Causes:

Halitosis has been divided into two categories:

• Physiological halitosis: is considered as “normal” and can be treated with daily oral hygiene.
• Morning breath: due to the decreased saliva production during sleep.
• Age: as we age, the quality and quantity of saliva changes and therefore its protective features, making us more prone to have halitosis.
• Dentures: old, stained and worn dentures with rough surfaces can accumulate plaque and food residues that can only be cleaned by a dentist.
• Smoking and chewing tobacco, as well as recreational drugs, use dry out our mouth by decreasing saliva production and its cleaning functions.
• Diet: foods such as onions or garlic produce bad breath, sugary foods increase the metabolic activity of bacteria resulting in bad odour. Also, crash diets and fasting cause a particularly bad smell due to biochemicals produced by the breakdown of body fat.
• Pathological halitosis: halitosis comes from the mouth in 80% of the cases.
• Oral causes: poor oral hygiene, dental decay, gum disease, low saliva availability, old and worn dentures, oral infections and throat, abscesses, and other oral pathologies associated with underlying health issues such as cancer, diabetes, viral and bacterial infections.
• Extraoral causes: chronic sinusitis, digestive diseases such as untreated acid reflux. Patients with diabetes tend to have a characteristic breath, as well as patients under certain medications like B complex or Iron supplements.

Diagnose and treatment:

Usually, bad breath can be self-diagnosed, or by asking someone you really trust if you have it. Commonly having bad breath is reversible and it can be solved by following a good oral hygiene regime. For example, the use of over the counter mouthwashes is helpful in reducing morning breath, as well as drinking peppermint tea with your meals or taking chewable mint tablets.

However, you should visit your dentist if you still noticing bad odour or if you have the following symptoms:

• Bad breath does not go away after a few weeks.
• You have gum pain, or your gums bleed when you brush your teeth.
• Your teeth are sore.
• Your dentures are stained, scratched or have tartar stuck to them.

To diagnose halitosis, generally, a full oral examination is needed. The dentist will take a look at your gums, teeth and their surrounding tissues including your tongue and cheeks. Your dentist will be able to find the source of the halitosis. If the oral treatment was not helpful, your dentist will refer you to your GP to look for other possible sources of the problem, like a systemic disease.

You might be a candidate for more frequent visits to your dentist for an oral hygiene appointment. This is because the quality of saliva is different for every patient, and some people get plaque build ups more frequently than others, which means they need to attend to their hygiene appointments more often.

Nevertheless, 90% of halitosis cases are solved by improving oral hygiene measures such as:

• Use floss or interdental brushes will be crucial to prevent plaque build ups on the surface of your teeth, soft tissues or dentures.
• Use a prescribed antibacterial mouthwash: your dentist can advise which mouthwash would be best in your case.
• Using specialised dentures hygiene products to disinfect and remove stains on your prostheses. When these products do not work as expected, you might be a candidate for professional cleaning of your denture. Your dentists will advise you and guide you through the process.
• If you have dry mouth, drink plenty of water throughout the day to keep your mouth moisturised and clean. Adding some peppermint can add a sense of freshness.
• If you cannot brush your teeth, rinse your mouth immediately after your meals.
• Chew sugar-free gum. It is proven that it helps to freshen your breath and stimulating saliva production, as well as removing food residues stuck between your teeth.
• Quit smoking

References:

• Fernández Amézaga, J. & Rosanes González, R. (2002). Halitosis: diagnosis and treatment in primary care. Medifam, 12(1), 46-57. Retrieved 17/04/2020 from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1131-57682002000100005&lng=es&tlng=es.
• Mayo Clinic (2018). Bad breath (Web Page). Rochester, NY: Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922 [Accessed: 11/06/19]
• Southern cross medical library (2019). Bad breath – Halitosis (Web Page). https://www.southerncross.co.nz/group/medical-library/bad-breath-halitosis