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Doc: my hubby complains that I have dragon's breath! what should I do?

Updated: Mar 1

TGIF dear friends! Even as we watch with dread the invasion of Ukraine on Live TV, we must continue to hope for a diplomatic solution before the war tears apart homes, families and casualties rise.


This week, we are responding to a popular choice of discussion on Bad Breath!


How can we recognise the signs of dental, sinus or tonsil issues leading to halitosis (bad breath)?



Q: What is Halitosis?


Halitosis is an oral health problem where the main symptom is bad-smelling breath.

In most cases, finding the cause of the bad breath is the first step toward treating this preventable condition.


Bad breath, also called halitosis, can be embarrassing and in some cases may even cause anxiety. It's no wonder that supermarket and pharmacy shelves are overflowing with gum, mints, mouthwashes and other products designed to combat bad breath. But many of these products are only temporary measures because they do not address the root cause of the problem.


Bad breath odours do vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odour, while others have bad breath and do not even realise it. Because it's difficult to assess how your own breath smells, perhaps ask a close friend or relative to confirm your bad-breath questions.


Illustration to show the various causes which can contribute to Bad Breath (Halitosis)

Courtesy of: www.frontiersin.org


Q: What causes Bad Breath?

Most bad breath starts in your mouth, and there are many possible causes, such as:

  • Food. The breakdown of food particles in and around your teeth and gums can increase bacterial growth and cause a foul odour. Eating certain foods, such as onions, garlic and spices, can cause bad breath. After you digest such foods, they enter your bloodstream, are carried to your lungs and affect your breath.

  • Tobacco products. Smoking causes its own unpleasant mouth odour. Smokers and oral tobacco users are also more likely to have gum (periodontal) disease, another source of bad breath.

  • Poor dental hygiene. If you do not brush your teeth and floss daily, food particles remain in your mouth, causing bad breath. A colourless, sticky film of bacteria (plaque) forms on your teeth. If not brushed away, plaque can irritate your gums and eventually form plaque-filled pockets between your teeth and gums (periodontitis). Your tongue also can trap bacteria that produce odours. Dentures that are not cleaned regularly or that do not fit properly can harbour odour-causing bacteria and food particles.

  • Dry mouth. Saliva helps to cleanse your mouth, removing particles that cause bad odours. A condition called dry mouth or xerostomia can contribute to bad breath because the production of saliva is decreased. Dry mouth occurs naturally during sleep, leading to "morning breath," and it worsens if you sleep with your mouth open. Chronic dry mouth can be caused by a problem with your salivary glands and some auto-immune diseases.

  • Medications. Some medications can indirectly produce bad breath by contributing to dry mouth. Some drugs can be broken down in the body to release chemicals that can be carried on your breath.

  • Infections in your mouth. Bad breath can be caused by surgical wounds after oral surgery, such as tooth removal, or as a result of tooth decay, gum disease or mouth sores. This is common, and one reason dentists advocate regular 6 monthly dental check-ups, scaling and cleaning.

  • Other mouth, nose and throat conditions. Bad breath can occasionally stem from small stones that form in the tonsils (tonsilloliths) and are covered with bacteria that produce odour. Infections or chronic inflammation in the nose, sinuses or throat, which result in postnasal drip, also cause bad breath.

  • Other causes. Diseases, such as some cancers, and metabolic disorders, can cause a distinctive breath odour as a result of the chemicals they produce. Chronic reflux of stomach acids (gastro-esophageal reflux disease, or GERD) can also be associated with bad breath. Bad breath in young children can be caused by a foreign body, such as a piece of food, lodged in a nostril. These can eventually become encased in soft tissue and even ossify (rhinoliths)


Tonsil stones ( tonsilloliths ) can be irritating and may be associated with bad breath ( Halitosis)

see the 2 small tonsil stones in the left tonsil; they appear as white specks when you look at the back of the mouth where the tonsils are located

Photo courtesy of E-medicine health


Q: How does one diagnose Halitosis?


Most often, patients consult their dentist or GP for suspected Bad Breath.


Your GP or dentist will likely smell both the breath from your mouth and the breath from your nose and rate the odour on a scale. Because the back of the tongue is most often the source of the smell, your GP or dentist may also scrape it and rate its odour.


An example of such a rating scale is shown here:

Table to show one classification for the intensity of Bad Breath (Halitosis)

(from Examination, classification, and treatment of halitosis; clinical perspectives. Available from: https://www.researchgate.net/publication/12484053_Examination_classification_and_treatment_of_halitosis_clinical_perspectives)


Q: What can be done for treating my Bad Breath?


To reduce bad breath, help avoid cavities and lower your risk of gum disease, consistently practise good oral hygiene. Further treatment for bad breath can vary, depending on the cause. If your bad breath is thought to be caused by an underlying health condition, your dentist will likely refer you to your GP or an ENT Specialist for further evaluation.


Photo Illustrations to show that MOST cases of Bad Breath (Halitosis) are due to dental issues

(from Shutterstock)


For such causes related to oral health, your dentist will work with you to help you better control that condition. Dental treatment may include:

  • Mouth rinses and toothpaste. If your bad breath is due to a buildup of bacteria (plaque) on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Your dentist may also recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup.

  • Treatment of dental disease. If you have gum disease, you may be referred to a gum specialist (periodontist). Gum disease can cause gums to pull away from your teeth, leaving deep pockets that fill with odour-causing bacteria. These are often anaerobic bacteria that can be difficult to eradicate. Sometimes only professional cleaning removes these bacteria. Your dentist might also recommend other dental extractions and tooth restorations, depending on the exact diagnosis.

Q: Are there any home remedies I can try?


To reduce or prevent bad breath:

  • Brush your teeth after you eat. Keep a toothbrush at work to use after eating meals eg at lunchtime. Brush using fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odours.

  • Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath.

  • Brush your tongue. Your tongue harbours bacteria, so carefully brushing it may reduce odours. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth) may benefit from using a tongue scraper. Or use a toothbrush that has a built-in tongue cleaner. These can be bought from your dentist or certain pharmacies.

  • Clean dentures or dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product to use.

  • Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water — not coffee, soft drinks or alcohol, which can lead to an even drier mouth. Chewing gum or sucking on candy (preferably sugarless candy) to stimulate saliva production. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.

  • Adjust your diet. Avoid foods such as onions and garlic that can cause bad breath. Eating a lot of sugary food/drinks is also linked with bad breath.

  • Regularly change your toothbrush. Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush.

  • Schedule regular dental checkups. See your dentist on a regular basis — generally twice a year — to have your teeth or dentures examined and cleaned.


Illustration to show how we can examine the patient's oral cavity and capture oral photographs for the patient/parents to review with their dentist (courtesy of Euan's ENT Surgery & Clinic)


If all these fail, do consult your GP or ENT Specialist to look for other possible causes eg Sino-nasal infections / retained foreign bodies eg Rhinoliths etc.


Do have a look at these references if you are keen to delve deeper into this topic of Bad Breath (Halitosis)!


Till next time, Have a good restful weekend! TGIF everyone :-)


Should you like a consultation, please feel welcome to contact us for an appointment 😊


References:


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2. Tonzetich J. Direct gas chromatographic analysis of sulphurcompounds in mouth air in man. Arch Oral Biol 1971; 16:587-97.

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4. Kaizu T. [Halitosis, its etiology and prevention]. Nippon Shika IshikaiZasshi 1976; 29:228-35. Japanese.

5. Yaegaki K. In: Rosenberg M, editor. Bad Breath Research Perspectives.Tel-Aviv: Ramot Publishing-Tel Aviv University; 1995. p. 87-108.

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21. Sugiura M. Approach to psychogenic halitosis. Dental Outlook 1982;60:859-66.

22. Miyazaki H, Arao M, Okamura K, Kawaguchi Y, Toyofuku A, HoshiK, Yaegaki K. Tentative classification of halitosis and its treatment needs.Niigata Dent J 1999; 32:7-11. Japanese.

23. Breath Odor Research, Official News Letter of the InternationalSociety for Breath Odor Research, vol.3, No.1, 1999; p. 2-4.

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