Though halitosis is not a fatal ailment, the instant recoil of friends, classmates, co-workers and even strangers can erode the confidence of people suffering bad breath and negatively impact their personal relationships and career advancement – Dr. Gita Mathai

Halitosis or bad breath is a common problem affecting individuals of all ages and both sexes. Yet the oddity about bad breath is that 10-15 percent of the people who suffer from it tend to be blissfully unaware of their affliction. Usually, spouses, family members and friends feel shy and delicate about informing them of their condition. Though halitosis is not a fatal ailment, the instant recoil of friends, classmates, co-workers and even strangers can erode the confidence of people suffering bad breath and negatively impact their personal relationships and career advancement.

Everyone’s breath smells bad in the morning, but halitosis all day is abnormal. To check if you have bad breath, cup your palms, hold it over your mouth and nose, breathe out and then smell your breath. You can also breathe directly on to your wrist. An even easier way is to ask a child. You are likely to receive an unflattering but truthful reply.

Bad breath in infants and toddlers

It’s not uncommon for infants to develop bad breath, even before teething sets in. This is usually because they are put to sleep with a milk bottle in the mouth, allowing bacteria to flourish. It results in “bottle mouth” with caries in milk teeth, a coated tongue and foul breath.

Toddlers also develop bad breath because their parents neglect to brush their teeth twice a day. Moreover young children tend to place objects such as erasers, twigs, crayons, or erasers in their noses. This is likely to result in bad breath. An ENT surgeon can safely remove such objects.

Dental problems

In adults, foul breath is usually the result of untreated dental cavities. Bacteria feast on food stuck between the teeth forming plaque between the gums and teeth. This provides a crevice for bacteria to grow and causes foul-smelling gum infections. In some cases the tongue may have fissures and cracks which harbour bacteria that produce malodorous gases.

Food-related odours

Our intestines teem with good and bad bacteria digesting food which produce gases with a characteristic odour. Some food additives and condiments contain sulphides which are absorbed into the bloodstream and then released through breath. For instance, onions and garlic cause halitosis for some time even after the mouth is rinsed and teeth are brushed. Moreover gastrointestinal reflux disease (GERD) can cause foul-smelling breath and belching.

Sign of other diseases

Some diseases produce breath with a characteristic odour. Diabetic ketoacidosis produces a fruity odour. Kidney and liver malfunction can cause an ammonia-like smell. Intestinal obstruction causes the breath to smell bad. Some cancers also release characteristic odours.

Respiratory tract problems often cause halitosis. For example, inflamed sinusitis results in a multiplication of anaerobic bacteria which cause putrid breath. Allergies can also produce post nasal drip or a blocked nose with foul-smelling mouth breathing. Infected tonsils, adenoids and lung infections such as bronchitis, lung abscesses and bronchiectasis are caused by bacteria which can result in bad breath.

Moreover constant tobacco use — chewing, smoking or snuffing — causes halitosis.

Treatment

If you feel you have halitosis, consult a physician to rule out GERD, diabetes, liver and kidney disease or other contributing systemic disease.

Here are some effective ways to fight bad breath:

• Brush teeth twice a day, morning and evening, with a fluoride toothpaste and soft toothbrush. The size and shape of your brush should fit your mouth, allowing you to brush all areas easily. Replace your toothbrush every three or four months or sooner if the bristles are frayed.
• The proper brushing technique is to place your toothbrush at a 45-degree angle to the gums. Gently move the brush back and forth in short (tooth-wide) strokes. Brush the outer, inner, and then chewing surfaces. To clean the inside surfaces of incisors, tilt the brush vertically and make several up-and-down strokes.
• Rinse the mouth well after every meal. Mouthwashes can also be swirled around in the mouth for 30 seconds after every meal. Drinking 2-3 litres of water in summer is advisable. Water cleanses the mouth and washes out food debris and bacteria.
• If the tongue is coated, scrape it gently with a U-shaped tongue cleaner.
• Avoid putting infants and toddlers to sleep with feeding bottles in the mouth.
• Consult a dentist to ensure there is nothing wrong with your teeth and gums.
• Consult an ENT surgeon to rule out sinusitis and other nasopharyngeal problems.
• Maintain a food diary to assess if any particular food item is contributing to bad breath.

(Dr. Gita Mathai is a Vellore-based paediatrician and author of Staying Healthy in Modern India)