What is Halitosis?
Halitosis is a fancy name for bad breath. I, as a family wellness dentist, treat halitosis in my family dental clinic routinely. Besides being an embarrassing phenomenon that affects a lot of the population, it could also affect your social life tremendously. Halitosis can really take a toll on your self-esteem and hinder your confidence while talking to people.
Although halitosis has multifactorial origins, 90% of the causes are from the mouth – poor oral hygiene, cavities, abscess teeth, gum disease, white tongue, unclean dentures, food impaction and retention between teeth or underneath the dentures or cleft palate, tonsillitis, diets, and oral ulcerations. The other origins of bad breath are from the other parts of the body – sinusitis, bronchitis, lung infections or malignancies, problems with the digestive system like stenosis, blockage, and ulceration etc. Vaping, smoking and certain food can also contribute to the problem. Liver and kidney failures are a potential cause of halitosis, but those cases are not commonly seen in my practice.
The odour comes from smelly volatile compounds, created by bacteria breaking down foods and tissues in our mouth and other organs. Those smelly compounds are mainly sulphur compounds from the breakdowns of proteins. Patients with diabetes can have a fruity but not too pleasant smell — caused by ketones. Patients on ketogenic diets like the Atkins diet with low-carbohydrate, high-fat foods also tend to produce more ketone breath.
Bad breath also tends to be more severe in the early morning after waking from a night of sleep. During that period, salivary flow is usually at its lowest and dry mouth happens especially for a person who breathes through the mouth during their sleep. Bacteria is flourishing, busy breaking down the food and tissue in the respiratory, mouth and the upper digestive system. Patients who eat right before sleeping are more likely to have stagnation of the food in their stomachs. The stagnation promotes acid reflux that brings stomach contents back up into their mouths for bacterial fermentation. The morning breath we complain about often is very common – all of us have morning breath to a certain extent, so it should not be a concern to some of us. If you feel that your breath during the day smells bad, then that could be troublesome, as it can imply infection and inflammation in your mouth or other systemic diseases.
If you are convinced that you have halitosis and wish to come to our dental clinic for treatment, the first thing to do is to do a comprehensive oral examination which also includes the review of your medical history, dental history, previous treatments, conditions and concerns. Then we would move to the confirmation about halitosis. There are subjective and objective measurements. The first thing to do is to smell your breath – sniff test. The second is a sulphide test, done by having you blow into a machine to measure the amount of volatile sulphide in your mouth. Then the third test would be to scrap your tongue of debris and test for the existence of some bacteria that are highly associated with swollen gums and gum disease.
Once halitosis is confirmed, then we would enter the treatment phase to eliminate the causes. If the source is outside the oral area, then a referral to his or her physician would be made. If it is in the oral or oropharyngeal areas, then we can treat the issue according to the findings. Obviously, we need to treat the sources – cavities, gum disease, food traps, a heavy tongue coating, fillings in poor form and shape, broken teeth, and ill-fitting dentures etc. Other predisposing factors could also be addressed like smoke cessation, weight loss, and good brushing and oral hygiene habits. A lot of patients may not realize that dentists are trained in diet counselling to address the nutrition and overall wellness of their patients. Control of diabetes, weight issues and high blood pressure can be modulated by your diets.
Medications can also be employed in the fight against bad breath. Prescription and over-the-counter mouth rinses, topical or systemic antibiotics, and natural herbal mouthwashes and pastes may be used. Sometimes a consultation with your physicians about switching certain medications can be helpful to reduce gum swelling.
We are a family dental clinic in Burlington that employs a holistic wellness approach to your oral health. In my next blog, I will share with you two recent cases that we treated at our dental clinic. We have been able to turn patients’ frowns upside down. Our goal is to take a patient who smiles minimally, to thinking positively about themselves after treating their mouth. Patients should always be able to clearly see and feel the transformation.