Saturday, February 4, 2017

Know All About Halitosis

Halitosis, colloquially called bad breath, or fetor oris, is a symptom in which a noticeably unpleasant odor is present on the exhaled breath. About 20% of the general population are reported to suffer from it to some degree.

As the mouth is worse than the anus, it is  embarrassing but often unrecognized offensive holocaust by our own systems. More than 80 million people suffer from chronic halitosis, or bad breath. In most cases it originates from the gums and tongue. The odor is caused by wastes from bacteria in the mouth, the decay of food particles, other debris in your mouth and poor oral hygiene. The decay and debris produce a sulfur compound that causes the unpleasant odor.

What Causes Bad Breath?
There are a number of reasons you might have dragon breath. While many causes are harmless, bad breath can sometimes be a sign of something more serious.

Bad breath can happen anytime thanks to the hundreds of types of bad breath-causing bacteria that naturally lives in your mouth. Your mouth also acts like a natural hothouse that allows these bacteria to grow. When you eat, bacteria feed on the food left in your mouth and leaves a foul-smelling waste product behind.
Dry Mouth
Feeling parched? Your mouth might not be making enough saliva. Saliva is important because it works around the clock to wash out your mouth. If you don’t have enough, your mouth isn’t being cleaned as much as it should be. Dry mouth can be caused by certain medications, salivary gland problems or by simply breathing through your mouth.

Gum Disease
Bad breath that just won’t go away or a constant bad taste in your mouth can be a warning sign of advanced gum disease, which is caused by a sticky, cavity-causing bacteria called plaque.

Garlic, onions, coffee… The list of breath-offending foods is long, and what you eat affects the air you exhale.

Smoking and Tobacco
Smoking stains your teeth, gives you bad breath and puts you at risk for a host of health problems. Tobacco reduces your ability to taste foods and irritates gum tissues. Tobacco users are more likely to suffer from gum disease. Since smoking also affects your sense of smell, smokers may not be aware of how their breath smells.

Medical Conditions
Mouth infections can cause bad breath. However, if your dentist has ruled out other causes and you brush and floss every day, your bad breath could be the result of another problem, such as a sinus condition, gastric reflux, diabetes, liver or kidney disease. In this case, see your healthcare provider.

Sinus, Mouth, or Throat Conditions: Bad breath odor may develop if you have sinus infection, postnasal drainage, chronic bronchitis or an infection in your upper or lower respiratory system. Tonsil stones also can be a source of bad breath because bacteria tend to collect on the stones.

Although halitosis has multi factorial origins, the source of 90% cases is oral cavity. In oral cavity, temperatures may be reached up to 37°C (and changed between 34 and 37°C). During exhaling also humidity may be reached up to 96% (and changed between 91% and 96%) in oral exhalations. These conditions may provide a suitable environment for bacterial growth. The number of bacterial species, which are found in oral cavity, are over 500,[8] and most of them are capable to produce odorous compounds which can cause halitosis. In these conditions, poor oral hygiene plays a key factor for multiplication of halitosis causative bacteria and causes an increase in halitosis.

The oldest way for unpleasant odor detection is by smelling with the nose. Measurement of unpleasant odors by smelling the exhaled air of the mouth and nose is called organoleptic measurement. It is the simple way for the detection of halitosis.

The measurement method is the organoleptic test; the patient takes breathe deeply by inspiring the air by nostrils and holding awhile, then expiring by the mouth directly or via a pipette, while the examiner sniffs the odor at a distance of 20 cm  and the severity of odor is classified into various scales, such as a 0- to 5-point scale (0: no odor, 1: barely noticeable, 2: slight but clearly noticeable, 3: moderate, 4: strong, and 5: extremely strong) or more widely point scale from 0 to10 point.

Gas chromatography: Measurement with the gas chromatography method is considered to be highly objective, reproducible, and reliable.Using gas chromatography we can measure VSCs. It separates and analyzes compounds that can be vaporized without decomposition; samples are collected from saliva, tongue coating, or expired breath. In this method, measurements are performed and equipped with a flame photometric detector or by producing mass spectra. The concentration of each VSC (ng/10 mL mouth air) was determined based on a standard of hydrogen sulfide and methyl mercaptan gas prepared with a permeater.

Sulfide monitoring: Gas chromatography has high accuracy and sensitivity, but the application method in chairside is difficult and expensive. In order to avoid these disadvantages, a new portable device which is a sulfide monitor was developed to measure VSCs.

In this method before taking measurement, patients should close the mouth and refrain from talking food for 5 min prior to measurement, then a disposable tube of the sulfide monitor is inserted into patient's mouth to collect mouth air. Meanwhile, the patient is breathing through the nose and the disposable tube is connected to the monitor. Sulfur-containing compounds in the breath can generate an electro-chemical reaction. This reaction related directly with levels of volatile sulfur-containing compounds.

BANA test: The BANA test is practical for chair-side usage. It is a test strip which composed of benzoyl-DL-arginine-a-naphthylamide and detects short-chain fatty acids and proteolytic obligate gram-negative anaerobes, which hydrolyze the synthetic trypsin substrate and cause halitosis. It detects especially Treponema denticola, P. gingivalis, and T. forsythensis that associated with periodontal disease. By using the BANA test, we can detect not only halitosis, but also periodontal risk assessment.

Beta-galactosidase test: levels of the enzyme beta-galactosidase have been found to correlate with mouth odor.

Treatment for bad breath (halitosis) will depend on its cause.

Usually, the most effective treatment is improving your dental hygiene. As part of your daily routine, you should:
- floss between your teeth
- brush your teeth and gums
- clean your tongue
- 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 linked to bad breath. Reduce coffee and alcohol consumption. Eating a breakfast that includes rough foods can help clean the back of the tongue.

An antiseptic mouthwash can help eliminate bacteria that cause bad breath. However if your dentist determines that your mouth is healthy and the odor is not of oral origin, you may be referred to your family doctor or to a specialist to determine the odor source and treatment plan. If the odor is due to gum disease, for example, your dentist can either treat the disease or refer you to a periodontist, a dentist who specializes in treating gum conditions. Your dentist might also recommend replacing faulty tooth restorations, a breeding ground for bacteria.

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