Bad breath , also known as halitosis , is a symptom in which an unpleasant odor is visible on the breath. This can cause anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder.
Bad breath worries can be divided into genuine and non-original cases. Of those who have bad bad breath, about 85% of cases come from within the mouth. The remaining cases are believed to be due to disruption in the nose, sinuses, throat, lungs, esophagus, or stomach. Rarely, bad breath can be caused by underlying medical conditions such as liver failure or ketoacidosis. Unnatural cases occur when a person feels they have bad breath but others can not detect it. This is estimated at 5% to 72% of cases.
Treatment depends on the underlying cause. Early efforts may include cleansing of the tongue, mouthwash, and flossing. Temporary evidence supports the use of chlorhexidine-containing mouthwash or cetylpyridinium chloride. Although there is a tentative benefit from the use of tongue cleaners is not enough to draw a clear conclusion. Treating underlying diseases such as gum disease, tooth decay, or gastroesophageal reflux disease may be helpful. Counseling may be useful for those who falsely believe they have bad breath.
Estimated rates of bad breath vary from 6% to 50% of the population. Worry about bad breath is the third most common reason people seek dental care, after tooth decay and gum disease. It is believed to become more common as we get older. Bad breath is seen as a social taboo and the people affected can be stigmatized. People in the United States spend more than $ 1 billion per year with mouthwash to treat the condition.
Video Bad breath
Signs and symptoms
Bad breath is when an unpleasant odor is believed to be present in the breath. This can cause anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder.
Maps Bad breath
Differential diagnosis
Mouth
In about 90% of cases of genuine halitosis, the origin of the odor is in the mouth. This is known as intra-oral halitosis, oral malodor or mouth halitosis.
The most common cause is the smell of producing biofilms on the back of the tongue, below the gum line, and in bags made by gum disease between the teeth and gums. This biofilm produces high-grade odor production. The odor generated is primarily due to the breakdown of proteins into individual amino acids, followed by further damage of certain amino acids to produce the detected gases. Volatile sulfur compounds are associated with oral malodor levels, and usually decrease after successful treatment. Other parts of the mouth can also contribute to the overall odor, but are not as common as the back of the tongue. These sites, in descending order of prevalence, sub-gingival and sub-gingival niches, damaged teeth, areas of food impaction between teeth, abscesses, and unclean dentures. Oral lesions caused by viral infections such as herpes simplex and HPV can also cause bad breath.
The intensity of bad breath may vary during the day, as it eats certain foods (such as garlic, onions, meat, fish, and cheese), smoking, and alcohol consumption. Because the mouth is exposed to less oxygen and is inactive at night, the smell is usually worse after waking ("morning breath"). Bad breath may be temporary, often disappearing after eating, drinking, brushing, flossing, or rinsing with a special mouthwash. Bad breath can also persist (chronic bad breath), which affects about 25% of the population in varying degrees.
Tongue
The most common location for oral halitosis is the tongue. Bacterial tongues produce foul-smelling and fatty acids, and accounts for 80 to 90% of all mouth-related mouth odor cases. A large number of natural bacteria are often found in the posterior dorsum of the tongue, where they are relatively unaffected by normal activity. The portion of the tongue is relatively dry and not well cleaned, and the convoluted microbial structure of the dorsum of the tongue provides an ideal habitat for anaerobic bacteria, which develops beneath the lining of the tongue that constantly forms food waste, dead epithelial cells, postnasal droplets and above. bacteria, life and death. When left on the tongue, the anaerobic respiration of the bacteria can produce indes putte, skatole, polyamines, or "egg rot" smells of volatile sulfur compounds (VSC) such as hydrogen sulfide, methyl mercaptan, allyl methyl sulfide. , and dimethyl sulphide. The presence of halitosis-producing bacteria on the back of the tongue is not to be confused with tongue coating. Bacteria are invisible to the naked eye, and the degree of white tongue lining is present in most people with and without halitosis. The visible white tongue lining is not always the same as the back of the tongue as the origin of halitosis, but the "white tongue" is considered a sign of halitosis. In oral medicine generally, the white tongue is considered a sign of some medical conditions. Patients with periodontal disease are shown to have a sixfold tongue coating compared with normal subjects. Halitosis patients were also shown to have significantly higher bacterial loads in this area than individuals without halitosis.
Gums
Gingival crevices are a small groove between the teeth and gums, and they are present in health, although they can become inflamed when there is gingivitis. The difference between gingival crack and periodontal pocket is that the former is & lt; 3mm in depth and the last one is & gt; 3mm. Periodontal sac usually accompanies periodontal disease (gum disease). There is some controversy over the role of periodontal disease in causing bad breath. However, advanced periodontal disease is a common cause of severe halitosis. The waste product from anaerobic bacteria growing under the gumline (subgingival) has a foul odor and has been clinically proven to produce a very strong odor of the mouth. The removal of subgingival calculus (ie tartar or hard plaque) and fragile tissue has been shown to significantly increase bad breath. This is done by subgingival scaling and root planing and irrigation with oral rinse antibiotics. Bacteria that cause gingivitis and periodontal disease (periodontopathogens) are always gram negative and are able to produce VSC. Methyl mercaptans are known to be the largest contributors of VSC in halitosis caused by periodontal disease and gingivitis. The rate of VSC on the breath has been shown to be positively correlated with the depth of the periodontal pocket, the number of sacs, and whether the sac is bleeding when examined by dental examination. Indeed, VSC itself has been shown to contribute to inflammation and tissue damage that is a characteristic of periodontal disease. However, not all patients with periodontal disease have halitosis, and not all patients with halitosis have periodontal disease. Although patients with periodontal disease are more likely to suffer from halitosis than the general population, the symptoms of halitosis have been shown to be stronger in relation to the level of the tongue layer compared with the severity of periodontal disease. Another possible symptom of periodontal disease is a bad taste, which does not always accompany a malodor that can be detected by others.
Other causes
Other less common causes reported from the mouth include:
- Deep caries lesions (tooth decay) - which causes local food impaction and stagnation
- Newest tooth extraction filters - fill with blood clots, and provide an ideal habitat for bacterial proliferation
- Interdental food packaging - (food is pushed down between teeth) - this can be caused by missing teeth, inclined teeth, spaces or juxtapositions, or patches of less contracted kotama teeth. Food stools become trapped, have slow bacterial decay and a foul-smelling volatile release. Food packing can also cause localized periodontal reactions, characterized by missing tooth pain by cleaning the food packaging area with a brush or interdental thread.
- Acrylic dentures (dentures plastics) Ã, - inadequate denture hygiene practices such as failing to clean and remove prosthesis every night, can cause odor from the plastic itself or from the mouth because the microbiota responds to the changing environment. The plastic is completely porous, and the surface is usually irregular, chiseled to fit the oral edentulous anatomy. These factors affect the retention of bacteria and yeast, which is accompanied by a distinctive odor.
- Oral infection
- Oral ulceration
- Fasting
- Stress/anxiety
- The menstrual cycle - midway through the cycle and during menstruation, increased VSC breathing is reported in women.
- Smoking - Smoking is associated with periodontal disease, which is the second most common cause of oral malodor. Smoking also has many other negative effects in the mouth, from increased tooth decay rates to premalignant lesions and even oral cancers.
- Alcohol
- Evaporative foods Ã, - eg. onion, garlic, durian, cabbage, cauliflower and radish. The volatile food may leave a foul-smelling residue inside the mouth, which is the subject of bacterial decay and VSC release. However, a volatile foodstuff can also cause halitosis through a blood-borne halitosis mechanism.
- Drugs - often drugs can cause xerostomia (dry mouth) which results in increased growth of microbes in the mouth.
Nose and sinus
In this case, the air coming out of the nostrils has a distinct odor of bad breath. The smell of the nose may be caused by a sinus infection or a foreign object.
Halitosis is often expressed as a symptom of chronic rhinosinusitis, but standard gold breath analysis techniques have not been applied. Theoretically, there are several possible mechanisms of both objective and subjective halitosis that may be involved.
Tonsils
There is disagreement about the proportion of cases of halitosis caused by the condition of the tonsils. Some claim that the tonsils are the most important cause of mouth smelling. According to one report, about 3% of halitosis cases are associated with the tonsils. Tummy conditions that may be associated with halitosis include chronic caseontal tonsillitis (ingredients such as cheese can be removed from the crypt tonsil orifi), tonsillolithiasis (tonsils), and less common peritonsillar abscesses, aktinomikosis, fungating malignancy, chondroid choristoma and inflammation. myofibroblastic tumor.
Esophagus
The lower esophageal sphincter, which is the valve between the stomach and the esophagus, may not close well because of a hiatal hernia or GERD, allowing acid to enter the esophagus and gas to get out into the mouth. Diverticulum Zenker can also cause halitosis due to aging food stuck in the esophagus.
Stomach
Abdomen is considered by most researchers as a very unusual source of bad breath. The esophagus is a closed tube and collapse, and the continuous flow of gases or foul substances from the stomach indicates health problems - such as serious reflux to enlarge the stomach contents or fistula between the stomach and the esophagus - which will exhibit a more serious manifestation than just a foul odor.
In the case of allyl methyl sulfide (a byproduct of garlic digestion), the odor does not originate from the stomach, as it can not be metabolized there.
Systemic diseases
There are some systemic (non-oral) medical conditions that can cause bad breath, but this is rare in the general population. These conditions are:
- Fetor hepaticus: an example of the rare type of bad breath caused by chronic liver failure.
- Lower respiratory tract infections (bronchial and pulmonary infections).
- Kidney infection and kidney failure.
- Carcinoma.
- Trimethylaminuria ("fish odor syndrome").
- Diabetes mellitus.
- Metabolic conditions, e.g. resulting in an increase in the blood of dimethyl sulphide.
Individuals suffering from the above conditions often exhibit additional symptoms, more conclusive diagnostics than bad breath alone.
Delusional Halitosis
A quarter of people who seek professional advice about bad breath have excessive worries of having bad breath, known as halitophobia, delusions of halitosis, or as a manifestation of the olfactory reference syndrome. They are convinced that they have bad breath, although many have not sought an objective opinion of anyone. The smell of the mouth can greatly affect the lives of about 0.5-1.0% of the adult population.
Diagnosis
Self diagnosis
Scientists have long thought that smelling their own breath is often difficult due to acclimatization, although many people with bad breath are able to detect it in others. Research has suggested that self-evaluation of halitosis is not easy because of the preconceived notions about how badly we think it should be. Some people assume that they have bad breath due to discomfort (metallic, acid, stool, etc.), but the discomfort is considered a bad indicator.
Patients often self-diagnose by asking a close friend.
One popular home method for determining the presence of bad breath is by licking the back of the wrist, allowing the saliva to dry for a minute or two, and kiss the result. The results of these tests are too high, as deduced from the study, and should be avoided. A better way is to slightly erode the back of the tongue with a disposable plastic spoon and to smell the remaining drying. House tests using chemical reactions to test for the presence of polyamine and sulfur compounds on tongue swabs are now available, but there are studies showing how well they detect odors. In addition, since the breath smell of intensity changes throughout the day depends on many factors, some testing sessions may be required.
Test
If continuous odor breath, and all other medical and dental factors have been ruled out, special testing and treatment is required. Hundreds of dental offices and commercial breathing clinics now claim to diagnose and treat bad breath. They often use several laboratory methods for the diagnosis of bad breath:
- Halimeter: portable sulphide monitor used to test sulfur emission levels (for specific, hydrogen sulfide) in the mouth air. When used properly, this device can be very effective at determining the level of certain VSC-producing bacteria. However, it has disadvantages in clinical applications. For example, other common sulphides (such as mercaptans) are not recorded easily and can be misunderstood in the test results. Certain foods such as garlic and onions produce sulfur in the breath for 48 hours and can cause false readings. Halimeters are also very sensitive to alcohol, so people should avoid drinking alcohol or using mouthwash containing alcohol for at least 12 hours before being tested. This analog machine loses sensitivity over time and requires periodic re-calibration to remain accurate.
- Gas chromatography: portable machines, such as OralChroma, are currently being introduced. This technology is specially designed to measure the digital molecular level of the three major VSCs in oral air samples (hydrogen sulfide, methyl mercaptan, and dimethyl sulphide). It is accurate in measuring the sulfur component of the breath and producing visual results in graphical form through the computer interface.
- The BANA test: This test is directed to finding salivary levels of enzymes that indicate the presence of bacteria associated with certain halitosis.
- ? - galactosidase test: salivary levels of this enzyme are found to correlate with oral malodor.
Although instrumentation and examination are widely used in respiratory clinics, the most important measurements of bad breath (the gold standard) are actual sniffing and scent levels and odor types performed by trained experts ("organoleptic measurements"). The odor rate is usually assessed on a six point intensity scale.
Classification
Two major classification schemes exist for bad breath, although they are not universally accepted.
Miyazaki Classification et al. Was originally described in 1999 in a Japanese scientific publication, and has since been adapted to reflect North American society, particularly with regard to halitophobia. This classification assumes three major divisions of the symptoms of halitosis, namely native halitosis, pseudohalitosis and halitophobia. This classification has been suggested for the most widely used, but has been criticized for being too simple and mostly only used for dentists rather than other specialties.
The classification of Tangerman and Winkel was suggested in Europe in 2002. This classification focuses only on cases where there is native halitosis, and has therefore been criticized for being less clinically useful for dentistry when compared to Miyazaki et al. classification.
- Intra-oral halitosis
- Extra oral halitosis
- A. The blood of halitosis is borne
- (i) Systemic disease
- (ii) Metabolic Disease
- (iii) Food
- (iv) Medication
- B. Non-blood borne halitosis
- (i) Upper respiratory tract
- (ii) Lower respiratory channel
- A. The blood of halitosis is borne
The same authors also suggest that halitosis can be divided according to the character of the odor into 3 groups:
- "Sulfurous or fecal" caused by volatile sulfur (VSC) compounds, especially methyl mercaptan, hydrogen sulfide and dimethyl sulfide.
- "Fruity" caused by acetone, is present in diabetes. Urine-like or ammoniacal caused by ammonia, dimethyl amine and trimethylamine (TMA), is present in trimethylaminuria and uremia.
Based on the strengths and weaknesses of previous classification efforts, a classification based on a cause has been proposed:
- Type 0 (physiological)
- Type 1 (oral)
- Type 2 (air dash)
- Type 3 (gastroesophageal)
- Type 4 (blood-borne)
- Type 5 (subjective)
Each of the symptoms of halitosis is potentially the sum of these species in any combination, which is superimposed on the physiological odor present in all healthy individuals.
Management
Efforts may include physical or chemical means to reduce the number of bacteria, products to cover odors, or chemicals to change the smell of creating molecules. It is recommended that those who use tobacco products stop. Evidence does not support the benefits of dietary changes or chewing gum.
Mechanical action
Brushing your teeth can help. Although there are temporary benefits of cleansing the tongue is not enough to draw a clear conclusion. A 2006 Cochrane review found tentative evidence that it might lower the level of odor molecules. Flossing may be useful.
Mouthwash
A systematic review of 2008 found that antibacterial mouthwash may help. Mouthwashes often contain antibacterial agents including cetylpyridinium chloride, chlorhexidine, zinc gluconate, essential oils, hydrogen peroxide, and chlorine dioxide. Cetylpyridinium chloride and chlorhexidine can be stained while teeth.
Underlying disease
If there is gum disease and cavities, it is recommended that this be treated.
If diseases outside the mouth are believed to contribute to the problem, treatment may result in improvement.
Counseling may be useful for those who falsely believe they have bad breath.
Epidemiology
It is difficult for researchers to make an estimate of the prevalence of halitosis in the general population for several reasons. First, halitosis is the subject of social taboos and stigma, which may affect the individual's desire to take part in the study or accurately report their experience of the condition. Secondly, there is no universal agreement on what diagnostic criteria and what detection methods should be used to determine which individuals have halitosis and which do not. Some studies rely on self-reported estimates of halitosis, and there is an opinion as to whether this is a reliable predictor of true or not halitosis. In the reflection of this problem, the reported epidemiological data vary widely.
History, community and culture
The earliest mention of bad breath is known to occur in ancient Egypt, where detailed recipes for toothpaste were made before the Pyramids were built. The 1550 BC Ebers Papyrus describes tablets for healing bad breath based on incense, cinnamon, myrrh and honey. Hippocratic medicine recommends mouthwash of red wine and spices to cure bad breath. Note that an alcohol-containing mouthwash is now considered to aggravate bad breath when drying the mouth, leading to an increase in microbial growth. The Hippocratic Corpus also describes recipes based on marble powder for women with bad breath. Ancient Roman physician Pliny wrote about methods to sweeten the breath.
Ancient Chinese emperors asked visitors to chew cloves in front of the audience. The Talmud describes the smell of bad breath as a defect, which could be the reason for breaking the marriage law. Early Islamic theology emphasized that the teeth and tongue should be cleaned with siwak, the rod of the plant tree Salvadora persica. This traditional chewing stick is also called Miswak, mainly used in Saudi Arabia, basically like a natural toothbrush made of twigs. During the Renaissance era, Laurent Joubert, doctor of King Henry III of France expressed his bad breath "caused by dangerous toxins that fall into the lungs and penetrate the heart, causing severe damage".
In BG Jefferis and JL Nichols 'Senter on Health' (1919), the following recipe is offered: "[One] one teaspoonful of the following mixture after each meal: One ounce of soda chloride, one ounce of potassa, one and one- phosphate soda, and three ounces of water. "
On this day, bad breath is one of the biggest social taboos. The general population is particularly concerned with bad breath evasion, illustrated by the $ 1 billion annual spent by consumers in the United States on deodorant mouth types (oral), sweets, and over-the-counter products. Many of these practices are just short-term attempts to cover up the smell. Some authors suggest that there is an evolutionary basis that concerns bad breath. An instinctive reluctance to unpleasant odors can serve to detect faulty food sources and other potentially harmful or dangerous substances. Body odor is generally considered to play an important role in the selection of a partner in humans, and unpleasant odors may indicate illness, and hence potentially an unwise partner. Although reports of bad breath are found in the earliest known medical writings, social stigma may have changed over time, perhaps partly due to socio-cultural factors that involve advertising pressure. As a result, negative psychosocial aspects of halitosis may worsen, and psychiatric conditions such as halitophobia may be more common than historically. There are rare reports of people committing suicide because of halitosis, whether there is genuine halitosis or not.
Etymology
The word halitosis comes from the Latin halitus , which means 'breath', and the Greek suffix -osis which means 'diseased' or 'condition'. With modern consumerism, there is a complex interplay of advertising pressures and the evolutionary unwillingness that exists against odor. Contrary to popular belief that Listerine coined the term halitosis, the date of its origin before the existence of the product, invented by the doctor Joseph William Howe in 1874 his book The Breath and the Disease That Gives It Fetid Smell , though it only became commonplace in 1920 when a marketing campaign promoted Listerine as a solution to "chronic halitosis". This company is the first to manufacture desserts in the United States. According to Freakonomics:
Listerine "... was discovered in the nineteenth century as a strong surgical antiseptic, then sold, in the form of a flute, both as a floor cleaner and medicine for gonorrhea, but it was not a runaway success until the 1920s, when it pitched as a solution for "chronic halitosis" - a medical term that is then unclear for bad breath.Listerine's new ad is shown for women and young men, who want to get married but is turned off by his rotten foam breath. "Can I be happy with him? Apart from that ? "a girl asked herself.That time, bad breath was not conventionally thought of as a catastrophe like that, but Listerine changed it.As an advertising expert James B. Twitchell said," Listerine did not make that many mouthwashes make halitosis. "In just seven years, corporate earnings rose from $ 115,000 to over $ 8 million."
Alternative medicine
According to traditional Ayurvedic medicine, chewing betel nut and betel leaf is a remedy for bad breath. In South Asia, there is a habit of chewing areca or betel nut and betel leaves among lovers because of the refreshing and refreshing medicinal properties of the mixture. Both peanuts and leaves are mild stimulants and can create addictions with repeated use. Betel seeds will also cause tooth decay and staining of red or black teeth when chewed. Both betel and betel chewing leaves, however, can cause pramalignal lesions such as leukoplakia and submucosal fibrosis, and recognized risk factors for oral and oropharyngeal cell carcinoma (oral cancer). Other traditional medicines for halitosis include guava leaves in Thailand, egg shells in China, parsley in Italy, and urine-based mouthwashes in certain European cultures.
Practitioners and alternative medicine suppliers sell a wide range of products that claim to be beneficial in treating halitosis, including dietary supplements, vitamins, and oral probiotics. Halitosis is often claimed as a symptom of "candida hypersensitivity syndrome" or related disease, and is claimed to be treated with antifungal drugs or alternative treatments to treat yeast infections.
Research
In 1996, the International Society for Breath Odor Research (ISBOR) was established to promote multidisciplinary research on all aspects of breath odor. The eighth international conference on the smell of breath occurred in 2009 in Dortmund, Germany, while the ninth was held in 2011 in Salvador da Bahia, Brazil.
References
External links
Source of the article : Wikipedia
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