Halitosis: treatment of bad breath


Breath is the air emitted during exhaling by the mouth and nose.
Normal breath smells of fresh chestnut.
By contrast, abnormal breath (bad breath or halitosis) is an unpleasant smell (eggs, rotten cabbage or fish, a dead mouse or a rotten apple) from the mouth or the nose. It could be the symptom of a local or general disease.

Halitosis may be temporary, linked to temporary changes in the dental situation: morning halitosis, dietary halitosis (due to certain foods: garlic, onion, tobacco, coffee or the administration of certain medication) or of longer duration due to local or general systemic disorders (conditions concerning the dental cavity, E.N.T. problems or conditions of the digestive, pulmonary, endocrine or other systems).

With pseudo halitosis, patients are wrongly convinced that they have bad breath and use products to mask it. Clinical examination shows they have normal breath. Reassuring them more often solves the problem but psychological care is sometimes necessary.

What factors promote bad breath?

Bad breath is the result of the spread of bacteria and tissue (organic or food) degradation. Volatile compounds producing a bad odour are the result.
Factors promoting this are:

  • Accumulation of dental plaque (very adhesive coating sticking to the enamel consisting of food residue, dead cells and bacteria) in the case of poor oral hygiene
  • Tooth decay
  • Periodontal diseases
  • Mouth ulcers: a major source of superinfection with the bacteria responsible for producing the volatile compounds
  • Dry mouth known as xerostomia: this is a reduction of the flow of saliva after taking certain medication, during certain diseases (Gougerot-Sjogren syndrom) or after irradiation. This leads to an increase of the microbial density and liberation of the volatile compounds in the form of gas. A quantitative reduction of saliva may be the cause of tooth decay, ulcerations, thrush, bacterial increase and elimination of various volatile compounds responsible for bad breath. Saliva is indispensible in maintaining good oral health. A high level of sulphurous amino acids in the saliva promotes bad breath. The quality and flow of saliva should be analysed in the case of halitosis.
  • Furry tongue; the dorsum of the tongue contains taste buds with dead cells that have not been eliminated as well as multiple fissures. This promotes the retention of bacteria. The coating on the tongue resulting from this is a major source of volatile sulphurous components.
An excess of proteins in the food increases the pH and consequently, the production of volatile components.

How to prevent bad breath?

Good personal hygiene is necessary in order to prevent bad breath: rigorous oral hygiene: brushing teeth with a soft brush at least twice a day (morning and evening after meals), using accessories such as dental floss, interdental brushes particularly those with a tongue scraper; using a mouth wash (following advice from the dental surgeon) with non-alcoholic products in order to prevent the mucous membranes from drying out, reducing alcohol and coffee intake, giving up tobacco, following a balanced diet and avoiding food that promotes bad breath: garlic, onions and protein-rich diets, rehydrate well (6 to 8 glasses of water a day).

What to do in the case of bad breath?

You first of all need to establish the cause(s) of the bad breath.
The dental surgeon can help you to research some etiologies directly linked to the oral cavity, the most frequent cause of halitosis (clinical and radiographic dental and periodontal examination) or direct you towards other specialists: E.N.T. specialist, gastroenterologist, respirologist...
In fact, more often a multidisciplinary approach is necessary.

The causes are oral in 90% of cases, E.N.T.-related in 7% and others in 3% of cases.
Once the etiological factors have been established, their removal should resolve or at least improve the bad breath. Rectification of the oral cavity and periodontal cleaning are almost always necessary.
Certain hygiene or food rules can be a big help: avoid certains foods that promote bad breath: garlic, onions, excess proteins; the same goes for coffee or tobacco;
practise rigorous oral hygiene, use mouth wash, oral spray, chewing gum that will counter temporary bad breath.