Halitosis and Halitosis Treatment

Halitosis, or bad breath, is a breath odor that is distinctive, unpleasant, and all too frequently, downright offensive. Although there are many causes of Halitosis and bad breath, the most frequent underlying cause is the presence of anaerobic bacteria and the sulfur compounds they produce.

These bacteria are called anaerobic (meaning "without oxygen") because they thrive in oxygen-free environments. Even though you take in oxygen with every breath, it's important to note that anaerobic bacteria live deep within your tongue's surface where the papillae, or fibers, connect to it. Under normal circumstances, oxygen does not reach that level.

Oddly enough, the presence of anaerobic bacteria is actually a good thing because they perform an important function. They're responsible for breaking down proteins found in specific foods, so they thrive on proteins. Unfortunately, proteins are also present in oral and sinus secretions which find their way to the tongue and to the back of the throat, as well as in blood and diseased oral tissue, all of which provide an excellent food source for the bacteria that cause Halitosis.

The breakdown process produces a number of Volatile Sulfur Compounds (VSC) such as Hydrogen Sulfide and Methyl Mercaptan, the release of which creates unpleasant odors and tastes. When the bacteria break down proteins at the normal rate, everything is as it should be. But from time to time (or always, in the case of chronic Halitosis), conditions occur which cause the bacteria to process proteins at higher rates. The resulting increase in VSC's is the primary cause of bad breath. As other factors come into play, the process may accelerate, producing agonizingly horrible bad breath.

Various forms of this disorder can give your breath specific characteristic odors. A fruity odor occurs as the body attempts to get rid of excess acetone through exhaling. This is a characteristic sign of ketoacidosis, which may occur in diabetes, and is a potentially life-threatening condition. A fecal odor to the breath (the breath smells like feces) can occur with prolonged vomiting, especially when there is a bowel obstruction. An ammonia-like odor (also described as urine-like or "fishy") may be present on the breath of anyone experiencing chronic kidney failure. Keep in mind, though, that if your breath has one of these characteristic odors, it doesn't mean you definitely have the underlying disease or condition.

If your breath has been normal and suddenly turns into halitosis, you should consider these possible causes:

1. Tonsilloliths or Tonsil Stones
2. Food or beverages consumed (such as cabbage, garlic, raw onions, or coffee)
3. Vitamin supplements (especially in large doses)
4. Poor dental hygiene
5. Dentures
6. Cavities
7. Smoking or chewing tobacco
8. Drinking alcoholic beverages
9. Dry Mouth
10. Throat infection
11. Sinusitis
12. Lung infection
13. Gum disease (gingivitis, gingivostomatitis)
14. Abscessed tooth
15. Impacted tooth
16. Foreign body in the nose (usually in children). Often (but not always) there is a white, yellowish, or bloody discharge from one nostril.
17. Prescription Medications as well as illegal drugs.

The best way to treat items 1 - 10 above, at least initially, is through improved oral hygiene. Use a family of oral hygiene products that delivers a good supply of oxygen to the areas that need it most. For details on a good oral hygiene program, read my article Fourteen Guidelines to Help You Prevent Bad Breath and use it to establish your own oral hygiene program.

Halitosis due to items 11 - 16 will benefit from a good oral hygiene program but are likely to require attention from your healthcare provider.

Diseases that may be associated with breath odor and which require treatment from a professional are (Presented in alphabetical order, not in order of likelihood -- some are extremely unlikely):

• Acute necrotizing ulcerative gingivitis
• Acute necrotizing ulcerative mucositis
• Acute renal failure
• Bowel obstruction (can cause breath to smell like feces)
• Bronchiectasis
• Chronic renal failure (can cause breath to smell like ammonia)
• Diabetes (fruity or sweet chemical smell with ketoacidosis)
• Esophageal cancer
• Gastric carcinoma
• Gastrojejunocolic fistula (fruity-smelling breath)
• Hepatic encephalopathy
• Diabetic Ketoacidosis
• Lung abscess
• Ozena, or atrophic rhinitis
• Periodontal disease
• Pharyngitis
• Zenker's diverticulum

Halitosis Treatment at Home

Use proper oral hygiene (especially flossing), and remember that most mouthwashes are not effective in treating the underlying problem. If you want an oral rinse that is effective, then click here.

Fresh parsley or a strong mint are often effective ways to fight temporary bad breath. But remember, these are simply masking techniques and will do nothing to treat the underlying causes. Avoid smoking. Otherwise, follow any prescribed therapy to treat the underlying cause.

Call your health care provider if the problem persists and there is not an obvious cause (such as smoking or eating odor-causing foods). Also call if you have Halitosis AND signs of a respiratory infection, such as fever, cough, or facial pain with nasal discharge.

When you arrive at your health care provider's office for your appointment, you can expect your provider to obtain a complete medical history and perform a physical examination. Some medical history questions documenting your Halitosis problem in detail may include:

• Is there a specific odor?
• Is there a fishy smell?
• Does the breath smell like ammonia or urine?
• Does the breath smell like fruit or is there a sweet-chemical smell?
• Does the breath smell like feces?
• Does the breath smell like alcohol?
• Has the person recently eaten a spicy meal, garlic, cabbage, or other "odorous" food?
• Does the person take vitamin supplements?
• Does the person smoke?
• Does good oral hygiene improve the odor?
• What home care measures have been tried? How effective are they?
• Is there a recent sore throat, sinus infection, tooth abscess, or other illness?
• What other symptoms are also present?

The physical examination will include a thorough examination of the mouth and the nose. A throat culture may be taken if you have a sore throat or mouth sores.

In rare cases, diagnostic tests that may be performed include:

• Endoscopy (EGD)
• X-ray of the abdomen
• X-ray of the chest
• Blood tests to screen for diabetes or renal failure

Your health care provider may prescribe antibiotics for some conditions which cause Halitosis. If for some strange reason, you have an object in your nose, the doctor will use an instrument to remove it (the object, not your nose, of course).

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