Bad breath is the odor emitted from the mouth or other air-filled cavities (such as the nose, sinuses, pharynx), and research studies show that 10% to 65% of people worldwide have suffered from bad breath, which seriously affects people’s psychological and social activities.
The causes of halitosis are complex, and different diseases can cause different smells of halitosis, and the composition of exhaled gas varies; for example, patients with digestive system diseases can have an acidic odor in the mouth; diabetic ketoacidosis patients exhale gas with acetone; liver disease patients have putrid breath; kidney patients exhale gas with ammonia. Therefore, according to the composition and nature of the patient’s exhaled gas, it helps the diagnosis and treatment of the disease.
First, physiological halitosis
Physiological halitosis refers to the organism without pathological changes, mainly caused by poor living and hygiene habits of transient halitosis, such as
1, leeks, stinky tofu and other irritating foods, containing sulfide components, odor can remain in the mouth after consumption.
2, tobacco contains not only volatile sulfides, but also can dry the mouth, lead to periodontal disease, causing bad breath.
3, saliva has antibacterial, bactericidal, clean oral role, sleep due to reduced saliva secretion, antibacterial effect is weakened, generating a large number of volatile sulfides, ammonia and other substances, thus triggering transient bad breath, mostly seen in the morning wake up.
4, not diligent brushing and other poor oral hygiene habits can lead to a large number of food residues embedded in the teeth for a long time, the oral bacteria fermentation, decomposition of a large number of volatile sulfide, indole and other substances, and produce oral odor, food residues and shedding mucosal epithelial cells can also cause the tongue and the back of the tongue plaque increases lead to bad breath;.
5, long-term alcohol consumption, meat, staying up late, insomnia, etc. can cause physiological halitosis.
In order to prevent the occurrence of such bad breath, we should maintain good and healthy living and hygiene habits, brush our teeth correctly and effectively in the morning and evening, maintain oral and tongue hygiene, avoid irritating food, avoid smoking and alcohol, and develop good work and rest habits.
Second, pathological halitosis
Pathological halitosis is caused by pathological changes in the organism causing oral odor, mainly for pathological changes in the oral cavity and many problems associated with systemic diseases. Depending on the location of the lesion, pathological halitosis is divided into orogenic halitosis and non-orogenic halitosis.
Third, orogenic halitosis
There are a large number of microorganisms in the oral cavity, mainly Gram-negative anaerobic bacteria, when the bacterial decomposition of protein substrates such as sulfur-containing amino acids can produce volatile sulfide, ammonia, organic acids and other substances and produce oral odor.
Research shows that 80%~90% of orogenic halitosis originates from local infection of the oral cavity; when caries, bacteria can multiply in the caries and produce a large amount of volatile sulfide to produce odor; the tongue can also increase the production of volatile sulfide, and studies have shown that the degree of halitosis is significantly related to the thickness and area of the tongue, acute respiratory infections can lead to thickening of the tongue, and the thicker the tongue, the easier it is to form an anaerobic environment Facilitate the growth of anaerobic bacteria, resulting in the production of volatile sulfide; suffering from gingivitis, periodontitis, gingival bleeding, inflammatory exudate increased, anaerobic bacteria fermentation decomposition of blood, inflammatory exudate in organic components, volatile sulfide, halitosis; Schegren’s syndrome and tumor radiation therapy caused by saliva reduction and oral mucosal disease can also cause orogenic halitosis.
Fourth, non-stomatogenic halitosis
1, Helicobacter pylori infection
The relationship between H. pylori infection and halitosis can be traced back to 1984, Warren et al. Since the discovery of H. pylori, in July 1984, animals were given oral suspension of H. pylori. In the 2nd week of the test, there was an unpleasant odor in their exhaled gas, indicating that the animals had halitosis after H. pylori infection. In recent years, more scholars have used different methods to study the relationship between H. pylori and gastrointestinal tube diseases to understand whether they are related.
2, gastroesophageal reflux disease
GERD is a digestive inflammation of the esophageal mucosa caused by reflux of gastric and duodenal contents into the esophagus, mainly due to various causes of anti-reflux dysfunction in the high-pressure zone of the esophagogastric junction, or local mechanical anti-reflux mechanism disorder.GERD includes non-erosive GERD, erosive GERD and chronic esophagitis (Barrett’s esophagitis).In addition to esophageal syndrome, GERD also has Moshkowitz et al. found a significant association between GERD and halitosis in upper gastrointestinal endoscopy, Helicobacter pylori testing and questionnaires in patients with GERD. Poelmans et al. also found that halitosis was present in 40% of patients with GERD with extraesophageal manifestations. It has also been shown that halitosis is more prevalent in celiac GERD than in non-celiac GERD, and that the symptoms of halitosis are more severe.
The mechanism of bad breath caused by GERD is due to the reflux of gastric acid, pepsin, bile salts and pancreatic enzymes from the stomach and duodenum into the esophagus, which damages the esophageal mucosa and causes inflammation, erosion, ulceration or stricture of the esophagus, spreading to the entire upper esophageal sphincter to the oral cavity, where anaerobic bacteria and parthenogenic anaerobic bacteria produce odor through the oral cavity, causing bad breath. In addition, GERD causes esophageal symptoms, and its reflux can cause similar symptoms in the oral cavity. In the oral cavity, GERD causes oral erosion so that patients can not maintain normal oral hygiene, so that plaque and soft scale deposited on the surface of the teeth, food residue retained in the oral cavity, through the plaque of anaerobic bacteria corruption necrosis, so that there is bad breath.
3, indigestion
Indigestion is mostly manifested as continuous or intermittent upper abdominal discomfort or pain, fullness, heartburn, belching, etc.. Indigestion can be divided into organic indigestion and functional indigestion. Epidemiological data related to dyspepsia show that 50% of people with dyspepsia have bad breath.
It is widely believed that the gastrointestinal tract of dyspepsia is weak, food is not easily digested and emptied and stays in the stomach for a longer period of time, the food is corrupted by bacteria and releases odor, the corrupted food and its odor are easily refluxed, the odor is exhaled through the mouth or remains in the mouth, and bad breath is formed. This part of the patient is accompanied by symptoms of gastroesophageal reflux, such as acid reflux, heartburn, bloating and belching.
4.Patients with inflammatory bowel disease
In addition to H. pylori infection, GERD and dyspepsia, some scholars found that patients with inflammatory bowel disease have a higher rate of bad breath, and Kinberg et al. found that adolescents and children with duodenal and esophageal diseases have bad breath.
5, constipation
Constipation can also cause bad breath. The number of probiotic bacteria, especially bifidobacteria, in the intestine of constipated patients is significantly reduced, and the number of pathogenic bacteria is significantly increased, resulting in more serious intestinal flora disorders and a reduction in the production of short-chain fatty acids, which eventually causes bad breath.
6.Metabolic diseases
Nutritional obesity, type II diabetes, fatty liver and other metabolic diseases can cause bad breath; patients with a long-term high-fat diet, the intake of dietary fiber is less, resulting in a lack of nutrients for the intestinal flora and a reduction in the synthetic substrate of short-chain fatty acids, resulting in a decrease in the amount of oral short-chain fatty acids, causing bad breath.
7, respiratory system diseases
It is often a transient bad breath, which is also rare clinically; chronic tonsillitis patients often have bad breath symptoms, Rio et al. confirmed that this may be the existence of crypt in the palatine tonsils, which accumulates shed epithelial cells and keratin debris to provide a good environment for the growth of anaerobic bacteria, these bacteria can ferment and decompose organic matter in the residue, producing sulfur compounds, released into the mouth, causing oral odor; lung cancer patients are also often accompanied by Patients with lung cancer also often have bad breath, which makes patients exhale gas with bad odor.
8.Other
The main causes include taking certain drugs, kidney disease, blood disease, heavy metal poisoning, etc. Some patients in taking certain drugs (dimethyl sulfide, quinine, antihistamines, phenothiazines) will produce bad breath, which is related to the metabolism of drugs in the body with irritating smell of volatile organic compounds, mostly transient halitosis, can disappear after stopping the drug; foreign research shows that women’s physiological period will produce bad breath, but the reason is the low level of sex hormones during menstruation, resulting in oral tissue Resistance is reduced, causing bad breath and oral mucosal ulcers; renal insufficiency of the patient’s breath contains trimethylamine components, with ammonia irritating odor, can also be used as a marker for the diagnosis of kidney disease and evaluation of treatment; in addition, vitamin deficiency, mental stress and anxiety can also cause bad breath.
Fifth, how to treat bad breath
If the cause of bad breath is of oral origin, patients should see a dentist for professional cleaning to treat gum disease and repair dental caries. Home treatment involves intensive oral hygiene, including thorough brushing, flossing, and scraping the tongue with a toothbrush or scraper. Mouth rinses are of limited use and only cover the ectopia for about 20 minutes. Psychosomatic halitosis requires psychological counseling.