Halitosis
(halitosis; from Latin halitus - breath and Greek -osis - disease) or halitosis is a term used to describe a noticeably unpleasant odor when exhaling.
It is known to be the third most common reason, after tooth decay and gum disease, that prompts people to visit the dentist.
For a person with halitosis, the symptoms are invisible because the olfactory receptors become accustomed to the stench. In most cases (90%) the cause of bad breath is in the mouth.
The intensity of this phenomenon can change throughout the day due to the consumption of odorous foods such as cheese, fish, seasonings, garlic, alcohol, as well as smoking and, in general, overeating.
Since self-cleaning does not occur in the mouth during sleep, halitosis is usually more intense in the morning (“kittens wrote in their mouth”).
Bad breath can be ephemeral (going away after rinsing with a freshener or brushing your teeth) and persistent.
Sustained (chronic, persistent) halitosis is present in 25% of the population.
Causes of halitosis.
In the mouth.
There are more than 600 types of microorganisms in the average person's mouth. About a hundred of them can produce a stench even when grown in a laboratory.
Solobacterium moorei is a microorganism that is recognized by some researchers as the most active producer of stench.
This stench is produced mainly due to the decomposition of proteins into individual amino acids with their further decomposition into odorous substances.
For example, the decomposition of cysteine and methionine produces hydrogen sulfide and methyl mercaptan, respectively. Volatile sulfur compounds have been shown to be statistically related to the degree of halitosis and usually disappear with adequate treatment.
1.1. The tongue is where odor in the mouth appears in most cases.
A significant amount of natural microflora is localized in the villi and folds of the back of the tongue, especially on the back (root of the tongue).
This part of the tongue is relatively poorly cleaned and the bacterial population multiplies here on food debris, dead cells and nasal mucus.
Such a nutritional environment on the back of the tongue is ideal for anaerobic bacteria that produce a specific gas, the components of which are:
- putrid odor of indole substances,
- skatola,
- polyamines;
- “rotten egg” smell of volatile sulfur compounds (hydrogen sulfide, methyl mercaptan, allyl methyl sulfide and dimethyl sulfide).
Cleaning the tongue.
Chewing gum, sprays, rinses, etc. can only temporarily muffle the odor produced by bacteria on the root of the tongue, but cannot eliminate halitosis because they do not eliminate its cause.
To neutralize the release of the above-mentioned volatile sulfur compounds, it is necessary to remove plaque from the back of the tongue along with the aerobic and anaerobic microorganisms contained in it.
Typically, a tongue scraper or toothbrush is used for this.
1.2. Gum diseases (periodontitis).
There is some controversy regarding the role of gum disease in the formation of bad breath. However, advanced periodontitis is always the cause of halitosis.
The waste products of anaerobic bacteria developing in periodontal pockets have a disgusting odor and, as has been clinically proven, lead to severe halitosis.
Removing calculus (tartar) and loose gums has been proven to significantly freshen the smell of your mouth. It is desirable that this event be accompanied by subgingival scaling, root planing and tissue irrigation with antimicrobial agents.
1.2.1. Particular attention should be paid to pericoronitis of the wisdom tooth.
- inflammation of the gums around the eighth tooth that has not fully erupted. After the exacerbation is relieved, it is reasonable to remove these teeth.
1.2.2.
Fetid sore throat and
Vincent's stomatitis.
Tonsils (chronic tonsillitis).
In general, suppuration from the tonsils is considered statistically insignificant in the occurrence of halitosis (only about 5%). About 7% of the population suffers from tonsillar plugs, small pieces of calcified material in the folds of the tonsils.
They smell extremely unpleasant and when released can cause halitosis.
Nasal passages.
The nose is the second major cause of halitosis due to sinusitis and foreign bodies. In this case, the smell rather comes from the nose and is different from bad breath.
Esophagus.
The cardiac valve between the stomach and esophagus may not close well when the stomach herniates into the esophagus, allowing acid and stomach gases to leak into the mouth. With diverticulosis (false pouch) of the esophagus, deposited food debris can cause halitosis.
Stomach
Rarely is the cause of halitosis; belching should not be confused with the latter. With reflux (backward release of stomach contents), an odor may appear.
Liver.
Hepatic respiration (fetor hepaticus) is a condition associated with portal hypertension and liver failure. In this case, odorous digestive products (mercaptan, ammonia, ketones), instead of being destroyed in the liver, enter the lungs and, accordingly, into the exhaled air.
The breath has a sweetish, fecal tint. In this case, the fight against symptoms is no longer relevant.
Lungs and bronchi in acute and chronic inflammation and tumors (carcinoma).
Other diseases:
- renal failure,
- diabetes,
- metabolic diseases.
In what cases should you be concerned about such a symptom?
In any case, it is logical to consult a physician, dentist or gastroenterologist when halitosis appears to rule out the presence of serious health problems. Having found out the true causes of the unpleasant “aroma”, together with the doctor it is necessary to determine further tactics of behavior.
If halitosis is associated only with dietary restrictions or fasting, then only successful “masking” of it will be a sufficient measure. Otherwise, you should immediately begin treatment of organs that are malfunctioning in the body.
Another important note: it is advisable to carry out any dietary restriction only under the “supervision” of a qualified specialist (nutritionist or doctor), otherwise it is possible that there will be many more health problems than the expected benefits.
also necessary to “enter” and “exit” the diet gradually : the body may experience severe stress, which will not have the best effect on its condition.
Diagnosis of halitosis.
Self-diagnosis.
Smelling your own breath is difficult due to the adaptation of the olfactory receptors, although many halitosis sufferers can smell it in others.
Sometimes people experience an unpleasant taste in their mouth, but this is not always accompanied by halitosis. Usually people reliably learn about the presence of halitosis from their loved ones or from their doctor.
Special diagnostics.
It is required if the possible causes of halitosis, especially in the mouth, have been eliminated.
2.1. Halitometer
This is a device that determines the amount of hydrogen sulfide in exhaled air. Other odorous agents, such as mercaptan, are not detected by this device.
2.2. Digital gas chromatograph
measures the molecular level of major halitosogenic substances.
Sour smell
A specific sour aroma, reminiscent of vinegar, most often occurs for the following reasons.
Hormonal disorders. In most cases, such an unpleasant symptom is observed in people suffering from thyroid dysfunction. As a rule, the vinegar smell occurs due to a lack of iodine or its excess, however, any other malfunctions can lead to this problem. Diabetes mellitus. Even a slight increase in blood sugar levels indicates diabetes. In this case, there is usually severe thirst, increased sweating and constant dry mouth. Almost always this condition is accompanied by excess body weight.
Lack of vitamins D and B. It may be worth taking a course of multivitamin medications.
Infectious and inflammatory diseases of the lungs. Patients with tuberculosis, inflammation of the bronchi and lungs emit a vinegary smell of perspiration. If, in addition to the sour smell, you are worried about general weakness and malaise, fatigue, severe cough, fever, be sure to consult a doctor. In tuberculosis, the release of a vinegary odor is also accompanied by severe sweating, especially at night.
Mastopathy. If the concentration of vinegar aroma is concentrated in the chest area, perhaps we are talking about mastopathy of the mammary glands. It is necessary to contact a mammologist for an in-person examination and ultrasound diagnostics.
Autonomic neuroses. Avoid stressful situations, maintain a proper daily routine, and do not overuse increased physical activity or lack of sleep.
Treatment and prevention.
1.
It is known that very few people observe sufficient personal hygiene measures necessary for fresh breath.
This is, firstly, adequate teeth cleaning using electric, sonic and ultrasonic toothbrushes and irrigators with quality control using special plaque indicators.
Secondly, it is advisable to clean the tongue with a scraper and brush. Medicinal rinses are also appropriate.
2.
Diet. When eating raw, hard vegetables and fruits, the oral cavity self-cleanses.
3.
High-quality regular, if necessary repeated, professional teeth cleaning with removal of plaque and stones using ultrasound and sandblasting (air-flo).
Sometimes deep scaling, root planing and gum margin management are required. In advanced cases, reconstructive gum surgery is used.
4.
Dental treatment and adequate dental prosthetics.
Drug therapy.
1.
Antimicrobial drugs.
2.
Probiotics. For example Streptococcus salivarius K12.
6. Traditional medicine.
Camomile tea.
Pour a teaspoon of chamomile flowers into a glass of boiling water, leave for 2 hours, strain. Rinse your mouth with freshly prepared chamomile infusion 3 times a day.
Treatment of disgusting oral odor
If the source of the unpleasant odor is the oral cavity, it will require complete sanitation.
If the source of the smell of rot is diseases of the internal organs, then the first step in treatment should be aimed at solving these problems. Here, doctors of individual specializations already come to the rescue, and this happens according to generally accepted standards.
It’s another matter when bad breath is affected by dental diseases.
- If there is a problem with diseased teeth, they are treated or removed if they cannot be saved. The dentist independently determines the recommended course of action.
- Carrying out professional teeth cleaning - the procedure helps to remove all plaque on and under the gums.
- Treatment of inflammation of the gums, sanitization of the mouth, replacement of fillings and dentures if they are installed incorrectly.
- Training from a hygienist in proper independent oral hygiene.
- Correction of salivation to normal when it decreases.
Halitosis and exposed roots
Two recent studies show that volatile chemicals and the gas that causes halitosis have damaging effects on surrounding tissue.
The first study demonstrates the role of hydrogen sulfide (SH2), which causes periodontal cell death through apoptosis (fragmentation or programmed destruction).
Another study shows that the same hydrogen sulfide (SH2) accelerates the proliferation (reproduction) of bone-destructive cells (osteocasts).
These are cells that take part in the physiological (normal) remodeling of bone: the phenomenon of bone resorption, which allows, among other things, orthodontic movements, during which the activity of bone-building cells (osteoblasts) is balanced with the activity of osteoclasts.
Under the influence of hydrogen sulfide, cellular metabolism accelerates, triggering the mechanism of bone destruction under the influence of osteoclasts.
The balance is thus disturbed and bone resorption develops. This results in periodontal disease (periodontitis) and exposed roots.
The vicious circle is complete because periodontitis and exposed roots are a common cause of halitosis (bad breath).
Halitosis and pulpitis
Hydrogen sulfide, released during halitosis (bad breath), is also toxic to pulp cells. One study demonstrates that hydrogen sulfide profoundly disrupts the metabolism of the mitochondrial membranes of dental cells, causing cell death through apoptosis (breakdown into fragments).
Situated in the pulp chamber in the center of the tooth, the pulp is not isolated from the surrounding oral environment because exchange constantly occurs through dentin, a porous tissue, and enamel, which acts as a selective membrane.
Hydrogen sulfide penetrates and diffuses through the hard tissues of the tooth to negatively affect its vitality.
This phenomenon may explain the appearance of pulpitis (inflammation of the pulp) in intact (undamaged) teeth. It should be noted that tobacco smoke can have a toxic effect on the dental pulp through a similar mechanism.
In the case of pulpitis, divitalization or removal of the nerve is the only possible solution.
When is it necessary to consult a therapist?
Sometimes halitosis can be one of the symptoms of a systemic disease of the body: diabetes mellitus, accompanied by the appearance of the smell of acetone, gastritis and peptic ulcers, inflammation of the pancreas or hepatosis of the liver, chronic tonsillitis and sinusitis, inflammatory diseases of the lungs, which are characterized by a particularly unpleasant odor.
In patients with such diseases (especially undiagnosed or in the acute phase), manifestations of halitosis may persist even after complete sanitation of the oral cavity. They should seek advice from a therapist or continue treatment with a specialized specialist - an endocrinologist, gastroenterologist, otolaryngologist or pulmonologist.
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