Bad breath - Halitosis - Morning Breath. Causes and treatment of bad breath.

Bad breath also called halitosis, there is no universal definition what is bad breath, because mostly it is subjective, but halitosis is common problem. Certain studies have shown, the prevalence of halitosis up to 50%.
halitosis is amongst the top 100 most distressful diseases in humans.
The most common causes of halitosis are: Gingival and periodontal diseases:
Gingivitis, herpetic gingivitis, periodontitis, pericoronitis, periodontal abscess.
The main mechanism of halitosis is accumulation of different gases generating by gram negative and anaerobic bacterias from periodontal infections.
This gases are: volatile sulfur compounds, hydrogen sulfide, methyl mercaptan and dimethyl sulfide.
Even in people who has healthy gum, they still have bad breath at the morning.
This is called physiological halitosis.
Morning halitosis is occurs on waking, the cause is putrefaction of entrapped food particles and desquamated epithelial cells by bacteria. The surface of the tongue has desquamated epithelial cells, leucocytes from periodontal pockets, food residues, and bacteria.
The depth of the tongue papillae affects the biofilm coating on top, which prevents the cleansing action of saliva and promotes the growth of anaerobic bacteria, giving rise to halitosis. This occurs even in individuals with healthy periodontal tissues and good dental hygiene.
Some food consumption causes halitosis. volatile foods like onions, garlic, spices, pickles, radish, condiments, betelnut tobacco, and alcohol resulting in malodor. Garlic and onions have a high sulfur concentration in their composition, which on degradation through the gastrointestinal tract, emits the characteristic odor which lasts for hours after consumption.
90% cases of bad breath comes from mouth, only small percentage is caused by serious diseases like:
Sinusitis, tonsillitis, pneumonia and chronic bronchitis. gastroesophageal reflux diseases and other gastrointestinal disorders also can cause halitosis.
In rare cases: Upper respiratory tract infection, Cystic fibrosis, Diabetes mellitus, Leukemia, Hepatic failure, Renal failure, Menstruation .
In individuals with halitosis, the back part of the tongue is the main source of malodor. Smears taken from this biofilm or scrapings would show desquamated epithelial cells, leucocytes from periodontal pockets, blood metabolites, different food residues, and bacteria. Some bacteria associated with this condition are:

Oral cavity: Gram-negative and anaerobic bacteria
Nasal mucosa: K. ozaenae
Pharynx, sinuses: Streptococcus species
Respiratory system (bronchitis, bronchiectasis, lung diseases): P. Aeruginosa

This is by far the commonest method used and the most effective in the clinical scenario. A plastic tube is placed in the patient’s mouth, and the clinician tests the odor from the other end of the tube as the patient exhales into one end of the tube, grading it between 0 and 5:

Grade 0: No odor detectable
Grade 1: Malodor is hardly detectable
Grade 2: Odor slightly exceeding the threshold of malodor recognition
Grade 3: Most certainly identifiable malodor
Grade 4: Strong malodor
Grade 5: Very strong malodor.
The test is easy, inexpensive, and does not require specialized tools but could get a little uncomfortable for the clinician.
First Step is to identify the cause.
If halitosis is physiological, or it is originated from oral cavity, we should further examine oral cavity.
To know tongue biofilm, deep carious lesions, large interdental areas with entrapped necrotic food debris, exposed necrotic pulp, ill fitter prothesis and mucosal lesions.
If cause is extraoral, or other diseases then treat the cause.
Because the most common cause of halitosis is poor dental hygiene, patient education is important, to remove tongue biofilm. Biofilm are composition of bacteria, and dead cells on the tongue.
Also plaque control is important.
This is best done by tongue scrapers than toothbrushes. Flossing teeth is also very important to keep the interdental spaces free of plaque and food debris, thereby controlling halitosis.
Mouth Rinses

For effective control of halitosis, antibacterial agents such as chlorhexidine, zinc, triclosan, and cetylpyridinium chloride are recommended for usage.
chlorhexidine is undoubtedly the best among the abomination mouthwashes, it may have an unpleasant side effect of the unsightly staining of teeth.

Tea tree oil has been used effectively to control malodor caused by the bacterium Solobacterium moorei strain.

By -, CC BY-SA 4.0,

By Mahdiabbasinv - Own work, CC BY-SA 4.0,
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