How does having bad breath impact our life? What are the main causes of bad breath? How likely is it to originate from the mouth or the stomach for instance?…
We all know the difference between times when we feel open, relaxed and at ease with people versus times when we are defensive, anxious and uncomfortable around others.
Chronic bad breath can completely transform our personalities: we become more introverted, self-conscious, less sociable, more anxious and preoccupied. Our self-esteem is low and we become quite unhappy.
Halitosis (bad breath) has a very powerful social stigma attached to it. Communication with others – the act of talking – becomes something we tend to avoid at all costs. Our daily life – every single action – is completely ruled by constant fears and thoughts related to halitosis and its consequences.
We think about it in the morning when we wake up, when somebody knocks on the door unexpectedly, when we kiss or hug our partners, when we read a book to our little ones, when we arrive at work and we realise we have forgotten our chewing gums…
Bad breath is in fact a symptom of other conditions, infections or diseases and, in the vast majority of cases, is caused by bacterial imbalances within the oral cavity. An excess proliferation of different types of (otherwise beneficial)bacteria takes place. In particular, large numbers of odour producing bacteria are present: these are usually anaerobic bacteria (bacteria that thrive in environments where oxygen is deprived).
So what are the main causes of bad breath? Where is it most likely to originate from? Well, it is estimated that between 85 and 90% of halitosis cases are mainly caused by a bacterial imbalance or overgrowth in the mouth.
Bacteria can reside on or underneath the gum line, underneath the surface of the tongue, on or inside the teeth, and also on or inside our tonsillar area.
Anaerobic bacteria metabolise (break down) waste present in our mouths. In particular, they metabolise proteins – which are present in food remains – dead tissue cells, blood and mucous. When these bacteria digest this waste, they start producing large amounts of by-products, mostly volatile sulphur compounds (VSC).
Since proteins are made up of aminoacid molecules, and some of these contain sulphur atoms, volatile sulphur compounds are released as a by-product when proteins are broken down. These types of gases (VSC) are the ones that are responsible for some the most offensive odours that cause bad breath. Here are some of the most common:
- methyl mercaptan (also called methanethiol) smells like rotten cabbage.
- hydrogen sulphide smells like rotten eggs.
- dimethyl sulphide smells like rotting fruit and vegetables.
In addition, it has been found that bad breath does not necessarily derive exclusively from volatile sulphur compounds, but also from other compounds not made of sulphur, most of them also metabolised by bacteria. Here are a few of the most common other compounds:
- cadaverine smells of putrefying flesh (gives corpses their “characteristic scent”)
- putrescine also smells of putrefying flesh
- butyric acid has an acrid smell (rancid butter, parmesan cheese, vomit)
- pyridine has a fish-like odour
Many different kinds of beneficial bacteria are actually present in a healthy mouth (usually over 100 different species!) where they usually live in harmony with each other. That is, in a healthy mouth there is a balance in the oral flora and so no unpleasant odours are released.
However, if for whatever reason, a few of these bacteria strains start reproducing in excess, an imbalance can be created and the oral flora changes its pattern to one that is not healthy, where some types of anaerobic bacteria take over and start metabolising proteins and other compounds at a very high rate. Thus nasty odours appear quickly due to the release of volatile compounds.
The second most common area where bad breath can originate from is the upper respiratory tract: the nose, sinuses, tonsils, throat and larynx. Sinus infections or sinusitis, throat infections such as tonsillitis, tonsil stones, rhinitis or post nasal drip are examples of common infections or conditions that can lead to oral and nasal malodours and they are also common causes of bad breath.
In these cases, it is also the proliferation of VOC-producing bacteria inside the throat, tonsils, nasal passages or sinuses that leads to halitosis.
However, halitosis caused by conditions outside the oral cavity is by far much less common than halitosis caused by conditions or diseases located inside the mouth (it is estimated that about 8 to 10% of halitosis cases originate in the respiratory tract).
It is not yet fully understood why some people are more prone to oral or respiratory tract bacterial imbalances than others. But it is clear that some factors and conditions (discussed below) can trigger bacterial overgrowth, so it is important to analyse whether any of these may apply.
These are the main causes of bad breath (factors or conditions that can lead to oral malodours):
- Oral infections, such as dental decay or an infected wisdom tooth
- Gum disease (gingivitis or periodontitis)
- Dry mouth condition (called xerostomia)
- Poor oral hygiene
- Sinus infections, throat infections, post nasal drips and allergies
- Tonsilloliths ( tonsil stones)
Statistically, bad breath is most often a direct consequence of the accumulation of bacteria underneath the surface of the tongue, and /or a build up of plaque (therefore, bacteria too) around teeth and below the gum line. Hence we are talking about oral infections, gum disease, dry mouth and poor oral hygiene as the most likely causes of halitosis.
Note that, apart from the mouth, nose, tonsils and throat, bad breath can also originate from the stomach, but this is extremely unlikely, it will rarely occur and only when there is a problem such as very severe chronic indigestion or chronic vomiting, for instance. In addition, halitosis can also be a side effect of certain medical conditions, such as liver, lung or kidney disease and infections, diabetes, oral cancer and certain blood disorders.
It is also worth mentioning the existence of the conditions pseudo-halitosis and halitophobia, which are psychological in nature. It is estimated that nearly a quarter of patients seeking professional advise suffer from an exaggerated concern of having bad breath and that are, in fact, “imagining” their halitosis.
These individuals are absolutely sure that they suffer from bad breath, although there is no evidence of offensive odour coming from the mouth at all.
Another important factor to be aware of is that it is very common for bad breath to stem from multiple causes, so it is important to follow a methodical approach so that we are able to identify any possible cause that applies, as well as rule out those that don’t.
Accurate diagnosis as to what the main causes of bad breath in each particular case is fundamental so that the most appropriate treatment can be sought. Since there are usually multiple causes involved, this requires a combination of treatments to effectively cure chronic bad breath.
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