Alitosis is a technical term for bad breath and originates from the Latin “halitus” meaning “breath” and the Greek “osis” meaning “abnormal”or “diseased”.Halitosis can be defined as any disagreeable odor in expired air, regardless of whether the odorous substances originate from oral or non-oral sources. Studies estimate that that 30-50% of the population have oral malodour.

The most common cause of halitosi is poor oral hygiene. However a broader classification is as follows:

  1. Physiologic causes such as lack of salivary flow during sleep (Morning halitosis), foods (garlic, onion, etc.), during menstruation, smoking and in alcoholics
  2. Pathologic disorders of the oral cavity such as poor oral hygiene, dental caries (decayed teeth), gingivitis / periodontitis, hairy tongue, stomatitis, oral cancers, necrotising ulcerative gingivitis (ANUG).
  3. Disorders of upper respiratory tract such as mouth breathing, sinusitis, tuberculosis, syphilis, etc.
  4. Disorders of lower respiratory tract such as pulmonary abscess, bronchitis, tuberculosis, lung cancer, etc.
  5. Gastrointestinal conditions such as Pharyngitis, Peritonsillar abscess (abscess), vincent’s angina, etc.
  6. Disorders of lower gastrointestinal tract such as gastritis, gastric carcinome, gastro-oesophageal reflux disease(GERD) etc.
  7. Neurologic Disorders
  8. Systemic adminestration of drugs
  9. Functional Disorders such as Psychosis and depression

Bad breath can be diagnosed or measured by

  • Self assessment
  • Subjective assessment
  • Objective assessment

Self assessment

  1. Smelling a metallic or nonodorous plastic spoon after scraping the back of the tongue.
  2. Smelling a toothpick after introducing it in an interdental area.
  3. Smelling saliva spit in a small cup or spoon (especially when allowed to dry for a few seconds so that putrefaction odors can escape from the liquid).
  4. Licking the wrist and allowing it to dry (reflects the saliva contribution to malodor)
  5. One’s own breath odor it is often undetectable due to habituation of the individuals. Most individuals are poor judges of their own breath odour

Subjective assessment – Organoleptic measurements

Sniffing of expelled air of the patient by using the nose of the examiner, and grading the level of halitosis. Organoleptic assessment by a judge is still the “ gold standard” in the examination of breath malodor.

Objective assesment

  • Osmoscope
  • Sulphide monitors such as halimeter
  • Gas Chromatography
  • Diamond probe
  • Chemical sensors / Electronic nose

Mechanical reduction

Because of the extensive accumulation of bacteria on the dorsum of the tongue, tongue cleaning has been emphasized. Interdental cleaning and toothbrushing are also necessary to control plaque. A one stage full-mouth disinfection, combining scaling and root planing with the application of chlorhexidine. Chewing gum may control bad breath temporarily because it can stimulate salivary flow.

Chemical reduction of oral microbial load

Mouth rinsing is a common practice in the patients with oral malodour. The most commonly used rinsing components are chlorehexidine, Listerine, Triclosan, etc.

If you have bad breath with painful swollen bleeding gums or loose teeth consult your dentist immediately. If you have bad breath with sore throat, fever, mucus producing cough, postnasal drip and colorless nasal discharge go to a doctor immediately.

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