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A matter of concern

DR. N. AMBALAVANAN

Bad breath can have serious social consequences. It is important to find and treat the underlying cause.

PHOTO: PARTH SANYAL

Social Handicap: Oral malodour can cause embarrassment.

AN unpleasant odour in exhaled air is generally referred to as bad breath. When the odour originates from the mouth, it is called Oral Malodour or halitosis in medical terms. Oral Malodour is an age-old problem. It is a social handicap and a matter of concern to many.

Many will notice a transient bad odour from the mouth after waking up in the morning. This is due to the drying of the mouth caused by reduced salivary flow during sleep. It disappears after brushing the teeth or after intake of food or fluids.

Consumption of garlic, onions, spicy foods, aromatic cheeses and alcohol can produce this transient odour irrespective of brushing, flossing or gargling. The real cause for concern for many is persistent bad odour through the day causing embarrassment.

Causes

In a vast majority of cases, gum diseases like gingivitis or periodontitis cause oral malodour. Other causes include coating on the tongue; poor oral hygiene; food stagnation due to cavities; abscesses; poorly maintained dentures or removable appliances; dry mouth due to fasting, medications, systemic diseases. Smoking, drinking alcohol and caffeine tend to dry the mouth and are causes for bad breath.

Causes that do not originate in the mouth include diseases such as chronic pharyngitis, purulent sinusitis; lung disease such as chronic bronchitis; gastrointestinal problems such as gastric hernia, gastritis and regurgitation; and metabolic diseases like uncontrolled diabetes, which produces a fruity odour.

One study found that 87 per cent of oral malodour cases were connected to the mouth; eight per cent were due to ENT problems and five per cent due to other problems. It is important to ascertain whether the problem is real or imaginary. Many people imagine they have bad breath and are afraid of it — a condition referred to as halitophobia.

A clinical assessment by a dental surgeon is necessary to diagnose the problem. Organoleptic assessment is a reliable one. On the day of assessment, the patient should not use perfume, shampoo or body lotion and should also refrain from smoking or consuming alcohol, caffeine or garlic for at least 12 hours before the examination. There are also portable electronic devices called halimeter, which can analyse expired air for the presence of malodour. But they react only to hydrogen sulphide and methyl mercapton and are therefore not reliable since many non-sulphur compounds also produce malodour.

Treatment

Oral diseases such as gum inflammation, cavities, tooth decay and other infections should be treated early. The teeth and tongue should be kept clean by brushing twice daily. The tongue can be gently brushed and cleaned with a soft toothbrush. Appliances like dentures should be well maintained and removed at night before going to bed. The patient can also use mouthwashes like chlorhexidine for a short while on the advice of a dentist to eliminate odour-causing bacteria. Frequent intake of water and non-caffeinated drinks will prevent drying of the mouth. If the malodour is due to systemic diseases like pharyngitis or bronchitis the concerned specialist should treat it. It is important to remember that oral malodour has serious social consequences. So the cure consists of identifying and treating the underlying cause. Masking the problem by using mouth fresheners is unhealthy and does not work in the long run.

The writer is a periodontist and dental surgeon based in Chennai.

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