A bad breath is enough to end any conversation. The thought of even having a bad breath is already embarrassing. However, when discussing bad breath this is a good place to begin. Psychogenic halitosis is a condition where an individual has ‘imaginary’ halitosis (bad breath). Such individuals have no objective evidence of halitosis and research shows their psychogenic halitosis results from a delusion of mono-symptomatic hypochondriasis. When halitosis is not a delusion it is often linked to either a systemic disease or a problem in the oral cavity. Here are some of the causes of a bad breath.
When it comes to bad breath, the oral cavity is where the problem is for most people. The gastrointestinal system is home to the most number of endogenous bacteria and the mouth is the entrance to this system. Bacterial putrefaction is the main reason behind bad breath of oral origin. Dead bacteria undergo proteolysis and subsequent aminolysis to form products of putrefaction. These products include volatile sulphur compounds like Hydrogen Sulphide and Methyl Mercaptan. If you want to know a bad smell, take a sniff of Hydrogen Sulphide. Sulphur compounds form the bad breath that hits your nose when most people speak.
Other disease processes in the mouth also lead to halitosis. Periodontal disease is one of the most common oral diseases and having it literally stinks. The disease represents infections of structures around the teeth. These include the gums, the centum that covers the root, the periodontal ligament and the alveolar bone. The earliest stage of periodontal disease is gingivitis where the infection is restricted to the gums. In severe cases, the entire supporting tissues are involved. Bacteria are still the culprits in periodontal disease, especially bacteria from dental plaque. The pathogenic process of a periodontal disease leads to the formation of volatile sulphur and non-sulphur gases which cause bad breath.
The tongue has been identified to be a source of bad breath. The surface of the tongue harbours a large amount of desquamated epithelial cells and dead leukocytes. The dorsal surface of the tongue has a large surface area and a unique papillary structure. Tongue coating leads to halitosis hence it’s crucial not only to brush your teeth but also your tongue. Dental caries and oral ulcers have also been implicated in halitosis. Although studies show increased levels of volatile sulphur compounds in patients with dental caries and oral ulcers, the mechanism by which such patients get halitosis remains unclear.
Bad breath can also be a consequence of a systemic disease. Lung abscess presents with a foul smell that comes out as bad breath. Owing to the fact that the respiratory system is connected to the oral cavity through the pharynx, it’s not shocking that a lung abscess would cause halitosis. If you have a bad breath that you can’t get rid of, the problem might be in your stomach. Gastroesophageal reflux disease is a common condition where the stomach fails to empty properly causing some of the gastric content to regurgitate back to the oral cavity. The gastric content may cause halitosis. Structural defects in the gastrointestinal system also lead to a bad breath. A pharyngoesophageal diverticulum is a pouch that forms on the oesophageal pouch. The pouch may collect food particles and harbour bacteria leading to halitosis. The condition is also associated with other symptoms including difficulty in swallowing and coughing.
Diabetes has also been linked to halitosis. However, a bad breath in diabetes is an indicator of severe complications of uncontrolled diabetes. The smell of the breath is acetone-like or fruity. In liver failure, a patient has a feculent odour that resembles that of a fresh cadaver. The smell is so distinct that it is called fetor hepaticus. Fetor hepaticus is different from the decayed blood odour that is found in patients with liver cirrhosis. Patients with severe kidney failure or uremia may also have a breath that smells like urine. Other conditions that may cause halitosis include toxaemia, syphilis, blood dyscrasias and Wegener’s granulomatosis.
Sometimes halitosis is caused by simple things like the food we eat. If you are a fan of garlic or onions then you understand how difficult it is to get rid of the bad breath that comes after taking them. Alcoholics also have the familiar odour of ethanol in their breath while smokers bear the smell of tobacco. Early in the morning, most people have a foul breath that is a consequence of low salivary flow and the stagnation of saliva during sleep. Some of the cases of bad breath can be resolved easily. If you suspect your breath is cutting short conversations don’t panic. Maintain good oral hygiene and avoid consuming some foods.
