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Check oral odour
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Halitosis may be a sign of a serious underlying systemic problem that warrants proper medical diagnosis and treatment. Certain breath odours are of significance.
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HALITOSIS or "bad breath" is a common, perplexing and often embarrassing problem.
It is a serious condition for anyone who has to interact closely with other people. It can arise from various anatomic locations from the mouth to bloodstream. Many people are unaware of the problem until they are told. Halitosis may be a sign of a serious underlying systemic problem that warrants proper medical diagnosis and treatment.
Certain breath odours are of diagnostic significance for the physician. For example the acetone odour of diabetic ketoacidosis, the ammonia smell of uremia and the rotten egg smell of liver failure. Halitosis in liver failure is due to the inability of the liver to break down diethyl sulfide, which is released due to bacterial action. This is excreted through the lungs.
Breath varies in quality depending on factors like age and hydration. In children it is sweet and pleasant, becoming pungent during adolescence and less pleasant during middle and old age. It also varies during the course of the day, being worst in the morning because the salivary flow diminishes during night and this is even more when there is associated dehydration.
Saliva is slightly acidic, which helps prevent the growth of gram negative and anaerobic bacteria in the mouth. When salivary flow diminishes, the mouth becomes slightly alkaline and bacteria thrive. Aminoacids and cellular proteins are broken down into sulphur containing compounds such as hydrogen sulfide and methylmercaptan, which produces bad breath.
Oral cavity conditions that can produce halitosis are dentures, chronic periodontal disease (gingivitis), coated tongue and Vincent's angina. Interestingly, dental carries usually do not cause halitosis unless there is a dental abscess or necrotic pulp space infection. Dehydration worses the condition.
Oral odours can be separated to some extent from odours originating elsewhere in the aerodigestive system by noting the differences in expired air through the mouth as against through the nose.
Sinusitis, tumours of the nose and paranasal sinuses, foreign bodies, infections and tumours of the aerodigestive tract can also produce bad breath. Unpleasant odours from the lungs may arise from either diseases within the lungs themselves or from systemic problems.
Gastric reflux (GERD) is a common cause of morning halitosis. In this condition, there is a reflux of gastric juice, bacteria and partially digested food into the pharynx.
Starvation causes excretion of fat and protein metabolic break down products to the lungs, which produces a characteristic smell. This disappears following ingestion of food.
Dietary factors like ingestion of garlic, onion or a diet high in milk fat produce halitosis. Their metabolic products are released in to the blood stream and excreted through the lungs.
Oral odours are best treated through meticulous oral hygiene and optimal dental care. For infections in the nose, paranasal sinuses and pharynx, appropriate antibiotic therapy is usually sufficient. Gastric reflux is treated by antacids, H2 blockers and appropriate changes in dietary habits. In all cases, hydration to optimise oral hygiene and salivary flow is essential. Substances to mask breath odours, like mouthwashes, mints and oil of peppermint, are helpful.
DR. K.K. RAMALINGAM
DR. RAVI RAMALINGAM
DR. K. MADHAN KUMAR
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