Halitosis is a symptom that emits a particular odor when breathing or when opening the mouth, and is most common in middle-aged and elderly people. Normal breath should be fresh and slightly sweet, even sometimes with a fragrance similar to the fragrance of a blooming chestnut flower. Halitosis can be divided into a broad sense of bad breath and a narrow sense of bad breath. Halitosis in English refers to bad breath from the gastrointestinal tract. There is also a phenomenon, called halitophobia, in which the patient does not have any objective evidence of halitosis but is self-conscious of suffering from halitosis, i.e. psychogenic halitosis.
Halitosis is a common phenomenon. Nearly 65% of people have experienced bad breath at one time or another. The prevalence of halitosis is significantly higher in men than in women, but women are seen in significantly greater numbers than men. Many patients with bad breath are distressed by this and seek medical help everywhere without success. More people lack a clear understanding of this, and are at a loss. At the same time, there are more and more products on the market, claiming to get rid of bad breath and solicit customers.
First, the cause of bad breath
Halitosis is latent in the teeth and tongue back of the anaerobic bacteria in the decomposition of proteins, peptides and amino acids, resulting in odor, sulfur-containing volatile components, in addition to oral diseases, diseases of organs near the mouth, such as tonsillitis, sinusitis, nasal polyps, respiratory tract foreign bodies, etc., is also a more common cause of halitosis. Many systemic diseases that are not well controlled, the patient’s exhaled breath will have a distinct idiosyncrasy with certain specific flavors. For example, the breath of diabetic patients with a fruity taste, the breath of patients with renal failure with a fishy smell, patients with cirrhosis of the liver have a strong sulfur smell in the mouth, and patients with lung abscess or bronchiectasis often have a foul odor. However, the etiology of bad breath goes far beyond these diseases. Materials containing clove oil and pomegranate oil are commonly used in oral treatments, and they are considered to be bad breath because of the unpleasant odor they produce when they break down in the mouth. It has also been found that dietary habits play an important role in the formation of bad breath. Foods such as onions, garlic, and animal fats can cause specific bad breath. This bad breath cannot even be removed by brushing your teeth. All of these bad breaths are transient and food or drug related, so they are easier to identify. Psychological halitosis is a self-perception of bad breath that is not actually present in the patient. These patients have obvious psychological manifestations. Its treatment is relatively difficult. There is a common misconception that gastrointestinal disorders are also an important cause of halitosis. In fact, the esophagus is closed when not eating. It is only when burping that gas from the gastrointestinal tract is expelled through the mouth. Therefore, the bad breath that can often be felt has little to do with the gastrointestinal tract. However, there are some more serious gastric diseases, such as gastric cancer, malabsorption syndrome, reflux esophagitis, etc., together with closed esophagus, often accompanied by persistent bad breath.
In daily life, bad breath is judged by the following methods.
1, the feedback of people living in close contact: the human brain has a special ability to almost completely inhibit its own odor. The reason for this is unclear, and it may be related to the self-protective function that gradually developed during the long-term evolution of animals. People in close contact with the patient can know the good time of halitosis, triggering factors and aggravating factors.
2.Spoon test method: Use a spoon to scrape the plaque and residue from the back of the tongue, and sniff it by yourself or others.
3, home microbiological testing: This method was invented by MitchellM, Strumpf. The specific practice is to ask the patient to take several deep breaths to make the tongue surface as dry as possible, and then use two sterilized cotton swabs to rotate with pressure at the midline of the back of the patient’s tongue to collect as much tongue coverage as possible.
After a clear diagnosis of halitosis, the source of halitosis must be identified. In the oral cavity, common sites of halitosis are the dorsum of the tongue (especially the root of the tongue), subgingival, adjacent surfaces of teeth, poor restorations (e.g., overhangs, crown edges), food-embedded sections, apical abscesses, and removable dentures.
Halitosis from the mouth and tongue has the following characteristics.
1, let the patient pinch the nose and exhale, still can smell the odor.
2.The back third of the tongue has a relatively thick tongue moss, and bad breath disappears after complete removal of the tongue moss.
3.There is food residue under or around the filling or restoration, and the bad breath disappears after removal.
4, there are ulcers in the mouth, mucosal ulcerative stomatitis, bad breath is reduced and disappears with the improvement and healing of ulcers.
5.The depth of periodontal pocket is more than 4 mm, there is gingival margin inflammation with bleeding or pus overflow.
6.Loose filling, cavity, alveolar abscess, calculus, bad restoration, interdental food embedment.
7.The patient is taking antibacterial agent for a long time may induce fungal infection.
8.Patients suffering from dry mouth syndrome may be accompanied by oral flora imbalance.
9.Tonsil infection and enlargement.
Dry mouth syndrome is also one of the common factors that produce bad breath. When saliva is reduced, the antibacterial substances in saliva are also reduced, and the flora in the mouth is out of balance. In addition to dry mouth syndrome, there are many diseases that cause decreased saliva production. Decreased saliva production is also more common in people over 50 years of age.
This type of halitosis is characterized by.
1. The patient’s saliva is significantly reduced.
2. The incidence of root surface caries and secondary caries is relatively high in patients. A small number of patients suffering from systemic diseases will also have bad breath.
For example, when diabetic patients have symptoms such as loss of weight, recurrent disease, obvious dry mouth, acidosis or near hyperglycemic coma, it means that the disease is out of control and bad breath is likely to occur at this time. Bad breath that occurs in systemic diseases is often associated with recurrent disease, is of relatively short duration, and is mostly expelled through the lungs. This type of halitosis has little to do with volatile sulfur-containing substances and is related to volatile blood-borne substances, which are not part of the discussion in this article.
Second, the treatment of bad breath
Bad breath can be prevented, and good oral hygiene habits can control plaque in the mouth well. For example, brushing your teeth can maintain no significant bad breath for 2 hours. Toothpaste containing sodium bicarbonate has a better effect on removing bad breath than fluoride toothpaste.
Analysis of the causes of bad breath, etiological treatment, that is, for all the above causes of bad breath for the corresponding treatment, often to get a better treatment effect, which is currently the preferred treatment for bad breath, the elimination of bad breath can be divided into mechanical and chemical two. Scaling, reconditioning fillings, flossing, etc. are mechanical methods, rinsing and denture rinsing are chemical, and brushing and rinsing are both. Chemical methods can also be divided into local and systemic.
Most patients with halitosis after proper oral cleaning, including the eradication of periodontal pockets, improve oral hygiene, treatment of dental caries, restoration of interdental contact points, full mouth cleaning, extraction of teeth that can not be restored, as well as the correction of other defects, adhere to the daily morning and evening brushing, rinse after meals, in order to achieve as much as possible to reduce the accumulation of food residues to reduce saliva stagnation, reduce the breakdown of protein products, can better treat halitosis.
For patients with bad breath originating from the back of the tongue, doing a gentle and thorough cleaning every day is the most effective way to eliminate bad breath. Nowadays, there are some applicable products sold in the market. Gargling can relieve bad breath, but only for 15 minutes. Experiments have proven that many oral microorganisms have an oleophilic tendency and they are easily attracted to the oil droplets. Therefore, gargling with salt water and olive oil alternately can remove most of the pathogenic bacteria and debris in the mouth, which is called biphasic gargling. The time to gargle is more suitable before going to bed, which can make the active ingredients in the mouthwash remaining in the mouth continue to work during sleep. When gargling, tilt your head so that the gargling solution reaches the back of the mouth.
In order to control bad breath caused by inflammation of the mouth, nose or sinuses, it is necessary to use antimicrobials, the problem is that an effective one must be chosen. In patients with dry mouth syndrome, medications that stimulate saliva production should be given. Elimination of bad breath related to the nasal and sinus cavities should be done in cooperation with an otorhinolaryngologist and, if necessary, in consultation with a specialist in allergy and allergic reactions.