Halitosis
(halitosis; from Latin halitus - breath and Greek -osis - disease) or halitosis is a term used to describe a noticeably unpleasant odor when exhaling.
It is known to be the third most common reason, after tooth decay and gum disease, that prompts people to visit the dentist.
For a person with halitosis, the symptoms are invisible because the olfactory receptors become accustomed to the stench. In most cases (90%) the cause of bad breath is in the mouth.
The intensity of this phenomenon can change throughout the day due to the consumption of odorous foods such as cheese, fish, seasonings, garlic, alcohol, as well as smoking and, in general, overeating.
Since self-cleaning does not occur in the mouth during sleep, halitosis is usually more intense in the morning (“kittens wrote in their mouth”).
Bad breath can be ephemeral (going away after rinsing with a freshener or brushing your teeth) and persistent.
Sustained (chronic, persistent) halitosis is present in 25% of the population.
Causes of halitosis.
In the mouth.
There are more than 600 types of microorganisms in the average person's mouth. About a hundred of them can produce a stench even when grown in a laboratory.
Solobacterium moorei is a microorganism that is recognized by some researchers as the most active producer of stench.
This stench is produced mainly due to the decomposition of proteins into individual amino acids with their further decomposition into odorous substances.
For example, the decomposition of cysteine and methionine produces hydrogen sulfide and methyl mercaptan, respectively. Volatile sulfur compounds have been shown to be statistically related to the degree of halitosis and usually disappear with adequate treatment.
1.1. The tongue is where odor in the mouth appears in most cases.
A significant amount of natural microflora is localized in the villi and folds of the back of the tongue, especially on the back (root of the tongue).
This part of the tongue is relatively poorly cleaned and the bacterial population multiplies here on food debris, dead cells and nasal mucus.
Such a nutritional environment on the back of the tongue is ideal for anaerobic bacteria that produce a specific gas, the components of which are:
- putrid odor of indole substances,
- skatola,
- polyamines;
- “rotten egg” smell of volatile sulfur compounds (hydrogen sulfide, methyl mercaptan, allyl methyl sulfide and dimethyl sulfide).
Cleaning the tongue.
Chewing gum, sprays, rinses, etc. can only temporarily muffle the odor produced by bacteria on the root of the tongue, but cannot eliminate halitosis because they do not eliminate its cause.
To neutralize the release of the above-mentioned volatile sulfur compounds, it is necessary to remove plaque from the back of the tongue along with the aerobic and anaerobic microorganisms contained in it.
Typically, a tongue scraper or toothbrush is used for this.
1.2. Gum diseases (periodontitis).
There is some controversy regarding the role of gum disease in the formation of bad breath. However, advanced periodontitis is always the cause of halitosis.
The waste products of anaerobic bacteria developing in periodontal pockets have a disgusting odor and, as has been clinically proven, lead to severe halitosis.
Removing calculus (tartar) and loose gums has been proven to significantly freshen the smell of your mouth. It is desirable that this event be accompanied by subgingival scaling, root planing and tissue irrigation with antimicrobial agents.
1.2.1. Particular attention should be paid to pericoronitis of the wisdom tooth.
- inflammation of the gums around the eighth tooth that has not fully erupted. After the exacerbation is relieved, it is reasonable to remove these teeth.
1.2.2.
Fetid sore throat and
Vincent's stomatitis.
Tonsils (chronic tonsillitis).
In general, suppuration from the tonsils is considered statistically insignificant in the occurrence of halitosis (only about 5%). About 7% of the population suffers from tonsillar plugs, small pieces of calcified material in the folds of the tonsils.
They smell extremely unpleasant and when released can cause halitosis.
Nasal passages.
The nose is the second major cause of halitosis due to sinusitis and foreign bodies. In this case, the smell rather comes from the nose and is different from bad breath.
Esophagus.
The cardiac valve between the stomach and esophagus may not close well when the stomach herniates into the esophagus, allowing acid and stomach gases to leak into the mouth. With diverticulosis (false pouch) of the esophagus, deposited food debris can cause halitosis.
Stomach
Rarely is the cause of halitosis; belching should not be confused with the latter. With reflux (backward release of stomach contents), an odor may appear.
Liver.
Hepatic respiration (fetor hepaticus) is a condition associated with portal hypertension and liver failure. In this case, odorous digestive products (mercaptan, ammonia, ketones), instead of being destroyed in the liver, enter the lungs and, accordingly, into the exhaled air.
The breath has a sweetish, fecal tint. In this case, the fight against symptoms is no longer relevant.
Lungs and bronchi in acute and chronic inflammation and tumors (carcinoma).
Other diseases:
- renal failure,
- diabetes,
- metabolic diseases.
Condition of mucous membranes
If the liver does not function sufficiently, then additional stress is placed on the skin. The skin is able to filter and remove toxins, and when the liver does not cope with its task, this is sure to affect the condition of the skin and mucous membranes.
A yellowish or excessively pale skin color may indicate liver disease. Yellowness is observed in hepatitis and gallbladder diseases, and indicates a high level of bilirubin. White skin color, especially noticeable on the fingertips and face, can also indicate a diseased liver.
In liver pathologies, the mucous membranes and eye sclera also change color. Swelling of the skin and mucous membranes may occur. The skin becomes dry, pustules and pimples appear on them.
Diagnosis of halitosis.
Self-diagnosis.
Smelling your own breath is difficult due to the adaptation of the olfactory receptors, although many halitosis sufferers can smell it in others.
Sometimes people experience an unpleasant taste in their mouth, but this is not always accompanied by halitosis. Usually people reliably learn about the presence of halitosis from their loved ones or from their doctor.
Special diagnostics.
It is required if the possible causes of halitosis, especially in the mouth, have been eliminated.
2.1. Halitometer
This is a device that determines the amount of hydrogen sulfide in exhaled air. Other odorous agents, such as mercaptan, are not detected by this device.
2.2. Digital gas chromatograph
measures the molecular level of major halitosogenic substances.
Features of the disease
If your breath smells unpleasant and strong, this may indicate that there are problems with the liver. It is necessary to examine this organ, as well as the stomach, if the smell is intense and constant, does not depend on the frequency of meals and its quality. The following manifestations are also observed in liver disease:
- changes in the color of the skin, mucous membranes and eye sclera, the skin becomes yellowish due to stagnation of bile,
- a putrid or garlicky smell comes not only from the mouth, but also from the skin,
- the color of the tongue changes, a coating appears on it,
- skin rashes appear that cause serious discomfort,
- dilation of veins, appearance of spider veins on the abdomen,
- dyspeptic symptoms: nausea, flatulence, periodic bowel movements,
- feeling of a bitter taste in the mouth,
- fatigue with little exertion, excessive drowsiness,
- pain in the right side of the abdomen.
If all these signs are observed, then it is necessary to urgently consult a doctor , since this combination indicates a serious illness characterized by insufficient functioning of the liver.
Treatment and prevention.
1.
It is known that very few people observe sufficient personal hygiene measures necessary for fresh breath.
This is, firstly, adequate teeth cleaning using electric, sonic and ultrasonic toothbrushes and irrigators with quality control using special plaque indicators.
Secondly, it is advisable to clean the tongue with a scraper and brush. Medicinal rinses are also appropriate.
2.
Diet. When eating raw, hard vegetables and fruits, the oral cavity self-cleanses.
3.
High-quality regular, if necessary repeated, professional teeth cleaning with removal of plaque and stones using ultrasound and sandblasting (air-flo).
Sometimes deep scaling, root planing and gum margin management are required. In advanced cases, reconstructive gum surgery is used.
4.
Dental treatment and adequate dental prosthetics.
Drug therapy.
1.
Antimicrobial drugs.
2.
Probiotics. For example Streptococcus salivarius K12.
6. Traditional medicine.
Camomile tea.
Pour a teaspoon of chamomile flowers into a glass of boiling water, leave for 2 hours, strain. Rinse your mouth with freshly prepared chamomile infusion 3 times a day.
Menu adjustments
When liver pathologies are detected, treatment is necessarily accompanied by the prescription of a special diet. The frequency of food intake, the method of processing it, and the temperature matter.
You need to eat food in small portions at fairly short intervals. Food should not be too cold or hot. You should not eat fried, canned, smoked, overly salted or spicy foods.
These measures help not to overload the liver, distributing the load evenly. You should also avoid eating fatty foods, confectionery, marinades, and sausages. No seasonings are used during cooking; salt is added in minimal quantities. Food is steamed, boiled or baked.
You should stop eating bread. You can eat biscuits or toasted baguette.
If you have liver disease, it is strictly forbidden to drink alcohol, since the diseased organ is simply not able to process it. You can’t drink sweet soda; you need to minimize the consumption of coffee and strong tea. You should drink only natural, non-concentrated juices.
It is useful to eat honey, nuts, dried fruits. Fermented milk products should be consumed with caution, little by little. Whole milk is excluded. Animal fats must be replaced with vegetable fats. Moderate but obligatory consumption of vegetable oils is beneficial for a diseased liver.
Halitosis and exposed roots
Two recent studies show that volatile chemicals and the gas that causes halitosis have damaging effects on surrounding tissue.
The first study demonstrates the role of hydrogen sulfide (SH2), which causes periodontal cell death through apoptosis (fragmentation or programmed destruction).
Another study shows that the same hydrogen sulfide (SH2) accelerates the proliferation (reproduction) of bone-destructive cells (osteocasts).
These are cells that take part in the physiological (normal) remodeling of bone: the phenomenon of bone resorption, which allows, among other things, orthodontic movements, during which the activity of bone-building cells (osteoblasts) is balanced with the activity of osteoclasts.
Under the influence of hydrogen sulfide, cellular metabolism accelerates, triggering the mechanism of bone destruction under the influence of osteoclasts.
The balance is thus disturbed and bone resorption develops. This results in periodontal disease (periodontitis) and exposed roots.
The vicious circle is complete because periodontitis and exposed roots are a common cause of halitosis (bad breath).
Halitosis and pulpitis
Hydrogen sulfide, released during halitosis (bad breath), is also toxic to pulp cells. One study demonstrates that hydrogen sulfide profoundly disrupts the metabolism of the mitochondrial membranes of dental cells, causing cell death through apoptosis (breakdown into fragments).
Situated in the pulp chamber in the center of the tooth, the pulp is not isolated from the surrounding oral environment because exchange constantly occurs through dentin, a porous tissue, and enamel, which acts as a selective membrane.
Hydrogen sulfide penetrates and diffuses through the hard tissues of the tooth to negatively affect its vitality.
This phenomenon may explain the appearance of pulpitis (inflammation of the pulp) in intact (undamaged) teeth. It should be noted that tobacco smoke can have a toxic effect on the dental pulp through a similar mechanism.
In the case of pulpitis, divitalization or removal of the nerve is the only possible solution.
