and the tooth. Food particles can find their way into this pocket. If the conditions are suitable, i.e. no oxygen is present in the atmosphere of the pocket, anaerobic bacteria will appear and start breaking up any protein fragments they find so increasing the quantity of VSCs in the mouth.

Certain activities can worsen the situation. Smoking reduces saliva formation, drying out the mouth. As saliva contains oxygen (which is poisonous to anaerobic bacteria) it helps to control the number of these bacteria in the mouth. If you have less saliva then conditions are more favourable for the bacteria. For this reason halitosis can be worse on waking in the morning as less saliva is produced while you sleep.

Coffee drinking also affects the acidity level in the mouth. Bacteria generally prefer an acidic environment, and coffee drinking boosts the acid level. As the mouth becomes more acidic, the anaerobic bacteria reproduce at a faster rate, again increasing the quantity of VSCs in the exhaled breath.

Since all human beings have anaerobic bacteria in their mouths, and we all eat proteins, an important question is why one individual may have a problem and another may not; there is no clear understanding about this. Hormonal changes, use of antibiotics or a genetic factor, these may all possibly affect the normal balance of bacteria in the mouth.

Poor oral hygiene and tooth decay will cause offensive breath. Halitosis can sometimes occur as a consequence of disease in the stomach or lungs, but this is quite rare. Odour on the breath may also result from alcohol drinking or diabetes. In these two cases, the odour results from chemicals in the blood (i.e. alcohol or sugar) being transferred into the exhaled air in the lungs. For example, high blood sugar can give a sweetish 'pear drop' aroma to the breath. But, by and large, halitosis is nearly always the result of bacterial activity in the mouth, not due to problems elsewhere in the body.

What complications might occur?

If the problem is the result of active gum or tooth disease, and this is left untreated, then teeth may eventually be lost. An essential part of dealing with halitosis is keeping your teeth and gums in good condition. Regular attendance at a dentist is essential.

What can I do to treat myself?

Halitosis is a complex problem that affects some individuals more than others. Tackling it effectively requires action on several fronts; you may also need to consult your dentist or the Pharmacy2U pharmacist for more advice.

Good oral hygiene is a must. Regular dental check-ups, daily teeth cleaning and flossing will all help to control the environment of the mouth. Gum disease will certainly add to any halitosis problem that may exist; this is thought to be minimised by the use of an electric toothbrush or plaque remover. If the mouth is kept clean and moist, the anaerobic bacteria will produce less VSCs and less odour. Allowing yourself to become dehydrated will reduce saliva formation. Drinking plenty of water will help to keep the saliva flowing and the mouth moist. Chewing gum, especially after eating, increases saliva production and helps to remove food debris.

Stopping smoking will help. Smoking can cause many diseases, the majority of which are life-threatening, so giving up is always a good thing. It can also make breath odour problems much worse because of the drying effect the smoke has on the mouth, and the chemicals that it deposits on the tongue, gums and teeth. Cigarette smoke also reduces the oxygen content of the blood, which makes conditions more favourable for anaerobic bacteria.

Attention to diet may help. Acidic foods will encourage the anaerobic bacteria to multiply more rapidly. Some people are 'lactose intolerant', that is, they may have problems digesting milk and other dairy products. The proteins contained in dairy products then become available for breakdown by anaerobic bacteria and produce more VSCs.

Using anti-bacterial mouthwashes can control the quantity of anaerobic bacteria present in the mouth. Mouthwashes which are not specifically anti-bacterial may not have much effect, especially if they are alcohol based. The alcohol in these mouthwashes dries the mouth and creates a more favourable environment for the bacteria.

Anti-bacterial mouthwashes are not a total solution. These bacteria are normally resident in the mouth and are needed to help with digestion. A mouthwash might remove them temporarily, but they will soon return.

What treatments are available for me to purchase?

There are a number of products which temporarily mask halitosis and are useful, for instance, after eating strong smelling foods such as onions or after smoking. These are available as sprays or pellets and include products such as Gold Spot and Amplex.

There are a number of antibacterial mouthwashes that reduce the number of bacteria which may be causing halitosis. It is important to note that these too only have a temporary effect as the bacteria concerned are naturally resident in the mouth and numbers soon increase.

One product, Retardex (available as an oral rinse and an oral spray), contains chlorine dioxide, which is an effective antibacterial and fights plaque, treating the underlying causes of halitosis.

To view the range of mouthwashes available from Pharmacy2U Click here.

What treatments are available from my doctor?

In most cases, persistent halitosis can be managed by your dentist, who will refer you to your doctor if it is felt that this is necessary. Dentists can prescribe treatments including antibiotics for mouth infections, and saliva replacement products for the management of xerostomia (dry mouth).

What additional investigations might be needed?

Breath odours are sometimes the result of illness, disease, or some medications. Depending on the odour and any other symptoms you have, your doctor or dentist might recommend a number of different investigations.

Any other information I should have?

The Pharmacy2U pharmacists can give help and advice on selecting products that are suitable for your needs. Please consult them if you require any assistance.