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Halitosis is the medical term for bad breath and is defined as the condition of having offensive, foul-smelling breath. The unpleasant odours can strike occasionally or temporarily, or they can be more periodic and persistent.
An example of temporary bad breath is “morning breath”, which is considered to be fairly normal. Most of the adult population suffer from it in the morning; it occurs primarily because during the night saliva flow is dramatically reduced and thus the mouth can become rather dry (dry mouth is one of the conditions which causes or exhacerbates bad breath).
However, when the malodours become persistent throghout most of the day or when they become recurrent, being strong and offensive most days, halitosis (bad breath) is termed chronic halitosis (chronic bad breath).
It is estimated that chronic bad breath affects between 25 and 40% of the population, although the degree or severity of it varies greatly from person to person.
Whether we suffer from halitosis or not, it is completely normal for our breath to vary greatly during the day, depending on factors such as levels of hydration, saliva composition, oral hygiene, stress levels, foods we have consumed, or lenght of time since last meal to name a few. However, highly unpleasant odours, varying in intensity, but being present most of the time, are characteristic of chronic bad breath sufferers only.
It is worth noting that bad breath is not a disease by itself, but a symptom of other underlying conditions, infections or diseases which need to be identified and treated appropriately.
It is estimated that between 85 and 90% of chronic halitosis cases are caused by a bacterial imbalance (or overgrowth) within the oral cavity. These bacteria tend to accumulate below the gumline, underneath the surface of the tongue and on or inside the teeth.
An excess proliferation of different types of (otherwise beneficial) bacteria occurs. A high percentage of these are anaerobic bacteria, which thrive in environments where oxygen is deprived, hence they tend to live and reproduce in difficult to reach areas within the mouth.
Anaerobic bacteria metabolise the waste that is present in our mouth: proteins present in food debris or mucous, dead tissue cells, blood… Upon breakdown of certain components present in this waste, different types of Volatile Organic Compounds are released (VOCs), many of them containing sulfur, hence called Volatile Sulfur Compounds (VSCs).
Here are the most common VOCs associated with chronic bad breath:
- Methyl mercaptan (also called methanethiol), which smells like rotten cabbage.
- Hydrogen sulfide, which smells like rotten eggs.
- Dimethyl sulfide, which smells like rotting foods and vegetables.
- Cadaverine and putrescine, which smell like putrefying flesh.
- Butyric acid, which smells like vomit or rancid butter.
- Pyridine, which has a fish-like odour.
The most common causes of overproduction of bacteria within the oral cavity are oral infections, such as dental decay, infected wisdom teeth or gum disease. Also dry mouth condition and poor oral hygiene can be important factors.
The second most common area where bad breath can originate is the upper respiratory tract, which includes the nose, sinuses, tonsils, throat and larynx. It is estimated that between 8 to 10% of cases of chronic bad breath originate in the upper respiratory tract.
Chronic sinus infections, recurrent throat infections, tonsil stones, rhinitis or post nasal drip are all examples of common infections or conditions affecting the upper respiratory tract which can lead to chronic halitosis. In these cases, it is also de case that a proliferation of VOC-producing bacteria (in the throat, tonsils, nasal passages or sinuses) leads to nasty odours emmanating from the mouth or nose.
Apart from the mouth and upper respiratory tract, chronic halitosis can also originate from the stomach, although it is very unlikely. It will only occur in very few cases, usually when there is a chronic indigestion problem, GERD, or a lack of certain enzimes for instance.
In addition, certain other conditions and diseases (very unlikely too), can also cause bad breath. Examples are: liver, lung or kidney diseases and infections, diabetes, oral cancer and certain blood disorders.
It is worth mentioning that chronic halitosis is caused, in many instances, by multiple underlying factors or conditions. Usually a combination of some of the above-mentioned conditions, either originating in the mouth, the upper respiratory tract, or both.
Yes! Absolutely! It is very important to follow a methodical approach so that we are able to identify all possible causes involved, and rule out those that are not.
It is also important to realise – even though it may be difficult at first – that no mouthwash or solution that you can gargle at home (not even the most effective ones or the ones that will be invented in the future) can cure chronic halitosis. A mouthwash or oral rinse is designed to either kill bacteria, to neutralise the VOCs they produce, or both. It is NOT designed to treat the underlying causes of chronic bad breath.
Remember: the real underlying causes of bad breath are not the bacteria nor the gases they produce, but the conditions, diseases or infections which are responsible for this excess proliferation of bacteria. Chronic halitosis can be cured as long as we treat the real underlying causes and not the bacteria or the malodours they produce directly.
So, if there are so many possible underlying conditions, infections or diseases which can cause halitosis, where do we start? Many times, there is no obvious underlying condition or disease that we are aware of, so how is chronic bad breath effectively treated?
Here is where the scientific approach is needed. It is vital that, step by step, you learn how to identify all these underlying causes so that the most appropriate treatments can then be sought.
Accurate diagnosis as to what is causing your halitosis is fundamental so that you can use the specific remedies and treatments which target your particular type of bad breath. Since there are often multiple causes involved, a combination of strategies, techniques and treatments is usually required to effectively cure chronic bad breath.
Mints, mouthwashes or oral sprays, for instance, are examples of remedies which can only ever achieve temporary effects. Their effectiveness is usually pretty limited too, so they are not good for treating chronic halitosis.
It is important that from now on you start focusing on identifying the real underlying causes of your halitosis. This, and nothing else, is the only way you will be able to treat your particular type of bad breath and the only way that can lead you to a permanent halitosis cure.
Learn, step by step, the precise procedures you need to follow so that you can successfully determine all the underlying causes of your bad breath and find an effective treatment for your chronic halitosis:
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