Bad breath: Causes and treatment

The article was written by MSc Nguyen Thi Cam Tu - Gastroenterologist, Department of General Internal Medicine - Vinmec Times City International General Hospital.

Halitosis is a common condition. The patient may not be aware of their own bad breath and pick it up from others.

Physiological Halitosis - Bad breath has no specific cause. It is usually worse in the morning and is usually transient. Pathological Halitosis - Bad breath due to a specific identifiable cause. False halitosis - Patients assume bad breath when there is no objective evidence of bad breath. Most affected people are not aware of halitosis, it affects all ages, including children, although it is more commonly seen in adults. Men and women are equally affected.

Halitosis can be classified as physiological, pathological, or subjective.
Physiological causes
Physiological halitosis usually occurs in the morning due to a relatively small amount of saliva. It is the result of bacterial action on sloughed epithelial cells and trapped food particles on the back of the tongue. It can be more prominent with a lack of attention to personal oral hygiene. It usually goes away soon after brushing, flossing, eating, or drinking water.
Other causes of temporary halitosis include smoking and eating fragrant foods (eg, garlic, onions) and certain beverages (eg, alcohol, coffee).
Customers can refer to:
>>> Common causes of bad breath and how to limit it
Causes from the mouth
Pathology in the mouth is the most common identifiable cause of bad breath . When oral disease produces halitosis, the observer will notice a strong odor from the mouth. Oral causes of bad breath include:

Periodontal infections. Halitosis can originate from the teeth in patients with severe cavities or food particles trapped between the teeth. Excessive tongue coating can cause halitosis. A bad-smelling tongue scraping indicates that too thick a tongue coating is the cause of halitosis. Dry mouth has been linked to halitosis, as lack of saliva flow compromises the antibacterial activity of saliva, leading to more bacteria in the mouth and increased plaque on teeth and the coating on the tongue. Many medications can cause dry mouth, including diuretics, antihistamines and decongestants, tricyclic antidepressants, and amphetamines. Tonsillitis accounts for a small percentage of cases Patients with chronic tonsillitis Peritonsillar abscess can also cause bad breath ●Less common causes of halitosis arising from the mouth include dentures improperly cleaned and necrotic tumors.
Causes from the nose
When halitosis is caused by the nose, the smell detected when exhaled will be larger than the smell exhaled through the mouth. Nasal causes of halitosis include:
Acute or chronic sinusitis Postnasal drip Foreign body in the nose, commonly seen in children, is an uncommon cause of halitosis

Respiratory causes
Lung infections, such as bronchitis, bronchiectasis, or lung abscess, are rare causes of halitosis.
Esophageal causes
Uncommon, halitosis can originate in the gastrointestinal tract. Smelly volatiles can be released from the stomach through the esophagus and mouth and cause bad breath. Gastroesophageal causes of halitosis include:
Zenker's diverticulum Gastric fistula Helicobacter pylori infection (unknown) Gastroesophageal reflux disease (GERD) (unknown) Causes systemic
With systemic causes of halitosis, the intensity of the odor from the mouth and nose is similar. Causes include:
Advanced kidney disease Advanced liver disease Diabetic ketoacidosis

The patient needs to see a specialist and will be consulted by a doctor in the following cases:
The patient will be referred to a dentist if the initial assessment shows signs of gingivitis, inflammation of the gums. periodontal disease or other serious oral disease. Patients will be referred to a neurologist if a neurological basis for subjective halitosis (disorder of taste or smell) is suspected. The patient will be referred to a gastroenterologist for an endoscopy to evaluate the possible source of the halitosis due to gastroesophageal reflux. Patients will be referred to an otolaryngologist for patients with chronic tonsillitis and tonsillitis who have persistent halitosis despite conservative measures to improve oral hygiene.

Unknown cause - For patients with halitosis for which no cause can be identified, a variety of self-care measures (including lifestyle modifications) can be applied. Such interventions include:
Sugar-free gum (which stimulates salivation). Drink enough water to avoid dry mouth. Reduce alcohol and coffee consumption. Proper oral care and oral hygiene, including daily flossing. Gently clean the tongue (e.g. with a plastic tongue cleaner). Gargle with mouthwash before going to bed. The best time to use mouthwash is before going to bed, because the residue of mouthwash can stay in the mouth longer and be more effective. In addition, the bacterial activity that leads to bad breath is greatest during sleep, when saliva flow is practically zero and bacterial activity is highest.