Vanya Vasudeva Sharma
The subjective perception after smelling someone’s breath. It can be unpleasant or even disturbing .If unpleasant, the terms breath malodor, halitosis or bad breath. Oral malodor is common and can affect people of all ages. When severe or longstanding, it may decrease self confidence and social interactions.
Oral malodour on awakening is common and generally not regarded as halitosis. Longstanding oral malodour is usually caused by oral, or sometimes nasopharyngeal, disease. The most likely cause of oral malodour is the accumulation of food debris and dental bacterial plaque on the teeth and tongue, resulting from poor oral hygiene and resultant gingival (gingivitis) and periodontal (gingivitis/periodontitis) inflammation. Although most types of gingivitis and periodontitis can give rise to malodour, acute necrotising ulcerative gingivitis (Vincent’s disease, trench mouth) causes the most notable halitosis. Adult periodontitis, characterised by gradual plaque related loss of periodontal attachment, can cause variable degrees of oral malodor.Aggressive periodontitis, rapid loss of periodontal bone and resultant tooth mobility, can cause intense oral malodour.
Lack of oral cleansing because of xerostomia (dryness of the mouth) also has the potential to cause or enhance malodour, and some evidence indicates that wearing dentures may sometimes cause oral malodour, possibly by virtue of increased tongue coat deposits.
What are the other causes of oral malodor?
Mild transient oral malodour often arises after sleep and is sometimes termed “morning halitosis.” This may be more likely in people with nasal obstruction for example, due to upper respiratory tract infection or when people sleep in a hot, dry atmosphere. Respiratory tract infections can cause oral malodor as a consequence of nasal or sinus secretions passing into the oropharynx or in people who breathe through their mouth. Tonsillitis and tonsiliths may also be causes of halitosis. Foreign bodies in the nose can produce a striking odour to the breath.
Treatments: Treatment is primarily directed towards educating the patient as to the cause and prevention and lessening the accumulation of oral bacteria. Effective teeth cleaning, including brushing and interdental flossing, can significantly reduce oral malodour, particularly in people with poor oral hygiene and related gingival and periodontal disease.
If oral hygiene is already good, or improves and yet oral malodour persists, the tongue may be the likely source of odour and hence tongue cleaning may be indicated.
Chewing gum seems to lead to only transient reduction in oral malodour.
The range of mouthwashes suggested for the treatment of oral malodour act by reducing either the bacterial load or the associated odoriferous compounds. Chlorhexidine gluconate produces a fall in bacteria that produce volatile sulphur compounds and the mouthwash or spray can be more effective at reducing oral malodour for several hours than is improving oral hygiene alone.
Triclosan has both a direct action against volatile sulphur compounds and an antibacterial effect; used in mouthwashes and toothpastes, it may reduce oral malodour.
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