There are different causes of bad breath. Bad breath, also known as halitosis, is a common oral health complaint globally. Over 50% of the population suffer from it. In fact, halitosis is ranked the third most common reason why people visit the dental clinic. The first two are dental caries and periodontal diseases.
Before a dentist can treat a case of bad breath, he or she must first of all determine the actual cause(s) of it.
What is Bad Breath (halitosis)?
Halitosis is the unpleasant smell from the mouth that is considered offensive and socially unacceptable.
Causes of bad breath are either from within the mouth (intra-oral causes) or from other sources other than the oral cavity (extra-oral causes)
Intra-oral Causes of Bad Breath?
90% of the causes of genuine halitosis are found within the oral cavity. Other causes are from sources other than the mouth.
1. Certain Food Substances
Food substances that contain sulfur compounds produce unpleasant smells after they have been eaten. Examples are onion and garlic. Fish, dairy products, beans and some nuts (pea nuts, cashew nuts) are also rich in sulfur. They are one of the causes of transient bad breath when eaten.
2. Tongue Coatings
The grayish-white substances deposited on the posterior surface of the tongue are the main causes of bad breath. Tongue coatings and periodontal diseases (e.g chronic periodontitis) are the major sources of volatile sulfur compounds (VSCs). VSCs are the primary elements in intra-oral halitosis.
3. Poor Oral Hygiene Practices
Poor oral hygiene causes bad breath. People who don’t brush properly will accumulate dental plaque and calculus (tartar). Dental plaque is the oral biofilm that contains invading bacteria. Calculus is a plaque retentive material. It is not removable by brushing.
Practice of good oral hygiene like brushing twice daily and frequent use of dental floss helps to eliminate dental plaque and reduce bacterial load.
4. Dental Caries
If left untreated, dental caries or tooth decay causes bad breath. Dental cavities trap food particles and bacteria thereby providing an enabling environment for bacteria growth and activities. Bacteria act on the food remnants and produce VSCs.
5. Periodontal(Gum) Diseases
Periodontal diseases are one of the main causes of bad breath. Periodontal diseases are infections of the gum and other supporting structures of the teeth. The main cause of gum infection is dental plaque. Dental plaque contains bacteria that produce foul smelling sulfur compounds.
Inflammation of periodontal structures may cause a pathological deepening of the gum resulting in what is medically referred to as periodontal pockets. Periodontal pockets retain food remnants and bacteria thereby creating an enabling environment for bacteria.
6. Poor Care for Dentures
Poor denture care causes bad breath. Dentures are artificial materials and as such accumulate debris more than the natural teeth. Many denture wearers don’t adhere to the instructions given to them on how to care for their dentures.
7. Poor Cleaning of Orthodontic Appliances
Orthodontic appliances like dentures are plaque retentive materials. Improper cleaning of these appliances causes bad breath. They trap food debris and accumulate bacteria. Bacteria will act on the food debris and release foul smelling VSCs. Wearers of orthodontic appliances both removable and fixed should adhere strictly to the instructions given to them by their dentists on how to properly clean and care for their appliances.
8. Dry Mouth (Xerostomia)
This is one of the causes of bad breath that people are not usually aware of. Dry mouth is a condition where there is decreased salivation. It could be caused by medication, salivary gland disorders, mouth breathing or by severe dehydration.
When there is decreased saliva production, the cleansing effect of saliva is also reduced, and as a result, this could lead to increased debris and bacteria accumulation, and subsequently halitosis.
9. Mouth Breathing
Switching from nasal breathing to mouth breathing causes some alterations in the lips, tongue, palate, mandible (lower jaw), and face. Mouth breathing also causes bad breath.
Saliva is very important in the mouth. In addition to several other roles it plays, it also has antimicrobial action.
Mouth breathing reduces salivary flow and dries the mouth. This encourages bacteria growth because the antimicrobial effect of saliva is also reduced. Because of the reduction in the cleansing effect of saliva, the oral mucosa becomes dry too and traps more food debris. All these will consequently lead to oral malodour.
10. Orofacial infections
This is one of the common causes of bad breath in our environment where people usually present late to the dental clinic. Infections from the teeth and gums will spread to involve deeper structures of the head and neck if not treated as soon as possible. This will result in increased bacteria growth and activities causing halitosis.
Infected extraction sockets, osteomyelitis of the jaw bones, and infection of the gums surrounding an impacted wisdom tooth (third molar impaction), a condition known as pericoronitis, are all associated with bad breath.
11. Use of Tobacco Products
Tobacco use causes bad breath in a number of ways. Cigarette smoking weakens the gums and causes periodontal attachment loss. This results in deepening of the gums in between the teeth (periodontal pockets). These pockets habour a lot of bacteria that further destroy periodontal structures such as the gum.
Tobacco stains the teeth. The stains in turn form a retentive layer for dental plaque.
12. Oral Cancer
Cancers of the head and neck regions can have oral complications. Intraoral ulcers, infected tumours are some of the usual causes of bad breath due to oral cancers. Proper cleaning of the oral cavity can be difficult in situations where oral cancers are associated with pain or inadequate mouth opening. This will lead to poor oral hygiene and consequently bad breath.
Extraoral Causes of Bad Breath
Bad breath also has other causes apart from those from the oral cavity.
13. Respiratory Infections
Bad breath may be a consequence of respiratory tract infections. This may be due to nasal secretions that pass into the oropharynx.
In situations where the nose is blocked due to a common cold or flu, the individual may start breathing through the mouth, which has some negative effects on the oral cavity.
14. Diabetes Melitus
Poorly controlled diabetes mellitus is associated with a couple of medical complications. Periodontal diseases are one of the oral manifestations of uncontrolled diabetes. Diabetes can weaken the immune system giving room for infections such as periodontitis.
Due to increased inflammation of the gums and bacteria accumulation in periodontal pockets, halitosis may result.
People with diabetes may experience a fruity breath. This may be as a result of diabetic ketoacidosis, which is a potentially life threatening condition.
15. Gastrointestinal Disorder
Disorders of the gastrointestinal system have also been implicated as causes of bad breath. People suffering from gastritis, peptic ulcer disease, gastroesophageal reflux disease and their likes may complain of foul smells from their mouth, especially if the conditions are poorly treated.
16. Liver Disorder
Liver disease also causes bad breath. A musty, sweet or fecal odour may be suggestive of fetor hepaticus, a condition in which the liver fails to filter toxic substances from the blood. It could be a sign of chronic liver failure.
17. Kidney Disorder
In chronic kidney disease, the kidneys may not be able to excrete toxic wastes from the blood. This causes build up of urea and may result in bad breath. Malodour due to urea accumulation has urine smell or ammonia breath.
The accumulation of urea in the bloodstream can also lead to certain oral lesions like periodontitis, gingival enlargement, and candidiasis.
Conclusion
Bad breath has a variety of causes. To be able to effectively treat halitosis, it is paramount that the cause has to be identified first. Not every case of bad breath will require treatment by the dentist. A simple brushing of the teeth can take care of early morning bad breath. Cases with underlying systemic conditions should be referred to the physician for adequate care.
