Battling Bad Breath

by: Busayo Adekoya

Halitosis commonly known as bad breath is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. However, it is important to be aware of the causes and symptoms and possible treatment in combating halitosis.

Halitosis or bad breath is an instant turnoff. It is not always easy to tell if you have bad breath, other people may notice it first but it’s often difficult to tell a sufferer he or she has bad breath. An honest observation from family, friends, colleagues, or a stranger may likely not be readily welcomed with open arms because sufferers may feel insulted or embarrassed.

Halitosis, equally known as bad breath, is a symptom in which a noticeably unpleasant odour is present on the exhaled breath.

According to the Academy of General Dentistry, in over 90 per cent of bad breath cases, the odour originates in the mouth, throat, and tonsils but it's usually caused by poor oral hygiene and for some people the condition can be chronic and antisocial.

In a recent survey of 5000 singles conducted by, 43 per cent noted that fresh breath mattered the most before a date which shows that bad breath is among the 3 most unattractive traits in dating prospects. Therefore, genuine halitosis is seen as a social taboo and can sometimes trigger social anxiety and depression in sufferers.

According to Dr. Temitope Owoeye, a dentist at the Lagos State University Teaching Hospital (LASUTH) Ikeja, not all who think that they have halitosis have a genuine problem.

“Of those who seek treatment, a significant percentage has been reported to have no genuine halitosis when professionally examined. Of those who have genuine halitosis, often the odour is caused by bacteria present below the gum line and on the back of the tongue. The remaining 10 per cent is accounted for by many different conditions, including disorders in the nasal cavity, sinuses, throat, lungs, oesophagus, stomach or elsewhere.

“Very rarely, halitosis can be one of many symptoms of a serious underlying medical condition such as liver failure, but in the vast majority of cases, the cause is minor and can often be reduced by adjustments to oral hygiene, including brushing or gently scraping the back of the tongue and improving the health of the gums, e.g. by using dental floss.

However, if the origin of the odour is not in the mouth, halitosis can be more difficult to diagnose and to manage successfully which is why most of these companies out there that promote their products with 'instant' cures sometimes pass the wrong message because Halitosis or Bad breath can originate from a wide variety of different places in the body,” Owoeye said.

He explained further that, “There are different classification systems that define all types of Halistosis. Bad breath that originates from the mouth such as cavities, gum disease, bacterial imbalance on the tongue, impacted wisdom teeth etc are known as ‘Genuine Halitosis’.

“Bad breath that emits from the oral cavity such as post nasal drip, tonsil stones, bacterial imbalance in the back of throat, retro-nasal mucosa are known as ‘Intra-oral halitosis’. Likewise you have the ones that originate from chronic gastritis, hiatal hernia, stomach and duodenal ulcers, lazy colon syndrome, which are from the digestive tract. The Blood borne halitosis are from the Liver and kidney diseases, pulmonary infections, and blood disorders.

Halitosis can also be traced to being psychological where a patient believes he or she suffers from breath odour when there is none. This symptom is known as Delusional bad breath or Halitophobia.”

Academy of General Dentistry estimated that between 35 and 45 per cent of people around the world has some level of halitosis. So the question is what causes halitosis?

Owoye noted that halitosis or bad breath can be the result of numerous things. According to him concern about halitosis is said to be the third most frequent reason for people to seek dental care, following tooth decay and periodontal disease (gum disease).

“If bacteria build up in your mouth, it can cause your breath to smell. Bacteria break down pieces of food in the mouth, releasing unpleasant-smelling gas. Any food trapped in your teeth will be broken down by bacteria, causing bad breath.

“Persistent bad breath can sometimes be a sign of gum disease. Eating strongly flavoured foods, such as onions and garlic, can also cause your breath to smell, as can smoking and drinking a lot of alcohol but occasionally, bad breath can occur following an infection or illness, or as a result of taking certain types of medication,” Owoeye said.

He added: “For people who diet, fast, and those that do not drink enough water regularly can slow the body's release of saliva, leading to bad breath. Saliva washes the teeth and keeps bacteria at bay. It's a natural buffer. And because the body makes less saliva while asleep, most people wake up with bad breath. Therefore drinking water before going to bed can help, as well as inculcating the habit of rinsing the mouth with water in the morning help reduce mouth odour.

“Most people avoid eating breakfast for many reasons but as qualified dentist I can authoritatively tell you that it’s better not to avoid nor forget to eat breakfast because anytime we eat, we are encouraging the body to make more saliva, which rinses the mouth. Eating breakfast will get the mouth moist again ultimately eliminating mouth odours or bad breath.”

The dentist also added that bad breath is rarely associated with life-threatening diseases noting that sometimes bad breath is triggered by severe health problems such as throat or mouth cancers, human immunodeficiency virus (HIV) infection, digestive system disorders or diabetes. Halitosis can also indicate dehydration or zinc deficiency.

Symptoms of Halitosis

According to Dr. Owoeye the most common symptoms of bad breath include post-nasal drip, a bitter metallic taste, a white coating on the tongue and thick saliva.

“Most symptoms of bad breath depend on the underlying cause of bad breath. Many individuals who suffer from bad breath because of dry mouth can experience difficulty speaking, difficulty swallowing, burning sensation in the mouth or dry eyes.

Fever, sore throat, persistent cough and swollen lymph nodes in the neck, indicates respiratory tract infections which can also mean bad breath. So it is vital that you consult your doctor or dentist as soon as you notice consistent white spots on the tonsils and sores in the mouth with or without a fever. Taking proper care of your teeth and visiting the dentist at least twice a year are the easiest ways to avoid breath problems.”

Halitosis Prevention and Treatment

Halitosis treatment depends on its cause. Because bacteria cannot survive or function in the presence of oxygen, researchers on dental health have found a much simpler and clinically-proven method to treat bad breath by interrupting the bacteria’s chemical production of odours by the introduction of oxygenating compounds to the oral environment.

“Please keep in mind that you cannot eliminate the bacteria that cause bad breath from the tongue. Consequently, scraping or brushing the tongue is a temporary solution at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution to bad breath. The bacteria that cause bad breath are actually part of your normal oral flora and need to be present in order to break down proteins as a key step in proper digestion,” Owoeye advised.

He said: “In general, a dentist will recommend mouthwashes and toothpastes that contain oxidizing agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odour causing bacteria found in the mouth.
However, some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually cause bad breath.

If you are experiencing dryness in the mouth, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil and xylitol.”

He further advised that people should cultivate the habit of eating foods rich in fibre, avoiding eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream.

“Drinking green and black teas is also a good method of eliminating halitosis because they are found to contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria. Avoid drying medication, taking antidepressants, diuretics, pain relievers and antihistamines unless it is absolutely, medically necessary. These drugs inhibit saliva flow and cause halitosis.

“Clean your mouth after eating meat, fish or dairy products - Practice consistent and thorough oral hygiene to prevent bad breath. Stop smoking, Breathe through your nose instead of your mouth - Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth and drink lots of water,” Owoeye said.

Dr Owoeye quickly noted that consultation is free at LASUTH, and treatment of bad breath is very affordable contrary to people’s belief.