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Oral health considerations

Halitosis: Recommendations to avoid bad breath

Halitosis, causes and recommendations to avoid bad breath

Halitosis, bad breath or bad oral odor are all synonyms of the same condition.
Halitosis is a common condition that affects 25% of the general population. It has a great social impact. Most patients are ashamed and affect their daily lives.
Halitosis can have multiple causes, being those of intraoral origin the most common. In about 85% of all cases of halitosis the problem is in the mouth, with gingivitis, periodontitis and saburral tongue (accumulation of whitish substance on the back of the mouth) as the main causes.
People with healthy gums can also suffer halitosis, this is caused by food impaction, bacteria, white blood cells and desquamated epithelial cells that accumulate mainly on the dorsum of the tongue.
The tongue has the highest amount of bacterial load than any oral tissue and makes the greatest contribution to the total number of bacteria present in saliva. The back of the tongue is the main place where the components that cause bad odor are produced.
Microbial degradation in the oral cavity is the main cause of bad odor. Due to this process, volatile sulfur compounds are formed. These compounds are mainly produced by anaerobic bacteria present in the mouth. Most of these microorganisms present in halitosis are related to periodontitis.
Poor oral hygiene, presence of plaque, decay, accumulation and putrefaction of food remains and poorly sanitized prostheses contribute to this microbial degradation and therefore bad breath.
Peri-implantitis (infection of an implant), pericoronitis (typical infection around a wisdom tooth), recurrent oral ulcerations, and herpetic gingivitis are also described as causing bad breath.
Another possible cause of halitosis is xerostomia or dry mouth. It has multiple causes such as systemic diseases (Sjogren's Syndrome, Diabetes ...) or as a side effect of many medications such as antihypertensives or antidepressants. These patients usually have a larger volume of plaque on their teeth and tongue, which causes a bad odour. This is due to the lack of saliva and therefore to the lack of its antimicrobial activity. This condition in turn increases the frequency of caries.
Only 10% of the causes of halitosis are extraoral causes such as sinusitis, nasal obstruction or nasopharyngeal problems. It is very important to know that the halitosis of extraoral cause can be the sign of an underlying systemic disease . Therefore it could be necessary in these cases to organize consultations with other medical specialists to be able to treat it.
Contrary to what many people believe, in less than 2% of cases halitosis is caused by stomach problems .

Morning bad breath

It is not proper halitosis but is a temporary physiological state. This is due to the decreased production of saliva during the night, which increases the formation of anaerobic bacteria causing the typical morning bad breath. The problem disappears as soon as routine hygiene measures are taken.

Treatment and recommendations

Dentists and periodontists are the first professionals to detect and address this problem, since the individuals themselves usually do not detect their own bad breath, being commonly warned by relatives, partners or friends.
In most cases halitosis can be treated by maintaining correct dental and lingual hygiene (through the use of tongue scrapers) and with the use of antiseptic mouth rinses such as chlorhexidine. Chlorhexidine is the most effective product against plaque. Toothpastes, which contain fluorides, zinc or triclosan, also seem to have a beneficial effect in reducing oral bad odor for a limited period of time.

  • You should brush your teeth three times a day: when waking up in the morning, after the midday meal, and immediately before going to bed at night.
  • After the dental hygiene, you should brush, with the brush without toothpaste, also the cheeks and the tongue, trying to get there as far back as possible. This operation can be carried out more easily using a tongue cleaner or scraper (sold at any pharmacy) instead of the brush.
  • In case of eating out, you should clean as indicated when you have the possibility to do so. If there is no other way, you can, exceptionally, do without the midday cleaning, but you should not stop practicing the morning and the night.
  • You should avoid having a dry mouth. If you have an occasional tendency to dry mouth, you can correct it by chewing sugar-free dental gum.
  • It is also convenient to practice a professional oral cleaning every six months approximately.

It is recommended to visit your periodontist for check ups and eventual treatment.

In our clinic we have a specialized department in Halitosis with which we can solve your bad breath problems.

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