Health>>How to tackle a bad breath

Halitosis, commonly known as bad breath, is a condition that can be prevented or treated, writes ARUKAINO UMUKORO

IN a crowded commercial bus in Lagos, three passengers at the back seat could not stand the odour emanating from a fellow passenger who was speaking to the other passenger beside him in a high-pitched voice.

Halitosis, which is commonly known as bad breath, often causes embarrasment both privately and publicly.

“It’s a bit embarrassing when one is told his or her mouth smells. The average Nigerian doesn’t want to be embarrassed. But the oral hygiene habit of the average and educated Nigerian could be described as good. Often, most Nigerians try to abide by the rule of brushing their teeth twice daily,” said a dentist and health management consultant, Dr. Adeuga Adekuoye.

According to experts, halitosis is a condition caused by sulphur-producing bacteria that live within the surface of the tongue and in the throat. It is usually caused by an accumulation of bacteria in the mouth as a result of gum disease, food, or plaque. The condition could result from poor oral hygiene or dental health habits.

 “Basically, mouth odour stems from a poor oral hygiene, especially if one doesn’t brush regularly and very well, especially the interior part or the tongue; where the breakdown of food particles by bacteria results in this odour. This odour could also be as a result of a decayed tooth, infected tooth or gums, or an injury in the mouth,” said a dentist, Dr. Mohammed Kabir.

Bad breath can also be made worse by the types of food one eats and other unhealthy lifestyle habits, noted a dentist, Dr. Seun Ogundeji.

“The odour is caused by bacteria present below the gum line and on the back of the tongue, nasal cavity problems, throat infections, lungs, stomach, food-impaction areas in-between the teeth, abscesses, and unclean dentures, and mouth infections,” he said.

He further said eating certain food such as garlic, onions, meat, fish, and cheese; smoking and alcohol consumption could also cause bad breath. “Bad breath may be temporary, often disappearing following eating, drinking, tooth brushing, flossing, or rinsing with specialized mouthwash.  It may also be persistent as chronic bad breath, which affects some 25 per cent of the population in varying degrees,” he noted.

Although halitosis is estimated to be the third most frequent reason for people to seek dental care, after tooth decay and periodontal disease or gum disease; about 55 per cent of the general population in Nigeria is reported to suffer from it to some degree, said Ogundeji.

 He said, “In Nigeria 55 per cent of the general population is reported to suffer from it to some degree due to the inaccessibility to dental facilities, poor motivation among the populace and inadequate oral education.

“In 90 per cent of genuine halitosis cases, the origin of the odour is in the mouth itself. This is known as intra-oral halitosis, oral malodour or oral halitosis. There are over 600 types of bacteria found in the average mouth. Some of these can produce high levels of foul odours,” he explained.

However, while the awareness of halitosis among educated Nigerians may have improved over the years, it is not the same for those in the lower rung of the economic ladder, said Adekuoye.

“There is a larger percentage of halitosis among people in the lower socio-economic strata, because they don’t really pay more attention to cleanliness due to several factors. The use of chewing sticks rather than fluoride toothpaste to brush their teeth is also common among these set of people. One out of three persons in the lower class may have some degree of halitosis, while in the average middle and upper middle class, it could be two in seven,” he said.

Adekuoye advised people to maintain good oral hygiene by proper tooth brushing twice a day to prevent halitosis.

He said, “Food particles sometimes stay at the back of the tongue and the bacteria at the back of the tongue break them down. In this process, it releases what causes mouth odour. So, it is good to gently scrape the back of the tongue with a tongue scraper using dental floss.

“The tongue scraper can reach the back of the tongue and scrap out all the debris there without giving that discomforting feeling that might cause one to feel like vomiting. After that, one could also gurgle with a mouth wash.”

Dentists also advise people with halitosis to go for regular dental checkups.

“If halitosis originates from the mouth, the dentist would treat the patient by cleaning the tongue of the patient or treating the gum infection. In some cases, the decayed tooth could be removed. Also, treatment can be done by scaling and polishing, where the dentist uses dental instruments to wash the teeth and removes deposits of dental plaque which cannot be removed by a toothbrush. The use of dental instruments helps to remove these deposits from the gum so the gum can be free of infection,” Kabir said.

Halitosis may also be one of the symptoms of an underlining medical condition rather than simply poor oral hygiene.

According to Wikipedia, “It could also be one of many symptoms of a serious underlying medical condition such as liver failure, but in the vast majority of cases, the cause is minor and can often be reduced by adjustments to oral hygiene, including brushing or gently scraping the back of the tongue and improving the health of the gums, e.g. by using dental floss. However, if the origin of the odour is not in the mouth, halitosis can be more difficult to diagnose and to manage successfully.”

Kabir added, “Bad breath could also result from other issues within other parts of the body, which could also lead to mouth odour, especially the abdomen, chest and any other parts that lead to the mouth. Chest or nose infections could lead to mouth odour, because the nose leads to the mouth.

“It could also result from odour coming from the stomach, as is common with people with liver or skin diseases, constipation or indigestions. But basically, what causes serious mouth odour is associated with poor oral hygiene, or if one has a decayed tooth, infected tooth or gums, or wounds in the mouth.”

In extreme cases, however, bad breath could sometimes also affect one’s psyche, noted Kabir. He further said because it is regarded as a social taboo by many, a perceived or genuine halitosis could sometimes trigger social anxiety and depression.

“We’ve seen cases where patients feel they have mouth odour, but medical checks reveal that they don’t. This happens because the patient is psychologically disturbed that there is odour somewhere, but clinically, the odour does not exist. In extreme cases, the use of some anti- psychotic depression agents is recommended to suppress the depression that causes the patient to feel he or she has bad breath, whereas the person doesn’t,” said Kabir, emphasising that halitosis is not a permanent condition.

“The first thing is to identify the source of the odour. Once that source is identified and removed, the problem is solved. But it becomes difficult if the patient is affected psychologically by it. Then, the person may require therapy,” he added.