Why does breathe smell bad? Common causes and simple solutions

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Bad breath, also known as halitosis is a common and really an embarassing condition. It is an offensive and unpleasant maldour coming from the mouth. Usually it is a temporary condition, but when it is chronic, it reduces patient's confidence, social interactions and overall quality of life.
Many people experience bad breath occassionally, especially after consuming certain foods, but if we have persistent bad breath, it reflects some underlying conditions and shuld be dealt accordingly.

Categorization
Halitosis is categorized as genuine halitosis, pseudo-halitosis and halitophobia.
Genuine halitosis: socially unacceptalbe malodour coming out from the exhaled air.

Pseudo-halitosis: condition in which patient complains of having bad breath but clinicians cannot establish it through the means of any scientific test.

Halitophobia: Despite adequate medical treatment, patient complains of bad breath although it is not evident clinically and socially.

Causes of bad breath
The cause of halitosis is usually multifactorial.
a) Poor oral hygiene: Most common cause. Intraoral micrbial communities colonize the tongue and teeth, gums forming a biofilm. It produces volatile sulphur compounds like methylmercaptan and hydrogen sulfite.

b) Dry mouth: Saliva produced by glands like parotid glands and submandibular glands cleanse the oral cavity. When saliva secretion is low, it may lead to multiplication of anaerobic bacterias leading to foul breath. Hyposalivation naturally occurs at night during sleep causing bad breath at morning.

c)Food and drinks: Certain food items like garlics, onions and spices may lead to bad breath.

d) Gingivitis: Inflammation of the gums can produce an unpleasant odour.
e) Smoking and tobacco use: produces bad breath to to chronic mucosal inflammation. Tobacco users are more likely to have gum disease.

f) ENT diseases: Several ENT causes like tonsilltis, tonsillolith, tonsillar cysts, chronic sinusitis and post-nasal drip may cause bad breath.

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g) Underlying systemic causes: Conditions like diabetes mellitus, Gastro-esophageal reflux disease, liver and kidney diseases may cause halitosis.

How can we get rid of bad breath?
a) Maintain good oral hygiene: Make habit of brushing twice daily. Good oral hygiene is the foundation of fresh breath and overall health. Brushng teeth twice daily removes food particles and debri preventing the sulfur producing bacteria from multiplying in the oral cavity.

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b)Mechanical scrubbing of the dorsum of tongue : removes tongue coating which is the foremost cause of halitosis. The tongue can be scraped by a variety of dental tools to remove the tongue coating.

c) Gargle: Make habit of gargling the oral cavity with solutions containing chlorhexidine, zinc, stannous fluoride and amine fluoride. Povidone iodine gargle can also be used.

d) Use of pahrmacological probiotics: Pprobiotics are the benificial bacterias that help to maintain a healthy balance of bacteria in the body. A probiotic capsule containing the bacteria Lactbacillus reuteri , Lactobacillus salivarius and xylitol is very benificial.

e) ENT checkup for conditions like chronic sinusitis, management of tonsilloliths, chronic tonsillitis and post nasal drips.

f) Treatment of systemic illnesses like diabetes, malignancies, liver and kidney diseases.

References:

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC10506127/
2. https://emedicine.medscape.com/article/867570-overview#a10
3. https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922