A Consultant in Oral Medicine at the Federal Medical Centre, Abeokuta, Ogun State, Dr. Mogaji Ibrahim, speaks to Dpath To Jannah Media Hub on the definition, causes, prevention and management of bad breath and mouth odour.
Can you describe to us what exactly is termed bad breath?
Consultant: Bad mouth odour or what we call halitosis is describe as an unpleasant breath, regardless of whether its source is from the mouth or not. It is bad breath with intensity beyond what is socially acceptable.
It is very common and estimated to be the 3rd most frequent reason for seeking dental consultation, following tooth decay & diseases of the gum. Almost everybody will have mouth odour at one point or the other. It can be so bad in some cases that it will impair patient quality of life as well as their social interactions and relationships. I have seen cases where intending couples break up because of perceived bad breath from the partner. These bad breaths are actually gases which are produced from the actions of some bacteria on food debris and other substances in our mouth. Foul smelling gases that can smell like rotten egg, rotten fish, dead body, decayed meat can emanate from the mouth.
What are the causes of these bad breath?
Consultant: The causes are numerous. Our foods and habits are a major cause. Intake of alcohol-containing liquids (wine and some mouthwashes) and cigarettes smoking produces characteristic foul odours from the mouth. Meals with high concentrations of protein for example dairy products, beans, egg. Eating a lot of suya or fish especially in the night without cleaning after the meal can bring foul odour in the morning.
Onion and garlic contain high concentrations of sulphur, which pass into the bloodstream through the intestinal lining, with subsequent release into the lungs and then exhaled. Some of the chemicals from garlic can be released even in sweat causing body odour. All these have to be taken in moderation.
So the causes of bad breath are majorly what we eat?
Consultant: Yes but there are other more sinister causes. Bad breath can be a sign of serious systemic illness. Diabetes, liver, renal diseases can produce bad breath and body odour. It is necessary to be managed by qualified personnel when we have these ailments. The drugs we take are also involved in producing mouth odour. The antibiotics, the antihypertensive, anti-diabetics for example can produce odours with prolonged use.
We must note however that perhaps one of the greatest causes is self-inflicted. Not taking good care of our mouth leads to accumulation of plaque and calculus which produces very foul and offensive odor from our mouths. These dirt cause diseases such as caries, gingivitis and periodontitis that can make the mouth smell badly while we talk to people around us. Some people report to the clinic so late that their self-esteem and mental health will be seriously compromised. I have personally seen many cases of perceived bad breath that has metamorphosed into mental health issues and will need to be handled by the mental health specialist.
Are all bad breath caused by disease condition?
Consultant: This is a very important question. We have what we call physiological halitosis. This means having such ‘breath’ at those period is expected and it should disappear after such conditions are over. For example after waking up in the morning, during fasting , having fever even hunger can cause such transient odour. These type of ‘mouth odour’ do not need treatment , they disappear after the condition is over.
Is bad breath preventable?
Consultant: Those who feel they have bad breath should visit the dental hospital. However, it is always better to prevent it. Generally, we advise people to brush twice a day, morning and night and also to visit the dental clinic at least twice a year for a general check up and possibly get a scaling and polishing of the mouth done at those periods. After meals, we should take enough water which will free the mouth of food debris. These debris are a major cause of foul breath as they decay in between teeth to cause these offensive odours. When we brush we must always remember the surface of the tongue. A lot of these odours are from bacteria action on debris on the surface of the tongue. Cleaning it adequately will prevent bad breath. Muslims can also leverage on the practice of the Messenger of Allah (saw) that encourage the use of siwak (chewing stick) at every time of prayer. Being conscious of cleaning the mouth at these periods will keep the mouth free of dirt and give pleasant odour.
How do you diagnose it?
Consultant: The diagnosis can be straight forward because bad breath cannot be hidden. We take a detailed history and the proceed to examine the patient. The oral examination and particularly the systemic examination is very important because as I have said earlier, some of the causes are not exclusive to the mouth. There are basic clinical assessment that are done when patients complain of halitosis.
Usually by simply smelling the exhaled air, first from the mouth (with nose closed by pinching nostrils) then from the nose (with patient’s mouth closed) and comparing the two. We call this organoleptic assessment. Organoleptic assessment is considered as the “gold standard” to diagnose halitosis in a clinical setting. The use of halimeter is becoming more popular in our setting. It can measure the amount of hydrogen sulfide produced from the mouth which is the primary cause of those who have rotten egg mouth odour. Chemical sensors is also available. It is used in the quantitative assessment of oral malodor that are associated with food and beverages There are some other more complicated test that can be done especially if research is of interest. Those whose cause are due to systemic illnesses; the relevant test will be done and collaboration with the relevant specialist will be important in such cases too.
How do you treat bad breath?
Consultant: Treatment starts by educating the patient. I need to point out an interesting finding. A good percentage of those who come to the clinic to complain of mouth odour don’t have it! Many are under the pressure of friends and colleagues whom they want to measure up to. They have a low self esteem of their own body and seek a perfection that doesn’t exist. Some patient can come to the clinic to complain that their mouth smells when they wake up in the morning and even after several explanations that this is normal, they will still insist on treatment. Some will believe all their colleagues cover their nose when he/ she comes to the office. Yet on proper examination the mouth will be very clean and doesn’t exude any odour. Therefore, education and counselling are an important part of the management.
We advise regular drinks of water and chewing of sugar free minty gum. It is important to rinse mouth after every meal or intake of snacks Patients are told to stop offending agent like smoking, alcohol and if possible, medications. Treatment also include elimination of whatever is noted in the mouth as a cause. These can include treatment of caries and periodontal diseases. If it is other systemic causes, the relevant specialist will be involved. In some cases, there will be need for regular recalls to the clinic.
What is your advice on the use of mouthwashes?
Consultant: We strongly advice against the use of alcohol based proprietary mouthwashes. There are other mouthwashes we recommend but it will be under prescription.
Jazakallahu khoiran sir.
I find this really helpful.