halitosis n : offensive breath
condition of having foul-smelling breath
Halitosis, oral malodor (scientific term), breath odor, foul breath, fetor oris, fetor ex ore, or most commonly bad breath are terms used to describe noticeably unpleasant odors exhaled in breathing – whether the smell is from an oral source or not. Halitosis has a significant impact — personally and socially — on those who suffer from it or believe they do (halitophobia), and is estimated to be the 3rd most frequent reason for seeking dental aid, following tooth decay and periodontal disease.
GeneralIn most cases (85-90%), bad breath originates in the mouth itself. The intensity of bad breath differs during the day, as a function of oral dryness, (which may be due to stress or fasting), eating certain foods (such as garlic, onions, meat, fish and cheese), obesity, smoking and alcohol consumption. Because the mouth is dry and inactive during the night, the odor is usually worse upon awakening ("morning breath"). Bad breath may be transient, often disappearing following eating, brushing one's teeth, flossing, and rinsing with specialised mouthwash.
Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees. It can negatively affect the individual's personal, social and business relationships, leading to poor self-esteem and increased stress. This condition is usually caused by the metabolic activity of certain types of oral bacteria.
Though the causes of breath odor are not entirely understood, most unpleasant odors are known to arise from proteins trapped in the mouth which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Several dozens of these can produce high levels of foul odors when incubated in the laboratory.
The most common location for mouth-related halitosis is the tongue. Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells and postnasal drip. The convoluted microbial structure of the tongue dorsum provides an ideal habitat for anaerobic bacteria, which flourish under a continually-forming tongue coating of food debris, dead cells, postnasal drip and overlying bacteria, living and dead. When left on the tongue, the anaerobic respiration of such bacteria can yield either the putrescent smell of indole, skatole, polyamines, or the "rotten egg" smell of volatile sulfur compounds (VSCs) such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide.
The odors are produced mainly due to the anaerobic breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. For example, the breakdown of cysteine and methionine produce hydrogen sulfide and methyl mercaptan respectively. Volatile sulfur compounds have been shown to be statistically associated with oral malodor levels, and usually decrease following successful treatment.
Other parts of the mouth may also contribute to the overall odor, but are not as common as the back of the tongue. These locations are, in descending prevalence order: inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses and unclean dentures.
Gum diseaseThere is some controversy over the role of periodontal diseases in causing bad breath. Whereas bacteria growing below the gumline (subgingival dental plaque) have a foul smell upon removal, several studies reported no statistical correlation between malodor and periodontal parameters.
NoseThe second major source of bad breath is the nose. In this instance, the odor exiting the nostrils has a pungent odor which differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies.
StomachSome people believe - and some businesses through advertising have attempted to foster the belief - that bad breath comes from the stomach rather than from the mouth.
In fact, most researchers consider the stomach as a very uncommon source of bad breath (except in belching). The esophagus is a closed and collapsed tube, and continuous flow (as opposed to a simple burp) of gas or putrid substances from the stomach indicates a health problem - such as reflux serious enough to be bringing up stomach contents or a fistula between the stomach and the esophagus - which will demonstrate more serious manifestations than just foul odor.
Individuals afflicted by the above conditions often show additional, more diagnostically conclusive symptoms than bad breath. People troubled by bad breath should not conclude that they suffer from these conditions or diseases.
Self diagnosis and home diagnosisScientists have long thought that smelling one's own breath odor is often difficult due to habituation, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis isn't easy because of preconceived notions of how bad we think it should be. Some people assume that they have bad breath because of bad taste (metallic, sour, fecal, etc), however bad taste is considered a poor indicator.
For these reasons, the simplest and most effective way to know whether one has bad breath is to ask a trusted adult family member or very close friend ("confidant"). If the confidant confirms that there is a breath problem, he or she can help determine whether it is coming from the mouth or the nose, and whether a particular treatment is effective or not.
One popular home method to determine the presence of bad breath is to lick the back of the wrist, let the saliva dry for a minute or two, and smell the result. This test results in overestimation, as concluded from research, and should be avoided.
- Gas chromatography: portable machines, such as the OralChroma, are currently being introduced. This technology is specifically designed to digitally measure molecular levels of the three major VSCs in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.
- BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
- β-galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodor.
Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts ("organoleptic measurements"). The level of odor is usually assessed on a six point intensity scale.
Home care and treatmentCurrently, chronic halitosis is not very well understood by most physicians and dentists, so effective treatment is not always easy to find. Six strategies may be suggested:
- Eating a healthy breakfast with rough foods helps clean the very back of the tongue.
- Maintaining proper oral hygiene, including brushing, daily flossing, and periodic visits to dentists and hygienists. Flossing is particularly important in removing rotting food debris and bacterial plaque from between the teeth, especially at the gumline. Dentures should be properly cleaned and soaked overnight in antibacterial solution (unless otherwise advised by your dentist). They may also contain alcohol, which is a drying agent and may worsen the problem. Rinses in this category include Scope and Listerine.
Other solutions rely on odor eliminators like oxidizers to eliminate existing bad breath on a short-term basis. Rinses in this category include TheraBreath, Closys and others.
Bad breath may be temporarily reduced by using a hydrogen peroxide rinse. Hydrogen peroxide at a concentration of 1.5% can be taken as an oral antiseptic by gargling 10 ml, about two teaspoons. Hydrogen peroxide is commonly available at a concentration of 3% and should be diluted to 1.5% by mixing it with an equal volume of water. Hydrogen peroxide is a powerful oxidizer which kills most bacteria, including useful aerobic bacteria. Prolonged use of hydrogen peroxide may be harmful. Concentrated hydrogen peroxide (>50%) is corrosive, and even domestic-strength solutions can cause irritation to the eyes, mucous membranes and skin. Swallowing hydrogen peroxide solutions is particularly dangerous, as decomposition in the stomach releases large quantities of gas (10 times the volume of a 3% solution) leading to internal bleeding. Inhaling over 10% can cause severe pulmonary irritation.
A relatively new approach for home-care of bad breath is by oil-containing mouthwashes. The use of essential oils has been studied, was found effective and is being used in several commercial mouthwashes, as well as the use of two-phase (oil:water) mouthwashes, which have been found to be effective in reducing oral malodor.
Halitophobia (delusion halitosis)Some one quarter of the patients seeking professional advice on bad breath suffer from a highly exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of Olfactory Reference Syndrome. These patients are sure that they have bad breath, although many have not asked anyone for an objective opinion. Halitophobia may severely affect the lives of some 0.5-1.0% of the adult population. Only few psychologists and health professionals have tried to come to terms with this debilitating and difficult-to-treat emotional problem.
Scientific researchIn 1996, an international scientific organization (The International Society for Breath Odor Research, ISBOR) was formed to promote multidisciplinary research on all aspects of breath odors. The seventh international conference on breath odor took place in August, 2007 in Chicago, and the next conference is expected to take place in 2009 in Dortmund, Germany.
- [American Academy of Periodontology.
- Halitosis fact sheet –by the British Dental Association.
- Halitosis – fact file – by the British Dental Association.
- Article on Bad Breath prevention – from CNN.com.
- http://www.badbreathhalitosis.com – from MSNBC.
- ISBOR – International society for breath odor research.
- Bad Breath - a Human Condition - video by the University of Toronto.
halitosis in Czech: Zápach z úst
halitosis in German: Mundgeruch
halitosis in Spanish: Halitosis
halitosis in Persian: بدبویی دهان
halitosis in French: Halitose
halitosis in Italian: Alitosi
halitosis in Hebrew: באשת
halitosis in Dutch: Foetor ex ore
halitosis in Japanese: 口臭
halitosis in Polish: Cuchnący oddech
halitosis in Portuguese: Halitose
halitosis in Russian: Галитоз
halitosis in Swedish: Dålig andedräkt
halitosis in Telugu: నోటి దుర్వాసన