Cosmetic Dentistry, Oral Medicine, Preventive Dentistry
Bad Breath (Halitosis): How is it treated?
Bad breath (or halitosis) is the unpleasant odor during breathing. It is evident that such a condition can have unpleasant social and psychological consequences.
Bad breath is a fairly common problem. It affects approximately 25% of the general population and mainly individuals over the age of 20.
It is classified as real (true) when it is obvious and noticeable by others. When the patient insists they have malodorous breath but this is not recognized by others, it is a case of pseudohalitosis or halitophobia, which is related to conditions of psychogenic etiology (such as depression, schizophrenia, etc.).
What causes it?
True halitosis is distinguished as physiological and pathological.
Physiological is considered the temporary bad breath observed:
- upon morning awakening, which subsides after oral hygiene is performed,
- after consuming specific foods containing malodorous sulfur compounds (such as garlic, onion, spices),
- in smokers,
- in individuals who consume alcohol,
- in women during menstruation,
- in individuals after a prolonged period of fasting.
Pathological bad breath, in the majority (85%) of cases, is due to causes located in the oral cavity and related to the accumulation of microbes.
The most common causes of pathological bad breath are:
- tongue coating,
- poor oral hygiene,
- fissured or hairy tongue, which favors the accumulation of anaerobic bacteria,
- various forms of periodontal disease,
- decayed teeth,
- post-surgical wounds under healing,
- reduced salivary flow,
- ulcers from local or systemic diseases,
- osteomyelitis, osteonecrosis,
- neoplasia.
In a small percentage (approximately 10% of cases), bad breath is due to extra-oral causes, such as:
- acute tonsillitis,
- chronic rhinitis and sinusitis,
- gastroesophageal reflux,
- chronic renal failure (ammonia odor),
- uncontrolled diabetes (rotten apple smell).
There are also medications that contain substances, such as sulfur and iodine, which when exhaled through breathing cause bad breath.
How is it treated?
The management of bad breath depends on the cause that creates it, and the patient should consult a specialist in Oral Medicine or a Dentist, who will identify it.
Since in the majority of cases the causes are intraoral, the management includes:
- meticulous oral hygiene and elimination of dental microbial plaque,
- cleaning the dorsum of the tongue,
- cleaning removable dentures,
- treatment of periodontal diseases,
- treatment of dental problems (cavities),
- topical use of chlorhexidine,
- systemic administration, if deemed necessary, of antibiotics that act against gram-negative bacteria,
- use of probiotics as a natural method of modifying the oral microbial flora.
In cases where the unpleasant odor is due to extra-oral causes, collaboration with physicians of other specialties is deemed necessary, such as an otorhinolaryngologist, gastroenterologist, pulmonologist, endocrinologist.
Dr. Alexandra Sklavounou
Professor of Oral Medicine, National and Kapodistrian University of Athens