BAD BREATH: 100% Efective ways to get rid of!! wootooth

BAD BREATH: 100% Efective ways to get rid of!! wootooth

“Do you mind if I sit back a little? Because your breath is very bad-it really is.” wootooth apprises you 100% effective ways to get rid of bad breath.

Telling someone their breath smells without hurting their feeling.

Well, I say instead, let’s go brush our teeth.

Halitosis, bad breath, fetor oris or oral malodor all are the same thing.

People interact with each other every day, and bad breath has a negative effect on a person’s social life.

The person with bad breath or halitosis may not be aware of this situation because he/she may have developed tolerance or olfactory disturbance.

Due to this reason, the patient generally cannot identify his/her halitosis and is usually complained by his/her partner, family member, or friends.

Bad breath causes a distressing effect on a person life and so the affected person may avoid socializing and going out in public. The wootooth team want a smile on everyone’s face.

Some bad breath like “morning mouth” is quite normal as changes occur in your mouth while you sleep. During the day, saliva washes away decaying food and odors.

The body makes less saliva at night. Your mouth becomes dry, and dead cells stick to your tongue and to the inside of your cheeks. When bacteria use these cells for food, they produce a foul odor.

Moreover, halitosis can be an indicator of any systemic disease. In fact, 10% of ear-nose-throat or 5% of gastrointestinal/ endocrinological disorders may contribute to it. We recommend you, to consult a physician if it lasts even with mouthwashes and chewing gums.

Nearly 25% of the population seems to suffer from bad breath on a regular basis.

Man and women seem to suffer in the same proportions, whereas women seem to seek faster for professional help than men.

Why do we have bad breath?

Microbial degradation in the mouth is the main cause of oral malodor. This process forms volatile sulfur compounds (VSCs).

The most important VSCs involved in bad breath (halitosis) are hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide (CH3)2S.

These VSCs are mainly produced by Gram-negative anaerobic oral bacteria including Treponema denticola, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Bacteroides loescheii, Enterobacteriaceae, Tannerella forsythensis, Centipeda periodontii, Eikenella corrodens, Fusobacterium nucleatum.

 The proteolytic degradation process of peptides produces these components. The most predominant substrates in this VSC production are cysteine, cystine, and methionine.

Bad breath in Smokers

It should come as no surprise that the most common cause of “smokers breath” is the tobacco itself.

Chemicals remain in the mouth even after a cigarette has been extinguished and produces bad breath.

Poor hygiene promotes halitosis

Poor oral hygiene, dental plaque, dental caries, accumulation and degredation of food debris and unclean acrylic dentures (worn at night or not regularly cleaned or with rough surfaces) contribute to bad breath.

Most of the responsible microorganisms in halitosis are involved in periodontitis.

So, there is a positive correlation between bad breath and periodontitis: the depth of the periodontal pockets is positively correlated to the height of the VSC concentrations in the mouth.

Gingivitis and periodontitis are the main causes of the problem.

Bleeding gums produces bad breath.

There is a positive correlation between the depth of the pockets and the concentration of the sulfur components. Necrotizing gingivitis or periodontitis cause extremely soiled odors.

This disease is caused by opportunistic bacterial infections occurring in individuals with stress, malnutrition, insufficient oral hygiene, smoking or systemic diseases.

How tongue coating induces bad breath?

The dorsum of the tongue, which is irregular and has a surface of 25 cm2 is an ideal niche for oral bacteria.

Tongue surface houses bacteria, food debris which on putrifaction causes bad breath.

Hence, the tongue surface seems to be an important reservoir in the recolonisation of tooth surfaces. Tongue coating is not easy to remove.

Daily scraping or brushing of the tongue can help to reduce the substrata for putrefaction, rather than to reduce the bacterial load. Moreover, tongue cleaning improves taste sensation.

How dry mouth induces bad breath?

Patients with a dry mouth (0.15 mL·min−1 instead of 0.25–0.50 mL·min−1) often show an increased volume of plaque on teeth and tongue.

The lack of salivary flow, leads to the disappearance of the antimicrobial activity of the saliva and the transition from Gram-positive bacteria to Gram-negative species.

Moreover, other salivary factors can influence the development of malodor: an increase of the salivary pH by the intake of amino acids, and a change in the oxygen depletion (a reduction stimulates the metabolism of Gram-negative bacteria, responsible for higher VSC production).

Saliva seems to undergo chemical changes with aging. As the amount of ptyalin decreases and mucin increases, saliva becomes thick and viscous and presents problems for the elderly.

One of the most prevalent causes of xerostomia is medication (anticholinergics, antihistamines and diuretics dry the mucosa).

Chronic mouth breathing, radiation therapy, dehydration and autoimmune diseases (as Sjögren’s) can also diminish salivation, as can systemic illness such as diabetes mellitus, nephritis and thyroid dysfunction.

Dry mouth symptoms are treated with hydration and sialagogues or with artificial saliva substitutes.

In patients with Sjögren’s syndrome and in those who have undergone any radiation therapy, pilocarpine shows good results.

ENT Pathology and halitosis

Maximally 10% of the oral malodor cases originate from the ears, nose and throat (ENT) region, from which 3% finds its origin at the tonsils.

A Plaut-Vincent angina (caused by Fusobacterium Plaut-Vincenti and Borrelia Vincenti) is another ENT cause for halitosis.

The presence of tonsilloliths represents a 10-fold increased risk of abnormal VSC levels.

Anaerobic bacteria tonsilloliths includes the species of Eubacterium,  FusobacteriumPorphyromonas,  Prevotella,  Selenomonas and Tanerella, all of which appear to be associated with the production of VSCs.

Sinusitis and halitosis

Streptococcus pneumonia and Haemophilus influenza are the main responsible bacteria.

A typical odor appears with the purulent mucous.

Since those bacteria are able to produce VSCs, a clear association to halitosis is available.

In the case of chronic sinusitis, 50%–70% of the patients complain about oral malodor.

The treatment of dentogenic problems (eventual with the additional use of antibiotics) decreases the anaerobic pathogens, even as the odor problem.

GIT and halitosis

When a Zenker’s diverticulum is present, a chronic unpleasant odor appears.

Also bleeding of the oesophagus can cause a musty odor. Bad breath with severe regurgitation is present.

In cases of intestinal obstruction, a fecal mouth odor may be detectable.

Metabolic diseases and halitosis

Renal disease in the form of chronic renal failure is associated with high blood urea nitrogen levels and low salivary flow rates.

The dispersed odor is a typical uremic odor in combination with a dry mouth.

Diabetic ketoacidosis leads to a typical breath odor. Diabetes type 2 demonstrates a typical sweet and fruity odor.

Several metabolic disorders in the bowels, like trimethylaminuria cause a specific fishy odor.

The liver is also involved in oral malodor.

Due to a reduced liver function, waste products are eliminated through the lungs, causing the ‘fetor hepticus’: a sweet, excremental odor (the breath of death).

How to check for halitosis?

There are two approaches – Intra oral and Extra oral examination.

  • Intra oral Examination
  1. Tongue: scraping the tongue with a spoon, smelling the scraping and analyzed with Tongue coat indices and tongue coat weight. Also chair side tests, such as HalitoxTM  for VSCs and polyamines which are based on its color changes are useful. The intensity of hue change from colorless to yellow to yellowish brown depicts the number of VSC producing bacteria.

      2.Saliva: Saliva is  tested for tissue breakdown products by TOPASTM– toxicity prescreening assay for hydrogen sulfide and methyl mercaptan along with polyamines.

  • SSS System – Salivary supernatant sediment test for cysteine breakdown products in saliva.
  • Swinnex filter test to determine the malodorous potential of stagnated saliva during nocturnal conditions contributing towards morning breath.
  • Extra oral examination

Organoleptic Scoring

The gold standard is the organoleptic scoring, i.e., smelling the odor of the patient.

The patient should refrain from spicy foods, garlic or onions the day before the examination.

At least 12 h before the consultation, do not be clean or rinse the teeth.Avoid perfumes for at least 6 h before the examination, and the intake of food or liquids. Quit smoking for at least 24 h before any examination.

Different samples are analyzed for:

  • mouth odor (smelled at 10 cm form the oral cavity: while the patient normally breaths and while the patient counts loudly to 10);
  • saliva odor ( wrist-lick test: the patient licks at the wrist, and after 10 s of drying, record the score);
  • tongue coating (debris  scraped from the dorsum of the tongue with a periodontal probe);
  • interdental ‘floss’ (after flossing with dental tape,score the odor of the floss);
  • nasal odor (while the patient is breathing through the nose (mouth closed), a score is given to the exhaled air);
  • prosthesis odor (if the patient wears a partial or full removable denture, scoring of the odor of this prosthetic)

 A well-trained clinician performs organoleptical scoring.

If the odor samples smells bad or not, giving a score to the intensity. These scores go from 0 up to 5.

The advantages of organoleptical scoring are: inexpensive, no equipment needed and a wide range of odors is detectable.

Disadvantages includes the extreme subjectivity of the test, the lack of quantification, the saturation of the nose . Still, organoleptic scoring is the gold standard in the detection of oral bad breath.

  • Portable gas analysis

The Halimeter (Interscan corporation, Chatsworth, CA, USA) and OralChroma (Abimedical corporation, Miyamae-ku Kawasaki-shi, Kanagawa, Japan) are electronic devices available to detect some of the volatile sulfur components in expired air.

The OralChroma is a portable gas chromatograph offering lower cost, higher performance and more user-friendly operations than conventional gas chromatographs by limiting the target gases to three types: H2S, CH3SH and (CH3)2S.

The Halimeter can only give an idea of the total amount of VSCs, present in a sample. In the Halimeter, we mark the total amount ppb (parts per billion) of VSCs in the sample.

In normal situations this value is less than 100 ppb. If we get a score of 300–400 ppb,means a persistent oral odor.

These portable machines have a lot of advantages: easy to handle, fast results, portable and reproducible.

Furthermore,even an untrained staff can control it. They are rather inexpensive.

Recently, the OralChroma may produce a more comprehensive assessment of VSC production by oral microflora than the Halimeter.It would desirable to select one machine as gold standard to make different studies comparable in the future.

 

  • Gas chromatography

In halitosis research, the gas chromatography (GC) analysis can be performed on breath, saliva and tongue debris. VSCs can be well detected, but the challenge will be to analyze the other contributing components of oral malodor.

GC has several advantages: an analysis of almost all components with high sensitivity and specificity.

The method is non-invasive, but expensive and requires a well-trained staff .

The progression of the method takes much more time and the machine cannot be used in daily practice.

Treatment

Self-care products

Halitosis interferes with normal social interactions. For these reasons, people use self-care products for preventing unpleasant odor.

Few lifestyle changes and home remedies for bad breath include:

  • Brush the teeth:Be sure to brush at least twice a day, preferably after each meal.
  • Floss:Flossing reduces the build-up of food particles and plaque from between the teeth. Brushing only cleans around 60 percent of the surface of the tooth.
  • Clean dentures: Clean anything that goes into your mouth, including dentures, a bridge, or a mouth guard,  on a daily basis. Cleaning prevents the bacteria from building up and being transferred back into the mouth. Changing toothbrush every 2 to 3 months is also important for similar reasons.
  • Brush tongue: Bacteria, food, and dead cells commonly build up on the tongue, especially in smokers or those with a particularly dry mouth. A tongue scraper can sometimes be useful.
  • Avoid dry mouth:Drink plenty of water. Avoid alcohol and tobacco, both of which dehydrate the mouth. Chewing gum or sucking a sweet, preferably sugar-free, can help stimulate the production of saliva. If the mouth is chronically dry, a doctor may prescribe medication that stimulates the flow of saliva.
  • Diet:Avoid onions, garlic, and spicy food. Sugary foods are also induces to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue.
  • Quit smoking: While the most obvious answer to cure bad breath after smoking is simply to kick the habit, we are well aware of how difficult this may be.
  • Chewing gum, mints: chewing gum may decrease halitosis, especially through increasing the salivary secretion.
  • Mouth rinses: Mouth rinses containing chlorine dioxide and zinc salts have a substantial effect on masking halitosis, not allowing the volatilization of the unpleasant odor.

However, by these products direct treatment of halitosis is not possible. Use these approaches  as a temporarily solution to relieve and improve the satisfaction of the patient. Professional treatment of real halitosis has crucial severity.

 

Professional treatment

  • Scaling and Root planning procedures: Initial periodontal treatment includes scaling and root planning which may alleviate the depth of the periodontal pockets and severity of gingival inflammation and it eliminates halitosis causing bacteria.
  • During periodontal therapy, usage of antiseptic mouth wash relieves reduction of the bacterial load. Chlorhexidine is a valuable antiseptic agent, but careful with the long-term uses of chlorhexidine as it can cause staining of teeth and mucosal surfaces.
  • Maintaining oral hygiene: Good oral hygiene instruction is another important issue for oral  halitosis.
  • Proper brush, dental floss, and inter-dental brush usage are very important. However, sometimes even if the periodontal health is perfect, tongue coating can be an important source of halitosis.
  • The tongue dorsum can be a shelter for these bacteria. If a patient has geographic or fissure tongue, the coating will be more.
  • Due to these reasons, cleaning of tongue dorsum by brushing, tongue scraper or tongue cleaner is important.

One of the studies showed the importance of tongue cleaning; there was reduction of VSC levels with the toothbrush 33%, with the tongue scraper 40%, and with the tongue cleaner 42%.

  • Chlorhexidine (CHX) mouthwash: CHX is the most efficient molecule against plaque. Rinsing with 0.2% CHX causes a reduction of 43% in VSCs and of 50% in the organoleptical scores on a day-long basis.
  • Essential oils: these products give only a short-term and restricted effect (25% reduction) for 3 hours. Also, limited reduction in odour-producing bacteria.
  • Chlordioxide: Chlordioxide is a strong oxidizing product that can reduce 29% of oral malodor up to 4 hours.
  • Triclosan: Triclosan is effective against the majority of oral bacteria. An 84% reduction of VSCs after 3 hours.
  • Aminefluoride/Tinfluoride: The combination of AmF/SnF2can cause an 83% reduction in the morning halitosis.
  • Peroxide(H2O2): a concentration of 3% of this product can result in a 90% VSC reduction after 8 hours.
  • Chlorhexidine and zinc mouthwash:  has a strong effect on volatile sulfur-containing compounds and is effective for at least 9 hours.
  • Cetylpyridinium and zinc mouthwash: has a good synergistic effect on volatile sulfur-containing compounds levels after 1 hour, but minimally above the effect of zinc alone.
  • Chlorhexidine, cetylpyridinium chloride and zinc-lactate mouthwash: Chlorhexidine is still the gold standard mouth rinse, but it does have some side effects.
  • Due to these disadvantages, companies are coming up with new formulations . Since CHX and CPC are both antimicrobial agents, it seems reasonable to assume that the new marketed mouthwash that contains CHX and CPC acts by reducing the number of VSC-producing bacteria on the dorsum of the tongue.
  • Probiotics: probiotic bacterial strains, originally sourced from the indigenous oral microbiotas of healthy humans, may have potential application as adjuncts for the prevention and treatment of halitosis.
  • The oral administration of the probiotic lactobacilli not only seemed to improve the physiologic halitosis, but also showed beneficial effects on bleeding on probing from the periodontal pockets.
  • Treating Dental pathology: Dentist first review any existing and necessary restorative conditions . Unsuitable prosthetics and conservative restorations, such as causing food impactions, uncleaned area or food retention, create a reservoir area for bacteria. Replacement or renewing of old restorations with proper restoration provides prevention of these reservoir areas. Also existing of the non treated cavity of decayed teeth, nonvital tooth with fistula or exposed tooth pulps may create a reservoir area for bacteria, so treatments of these teeth with proper restoration are important.
  • Treating Medical conditions: If halitosis originate from nonoral causes , consult with the specialist.
  • You must know the actual disease and treat it, otherwise the effect of halitosis will affect a your social life . Accordingly duties of a dentist in extra-oral cause halitosis are aware of patient about source of halitosis and sending him/her to the specialist.

Delusional halitosis

Sometimes people can think have halitosis in spite of them have no measurable halitosis. This condition is called a halitophobia and this condition can be mono symptomatic delusion (“delusional halitosis”) or manifestation of olfactory reference syndrome.

Management of halitophobia is complex than management of real halitosis.

Halitophobia persons avoid socializing and even avoiding talking with people; therefore, treatment of halitophobia is very important.

Prior to treating people who have halitophobia, check if he/she has no measurable bad breath by measuring devices. If you getting obsessed with the idea of having bad breath, then consult a psychologist.

Do I have bad breath?

It’s not always easy to tell if you have bad breath. Other people may notice it first, but they could feel uncomfortable telling you.

A simple test to find out whether you have bad breath is to lick the inside of your wrist with the back of your tongue.

wait a few seconds until the saliva dries.

If your wrist smells unpleasant, it’s likely your breath does, too.



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