Causes of Bad Breath


Causes of bad breath?

Bad breath is a common health problem that greatly affects the day to day activities of so many people. The offensive odour from the mouth is an unpleasant experience, to say the least. The problem will be doubled by psychological trauma leading to depression. The sufferers from this problem feel isolated from society at large and from their closest family members. There are many causes of bad breath.

The oral cavity contains millions of anaerobic bacteria like Fusobacterium and actinomyces which acts on the protein of food materials and putrifies them. This process results in the formation of offensive gases like hydrogen sulphide, methyl mercaptan, skatol, and putrescine causing a bad odour. If oral hygiene is not maintained properly all will suffer from bad breath. This can be controlled by regular brushing, tongue cleaning and gargling. Even after maintaining cleanliness in the mouth some individuals suffer from offensive smell due to various causes that have to be diagnosed and treated properly. Some common causes of bad breath.

1) Poor oral hygiene

If oral hygiene is not maintained properly the mouth becomes the seat for millions of bacteria that produce offensive gases by degrading the food debris. Bad breath is severe in those who do not brush their teeth regularly and clean their mouth after every food. Snacks taken between meals can also produce bad breath because of improper cleaning. Bad breath is common in almost all people in the morning on waking. During sleep, there is less production of saliva. Saliva has antibacterial properties that help to keep the mouth clean. Saliva contains oxygen molecules that are needed to make oral cavity aerobic. So the reduction in its quantity during sleep makes a favourable condition for anaerobic bacteria.

2) Food habits: Watch what you eat!

The main cause of bad breath is due to the degradation of protein by the bacteria and hence all food products rich in protein favours bad breath. Meat, fish, milk products, eggs, cakes, nuts, pear and it can cause bad breath. Some food articles can produce a particular type of smell which may be unpleasant. Raw onion can produce a bad smell. It is said that an apple a day keeps the doctor away, yet a raw onion a day keeps everybody away. Eating groundnuts can also produce a bad smell. However, if proper cleaning is done smell can be reduced irrespective of the nature of food. Irregularity in the timing of food can also produce bad breath. Small food articles taken in between the meals can also produce a bad smell.

3) The layer of Biofilm

There is the formation of a thin sticky coating called biofilm on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram-negative bacteriae are seen. The thick coating on the tongue is always associated with bad breath. Even a thin biofilm can make anaerobic conditions favourable for bacterial proliferation.

4) Your dental health could be the reason for your bad breath: Watch out for Dental caries.

This is a destructive process causing decalcification with the destruction of enamel and dentine resulting in cavitation of the tooth. These are produced mainly by the lactobacilli. Food particles are deposited inside these cavities and are putrified by the anaerobic bacteria producing bad smell. Normal brushing will not remove the food debris easily and hence they are putrified completely. Caries is common in school children and in those who don’t maintain proper oral hygiene.Calcium and vitamin deficiency can also predispose caries.

5) Gingivitis: inflammation of the gums

The mucus membrane with supporting connective tissue covering the tooth-bearing borders of the jaw is referred to as the gingiva. The main function of gum is protection. Gingivitis is the inflammation of the gum. Due to various causes gum tissue gets infected resulting in swelling, pain and discharge. If the condition becomes worse the infection spreads towards the periodontal area leading to continuous discharge called pyorrhoea. Some times the infection goes deep producing alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis.

6) Gum retraction

When the gums retract from the teeth a gap is developed which will lodge food particles and cause bad breath.

7) Dental plaques and tartar deposits

Plaques and tartar are deposited mainly in the gaps between the teeth and gum. This will provide shelter for the food debris and bacteria causing bad breath.

8) Ulcerative lesions & coatings

Almost all ulcerative lesions of the mouth are associated with bad breath. These lesions may be caused by bacteria, viruses, food allergies or due to autoimmune disorders. Aphthous ulcer is the commonest among ulcerative lesions. Others are herpes, fungal infections, infectious mononucleosis, scarlet fever, diphtheria or drug reactions. Cancerous ulcers produce severe bad breath. All fungal infections produce a white coating(candidiasis). Leucoplakia is a white thick patch on the mucous membrane of the mouth & tongue. It is considered a precancerous condition. Offensive breath is associated with these conditions.

9) Diseases of the salivary glands:

Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin film of coating called biofilm can provide an anaerobic condition in the mouth. Saliva can wet these layers and make an aerobic condition which is unfavourable for the bacteria. Any condition which reduces the production of saliva can increase bacterial activity. Some times the salivary duct is obstructed by stones or tumours. In cases of suppurative parotitis purulent discharge into the mouth causes bad breath.

10) Tonsillitis

Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.

11) Tonsillar plaques & tonsillar fluid

If bad breath persists even after maintaining proper oral hygiene there is a possibility of this condition. Serous fluid secreted from the folds of the tonsil is very offensive. Some patients complain that they have some cheesy materials from the throat; which are very offensive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteriae. In such conditions, the doctor may recommend a tonsillectomy which gives noticeable relief from bad breath.

12) Pharyngitis & pharyngeal abscess

The Pharynx is a fibromuscular tube that forms the upper part of the digestive & respiratory tract. Inflammation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis along with other signs like cough and throat irritation. Abscesses in the wall of the pharynx can also produce an offensive discharge of pus into the throat.

13) Dentures

Denture users may complain about bad smell due to the lodgement of small food debris in between the mouth and the denture. Proper brushing may not be possible in denture users especially fixed dentures. In this case, it is important to seek dental care.

14) Tobacco

Tobacco chewing is associated with bad breath. The smell of tobacco itself is unpleasant for others. Tobacco can irritate the mucous membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. All these cause offensive smells.

15) Smoking

Smokers frequently have bad-smelling breath. Smoking produces lesions in the mouth & lungs causing bad breath. Smoking increases carbon dioxide in the oral cavity & reduces oxygen level, causing a favourable condition for bacteria. Smoking reduces appetite & thirst hence the acid peptic disease is common in chain smokers.

16) Lesions in the nose & ear

Bad breath is occasionally seen in sinusitis (infection of the sinuses). In the case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with a discharge of pus into the throat through the eustachian tube(passage from the middle ear to the throat) can also cause offensive mouth odour. Chronic rhinitis(infection of the mucous membrane of the nose) and foreign bodies in the nose can also produce bad smell in the expired air.

17) Diabetes Mellitus

Many diabetic patients suffer from bad breath. Coated tongue, ulcers and coatings in the mouth are responsible for bad breath. Bacterial growth in diabetic patients is very faster than non-diabetic individuals.

18) Fevers

Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. Severe bad breath is seen in typhoid. Other infectious diseases like Tuberculosis and AIDS may cause lesions in the mouth that produce a bad smell.

19) Fasting & dehydration

Dry mouth favours bacterial activity. So any condition which produces dryness in the mouth makes the breath offensive. Even though the food particles are known to produce bad breath, fasting can also produce the same. Production of saliva is also reduced during fasting. Chewing and swallowing also help to keep the mouth clean.

20) Bedridden patient

Bedridden patients suffer from offensive breath due to a thick coating on the tongue. Water intake is also limited in these patients. Regurgitation of food may aggravate the condition. Since they talk less aeration in the oral cavity is reduced which favours anaerobic bacteria to become active.

21) Diseases of stomach & esophagus

Eructation of gas and food produce an unpleasant smell. Abnormality in the function of the lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis, gastric ulcer and cancer of the stomach.

22) Intestinal diseases

Bad breath is common in patients suffering from ulcerative lesions of intestine like ulcerative colitis. Other diseases are such as malabsorption syndrome, intestinal tuberculosis, or peritonitis may also play a role in causing bad breath.

23) Diseases of lungs

Lung diseases like pneumonia, lung abscess, chronic bronchitis, bronchiectasis can produce bad odour during expiration.

24) Liver disorders

Liver diseases like hepatitis, cirrhosis, can cause bad breath. Gall bladder diseases with vomiting are also one of the causes of bad breath.

25) Psychiatric patients

Bad breath is common in psychotic patients due to poor hygiene, irregular food habits and reduced water intake.

26) Somatization disorder

This is a psychiatric disorder characterized by the presence of a physical symptom that suggests a medical illness.These patients come with physical complaints like pain, nausea, difficulty in respiration, or bad smell. This condition is diagnosed after a detailed examination of the patient with all investigations. Since this is a psychiatric disorder it has to be managed with a psychological approach.

Make sure to consult your physician and dentist to assess your health if you have bad breath, as it could be an indicator of an underlying condition.

Photo by Oleg Magni from Pexels


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