Halitosis or chronic bad breath is very common, affecting up to 50% of the general population. Unlike onion or morning breath, halitosis is a condition that persists and is not remedied by breath mints or mouthwash. Though the occasional bout is common, those with chronic halitosis may endure embarrassment, lack self-confidence and see social relationships suffer. Often, people are unaware of the problem with others reluctant to tell them lest causing discomfort.
Dentists have an intimate relationship with malodorous breath, which is often an indicator of the oral and sometimes overall health of an individual. Typically patients will mention that a partner or family member has complained about their breath causing them to feel self-conscious. While the majority of cases arise from the mouth, other factors can be involved. Let’s have a look at the more common ones and see how we can help those afflicted.
Down In The Mouth
Although halitosis can be multifactorial, 90% of cases arise from the mouth with poor oral hygiene being the leading culprit. Our mouths naturally contain hundreds of types of potentially foul odour-causing bacteria, feeding on food debris and plaque accumulated on the teeth, tongue, along and under the gumline. By providing a warm, moist environment, the mouth is essentially a five-star hotel for microbes complete with room service in which they flourish. Ingesting food left following eating, oral bacteria produce the volatile sulphur compounds mainly responsible for halitosis. Good oral hygiene habits consisting of two brushings a day, including the back of the tongue, flossing and using a non-alcohol mouth rinse can greatly reduce the incidence of halitosis.
What would Montreal be without its souvlaki and shish-taouk restaurants? And in the pre-mask wearing days prior to COVID, it was never hard to tell when someone had recently eaten one. Garlic, onions and many spicy foods can cause transient malodorous breath, which can often be masked with breath fresheners. Given the potential health benefits these foods provide, an occasional bout of bad breath is a small price to pay, though likely not a good choice for a first date.
Keeping our mouths in good order is an important part of overall healthcare. Gum disease, oral infections and untreated cavities can all contribute to halitosis. Sufferers of periodontal disease typically develop deep, hard-to-clean pockets between the teeth and under the gumline in which bacteria can thrive. Having these conditions diagnosed and treated by a dentist, regular checkups combined with a good oral hygiene program can significantly reduce the incidence of chronic bad breath.
When asked about the most difficult thing following his battle with throat cancer, the late, great Hab’s captain Jean Beliveau mentioned the terrible discomfort of dry mouth, or xerostomia resulting from radiation treatment affecting the salivary glands. Often seen carrying a water bottle, he commented on how everyday things like swallowing and eating were hampered by chronic dry mouth. Saliva, being the natural cleanser of the oral cavity, has antibacterial, digestive and moisturizing properties which help keep the mouth healthy. Xerostomia, often caused by certain medications, dehydration and mouth breathing can be a leading cause of halitosis. Products that help stimulate saliva flow such as xylitol-containing chewing gum or lozenges along with artificial saliva agents can help alleviate this uncomfortable condition.
Tobacco and Alcohol
Consumption of these products can also contribute to unhealthy oral conditions, including halitosis. Both may cause dry mouth and characteristic unpleasant breath that can keep associates at bay. Addiction to these items should not be taken lightly nor stigmatized and quitting often requires therapeutic intervention.
While mostly emanating from the mouth, certain medical conditions can cause halitosis. Diseases affecting the liver, kidneys, digestive system, certain types of cancer and metabolic disorders may be involved. Chronic postnasal drip, gastric reflux, throat and tonsil infections are other examples of potential sources. People suffering from these issues should seek medical attention.
While we all occasionally have bad breath, sufferers of halitosis should take comfort in knowing that for the majority of cases, improved oral hygiene along with a visit to the dentist can set them on the path to recovery. And that should certainly have them breathing easier.
Dr. Mark Grossman is a practicing dentist and likes to take a bite out of nonsense when it comes to dental issues.