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Is your breath chasing friends away? Time for a fresh approach!
Bad breath, medically known as "halitosis" is an unpleasant or offensive odour from the mouth. It is a serious problem that adolescents face and it impacts negatively on a social and psychological basis. Also, halitosis is associated with isolation, low self-esteem, anxiety etc., which could drag adolescents back from their social lives, and lead to broken relationships, hence having a greater impact on their quality of life. (Briceag et al., 2023).
What can cause bad breath?
Tongue coating, poor oral hygiene (Khounganian et al.,2023) and periodontal diseases are the main intra-oral sources responsible for halitosis. Other contributing factors could be diet, smoking, alcohol and dry mouth. However, oral malodour can occur due to extra-oral systemic sources such as liver diseases (main cause), respiratory tract infection (nasal and sinus secretions), gastrointestinal diseases, and haematological and endocrine system disorders (Aylikci & Colak, 2013).
Bacteria on the tongue, saliva, and gum pockets break down proteins, releasing volatile sulfur compounds (VSCs) that cause bad breath (Bathla, 2011).
Sources of Bad Breath
Tongue coating:
The posterior third of the tongue is covered by bacteria containing deposits, shredded epithelial cells and other non-cellular components such as salivary protein and, post-nasal and gum secretions (which can vary in thickness, size and colour). Most cases of malodour arise from this region (Sterer & Rosenberg, 2011).
Poor oral hygiene:
Food particles and debris can be entrapped between the teeth, prosthesis and overhanging restorations. If the debris is not cleaned properly, it can be broken down by bacteria, rot and produce an unpleasant smell. Over some time, dental plaque can form and irritate the gum. This eventually leads to gum disease and causes bad breath.
Periodontal disease:
A direct correlation exists between periodontal disease and halitosis. Active gingivitis and periodontitis, along with bacterial activity, increased flow of gum fluid and presence of blood cells, take part in the malodour production process (Sterer & Rosenberg, 2020).
Dry mouth:
Dry mouth is a condition characterised by decreased salivary flow. The saliva has a major role in flushing debris and cleansing the oral tissue. Thus, lower saliva levels cause dryness of oral mucosa and are associated with more malodour-related compounds (Suzuki et al., 2016).
Smoking and Food:
Tobacco chewing and smoking can leave chemicals in the mouth that lead to bad breath.
Foods like onion, garlic, and dairy products can cause temporary bad breath (Wu et al., 2019).
Extra-oral causes:
Liver, respiratory and gastrointestinal diseases are all extra-oral contributors that can also cause halitosis.
Mechanical therapy
Mechanical therapy is done by regularly brushing with toothpaste and cleaning the dental and oral tissues. Tongue cleaning is the most accurate oral hygiene activity in reducing oral malodour. Special aids such as tongue scrapers are found to be more effective as they can dislodge food particles, and bacteria entrapped on the tongue, thereby decreasing the volatile sulphur compound (Sterer & Rosenberg, 2011). Toothbrushes can be used but are said to be not as effective as the specially designed aids for cleaning the tongue. Floss and interdental brushes can be used to clean between the teeth.
Chemical therapy
This includes the use of
Chlorhexidine,
Cetylpyridinium chloride,
Essential oils, triclosan
Chlorine dioxide
Hydrogen peroxide
Zinc
These are effective in reducing the malodour individually or combined as these are mostly antibacterial or antiseptic agents (Sterer & Rosenberg, 2011).
Professional treatment:
Periodontal treatment
Supragingival prophylaxis
Professional teeth cleaning
Disinfecting agent (1% CHX gel) – application within the periodontal pocket and brushing tongue (Sterer & Rosenberg, 2011)
Thinking of Natural Products?
Yes! Some natural products can reduce bad breath (Khan et al., 2023).
References
References
Aylikci B.U., & Colak H. (2013). Halitosis: from diagnosis to management. J Nat Sc Biol Med, 4:14–21.
Bathla S. (2011). Periodontics revisited, First edition. Jaypee Brothers Medical Publishers.
Briceag, R., Caraiane, A., Raftu, G., Horhat, R.M., Bogdan, I., Fericean, R.M., Shaaban, L., Popa, M., Bumbu, B.A., Bratu, M.L., Pricop, M., Talpos, S. (2023). Emotional and Social Impact of Halitosis on Adolescents and Young Adults: A Systematic Review. Medicina, 59, 564. https://doi.org/10.3390/medicina59030564
Khan, K.M., Hameed, S., & Shamim, S. (2023). Natural Product to Cure Bad Breath, Pharmacological Studies in Natural Oral Care, 217-252. https://onlinelibrary.wiley.com/doi/abs/10.1002/9781394167197.ch12
Khounganian R.M., Alasmari O.N., Aldosari M.M., Alghanemi N.M. (2023). Causes and Management of Halitosis: A Narrative Review. Cureus, 15(8): e43742. doi: 10.7759/cureus.43742. PMID: 37727189; PMCID: PMC10506127.
Sterer, N., & Rosenberg, M. (2011) Breath Odors. Springer-Verlag Berlin Heidelberg. DOI: 10.1007/978-3-642-19312-5_1
Suzuki, N., Fujimoto, A., Yoneda, M., Watanabe, T., Hirofuji, T., Hanioka, T. (2016). Resting salivary flow independently associated with oral malodor. BMC Oral Health, 17(1):23.
Wu, J., Cannon, R. D., Ji, P., Farella, M., Mei, L. (2019). Halitosis: prevalence, risk factors, source, measurement and treatment – a review of the literature. Australian Dental Journal, 65:4-11. doi: 10.1111/adj.12725
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