What is Halitosis?

Local oral diseases are the main cause of bad breath, but it should not be ignored that bad breath is often the oral manifestation of some serious systemic diseases, and some organic diseases can also cause bad breath.
Halitosis

Ouyang Xiangying	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Kang Jun	(Chief physician)	Department of Periodontology, Peking University Stomatological Hospital
Shi Dong	(Deputy Chief Physician)	Department of Periodontology, Peking University Stomatological Hospital

Breath refers to the odor emitted from the mouth or other air-filled cavities, such as the nose, sinuses, and pharynx. It seriously affects people's social communication and mental health. WHO has reported bad breath as a disease. Surveys show that the prevalence of halitosis in China is 27.5%. In Western countries, it is 50%. About 10% to 65% of people worldwide have had bad breath.

Western Medicine Name

Bad breath

Other name

Oral odor

Affiliated Department

Department of Physiology-Stomatology

Disease site

Oral cavity

Main cause

Local oral disorders

Contagious

Non-contagious

Causes of halitosis

Local oral diseases are the main cause of bad breath, but it should not be ignored that bad breath is often the oral manifestation of some serious systemic diseases, and some organic diseases can also cause bad breath.

Halitosis

Halitosis

Halitosis

According to statistics, 80% to 90% of bad breath comes from the mouth. Untreated caries, residual roots, residual crowns, poor restorations, abnormal anatomical structures, gingivitis, periodontitis, and oral mucosal diseases in the oral cavity can cause bad breath. Among them, dental caries and periodontal diseases are the most common related diseases. Food residues and plaques often remain in the deep caries cavity and under the overhang of the bad restoration. Dental pulp necrosis or purulent pulpitis, can also give off odor without treatment; patients with periodontal disease are often accompanied by a large amount of tartar, plaque, and bacteria in the periodontal pocket produce hydrogen sulfide, indole and ammonia, so Stink. In addition, periodontal abscesses and periodontal pouch overflows are mostly Staphylococcus aureus combined with periodontal pathogen infection, and they also emit odor. The quality and quantity of saliva also play an important role. The reduction of saliva and the increase of organic components such as protein reduce the scouring and buffering effects of saliva, allowing bacteria to multiply, decomposing organic components in saliva, gingival crevicular fluid and food residues, and generating a large amount of volatile sulfides and indole. And other substances that cause bad breath.

Causes of bad breath

Non-oral halitosis

Diseases of the adjacent tissues of the oral cavity, such as purulent tonsillitis, chronic maxillary sinusitis, atrophic rhinitis, etc., can produce purulent secretions and emit odors; common clinical medical diseases such as acute and chronic gastritis and peptic ulcers have acid odor; Pylori obstruction and advanced gastric cancer often have stinky ducky bad breath; patients with diabetic ketoacidosis can breathe acetone gas, and patients with uremia exhale rotten apple smell. In addition, leukemia, vitamin deficiency, heavy metal poisoning and other diseases can cause bad breath.

Halitosis

Hunger, consumption of certain drugs or irritating foods such as onions, garlic, smoking, and the reduction of saliva secretion during sleep caused a large number of bacteria to break down food residues, etc., which may cause temporary bad breath. The bad breath of healthy people may be caused by the increase in plaque and thickening of the back of the tongue caused by poor oral habits and oral hygiene. Due to the large surface area of the back of the tongue, there are many nipples, furrows and depressions, which are conducive to the retention of bacteria, shed epithelium of the oral mucosa, food residues, etc., and serve as a "bacterial storage room", which is conducive to the production of bad breath. Studies have shown that there is a positive correlation between the degree of bad breath and the amount of volatile sulfur compounds with the thickness and area of the tongue coating, which is more closely related to the thickness of the tongue coating, and the volatile sulfur compounds are reduced after the tongue coating is removed. This may be because the thicker the tongue coating, the easier it is to form an anaerobic environment, the more conducive to the growth of anaerobic bacteria, and the more conducive to the production of volatile sulfides, leading to bad breath.

In addition, there is false halitosis, that is, the patient himself feels oral odor, but the test result is negative. Those who can be improved through explanations and counselling.

Halitosis self-examination

(1) Self-sensing method (cover your mouth and nose with your hands, exhale, then smell the exhaled gas for odor)

(2) Close relative feedback method: Based on feedback from relatives, friends or spouses;

(3) Clinical test method: It mainly includes wrist addition experiment and plastic spoon experiment;

(4) Direct nasal test by professional physicians: It is one of the easier and more accurate methods for objective evaluation of bad breath. The diagnosis is made by a professional bad breath nasal doctor, and the score of 0 to 5 is used to measure the degree of bad breath. The results are repeatable.

(5) Laboratory tests: chemical analysis (gas chromatography / mass spectrometry sulfide monitor, high performance liquid chromatography analysis, zinc oxide thin film semiconductor sensor, BANA analysis), milk mouthwash oxygen depletion experiment, microbiological and fungal detection, Saliva culture and so on.

(6) Artificial nose: Including portable sulphide analyzer (Halime-ter) and electronic nose. Halimeter uses the principle of chemical reaction to digitally represent the ppb concentration of H2S in the mouth. The method is simple and easy to operate. But vulnerable

Effects of other oral odors, such as alcohol, volatile fragrances (perfume, hair styling, etc.). Electronic nose is a method for diagnosing bad breath by identifying the characteristic odor in the mouth of patients with bad breath, but its function still needs to be improved.

Bad breath to find the cause

Bad breath is not terrible, as long as the cause can be treated. First consider whether halitosis is oral or non-oral.For factors that cannot be ruled out, such as respiratory diseases (nasal cavity, maxillary sinus, pharynx, lung infection and necrosis), digestive diseases (gastritis, gastritis, Gastric ulcer, duodenal ulcer, gastrointestinal metabolic disorder, constipation, etc.), parenchymal organ damage (liver failure, kidney failure) and diabetic ketosis, uremia, leukemia, vitamin deficiency, etc., these diseases should be addressed first Perform local or systemic treatment.

If there are oral diseases that may cause bad breath, such as untreated dental caries, residual roots, residual crowns, bad restorations, gingivitis, periodontitis and oral mucosal disease, etc., medical treatment of dental caries should be promptly removed to remove useless residual roots Residual crowns, removal of bad restorations, removal of incorrect anatomical structures, treatment of oral mucosal disease, for patients with periodontal disease, basic treatments such as cleaning and root surface scraping are performed first, followed by systematic periodontal treatment and plaque control .

Bad breath strengthens oral hygiene

Choose the correct brushing method, brush at least twice a day, and develop the habit of mouthwashing after eating. It is also very important to perform tongue cleaning. Since 80% to 90% of bad breath comes from the back of the tongue, the dentist should teach patients to use the tongue curette to clean the tongue properly. It is also possible to find out the main pathogenic bacteria of the patient through in vitro tests, and choose a mouthwash that can effectively inhibit the growth of microbial growth on the tongue for local antibacterial. Mouthwashes commonly used today include chlorhexidine, chlorinated compounds, hydrogen peroxide, sodium salts, zinc salts, etc. Good mouthwashes should achieve an ecological balance that can maintain the normal flora of the mouth and prevent new diseases caused by imbalanced flora . Stimulate saliva secretion or use alternatives. Because saliva has antibacterial, bactericidal, and oral cleansing effects, you should also consider increasing the amount and velocity of saliva, enhancing tongue movement, and chewing fiber-rich foods or chewing gum. Reduces bad breath. ^[1-3]