Halitosis, also called bad breath, is defined as the set of unpleasant odors emitted from the mouth. It is a problem that affects one in two people.
Social problem related to poor oral hygiene or diseases of the oral cavity, although it may be a manifestation of some other disease is considered.
Depending on your source, there are two types of Halitosis: Halitosis Oral and extra oral Halitosis.
Oral halitosis originates from the oral cavity itself and is mainly (41%) to the accumulation of oral biofilms (plaque) in the tongue. Although it can also be caused by other conditions such as periodontal problems, dental caries, smoking, among others. According to multiple scientific studies, oral Halitosis corresponds to 90% of cases.
When the halitosis originates outside the oral cavity, is called extra oral Halitosis. Is mainly due to systemic disorders, upper / lower respiratory tract, the digestive system and liver or kidney disease. And this corresponds to 10% of cases.
Production of malodorous substances, the most frequent Volatile Sulfur Compounds (CVS), is associated with the degradation products resulting from the metabolism of bacteria, usually gram-negative, anaerobic bacteria that are mainly located in the back of the dorsum of the tongue and in other locations such as periodontal pockets.
The causes of oral halitosis can be pathological and non-pathological.
Non pathological be:
- Morning breath during sleep the saliva flow decreases; it facilitates the uncontrolled growth of bacteria producing foul-smelling gases.
- Age: breath quality changes with age. It is likely that the elderly suffer regressive changes in the salivary glands and affect the quality and quantity of saliva, even with good oral hygiene.
- Dental prostheses: the plate and bridges dentures can accumulate food debris. If left overnight and characteristic unpleasant odor is produced.
- Drugs: There are medications that cause xerostomia (dry mouth), such as anticholinergic, antidepressants, etc.. Saliva helps clean oral cavity and reduces odor.
- Snuff: smoking breath creates a characteristic that can last a few days, even after quitting.
- Periods of fasting: skipping meals and carry a low calorie diet can promote bad breath.
- Diet: after ingestion of certain foods (onions, garlic) or consumption of alcohol, certain metabolites can be absorbed at the gastrointestinal level, enter the circulation, are metabolized in the liver and mucosa and are expelled through the lungs.
- Periodontal disease, caries.
- Poor oral hygiene, lack of elimination of biofilm oral (dental plaque), causing bacterial growth. Places where bacteria are usually accumulate tongue, interproximal spaces, sub gingival area, and abscesses. Language is the location of predominance of anaerobic bacteria in the mouth.
- Ulcerative causes: traumatic ulcers, infectious stomatitis.
- Pharynx: viral, bacterial or fungal infections.
- Necrosis radiotherapy and chemotherapy in patients with malignancies.
- Causes of Halitosis extra oral could be: nose (sinusitis), digestive diseases, respiratory diseases, systemic diseases (diabetes mellitus poorly controlled, kidney infection, liver dysfunction, Sjögren’s syndrome, rheumatoid arthritis, etc…)
In general, Halitosis is difficult to diagnose because it is unlikely that self-detect your own bad breath. In some cases simply bad breath suspected. When in doubt, consult the topic with someone you trust, who can more easily detect the presence of bad breath.
From the health care perspective, the help of a dental professional area may contribute to the diagnosis. On examination of a patient with Halitosis fundamental aspects such as general health status with lifestyle (customs and habits) but also the situation and oral hygiene habits are involved. In addition, you must perform a quantitative measurement of bad breath.
The treatment of oral halitosis is aimed at reducing the number of odor-producing bacteria deposited on the posterior dorsum of the tongue and groove or periodontal pocket and volatilization of odorous products.
Among the antimicrobial agents used in the treatment is the Chlorhexidine 0.05% at low concentration, the cetylpyridinium chloride and zinc lactate that have proven effective in reducing Halitosis associated variables.
Overall, treatment protocols include holding a professional dental cleaning and oral hygiene instructions ranging from proper brushing and interdental cleaning, a thorough cleaning of the lengua4 (with a tongue cleaner along with a mouthwash gargle for performing reach the back of the tong