Mouth Odour

Oral malodour also called halitosis or fetor oris; in simple terms means “Bad breath”. It is therefore defined as an unpleasant or offensive odour emanating from the oral cavity (mouth). This odour can either be originating from the mouth (oral) or from other areas such as the respiratory and gastrointestinal organs (non oral).

It is a common complain of up to one third of the general population and a crippling social problem. Even though a few patients mention it as a secondary problem, it is however a major cause of embarrassment and usually affects interpersonal social communication.

Halitosis can gave a range of causes but for the purpose of educating the public we will group the causes into four:

A. Intra oral causes

B. Extra oral causes

C. Psychogenic causes and,

D. Transient causes.

Intra oral causes.

Bad breath can occur as a result of breakdown of food substrates by anaerobic bacteria resulting in production of a range of malodorous molecular components chief of which are volatile sulphur compounds. Some of these sulphur compounds play a major role in periodontal tissue damage and periodontal diseases.

Therefore, acute oral infections such as acute necrotising gingivitis, pericoronitis and other infection in the mouth can cause bad breath. Simple tooth decay caused by bacteria action on food substrates which invariably creates a cavity and eventually allowing food to pack serving as more substrate for bacteria action can also be a cause of mouth odour.

The tongue which also accumulates food especially greasy foods leading to coating of the tongue can also cause mouth odour. This area of the tongue is usually the posterior part where bacteria action is high and it is an area often missed during brushing.

Also people with poor oral hygiene; individuals who don’t brush regularly and those who don’t spend time brushing well are also prone to having bad breath. Those who use dentures are not also spared because dentures do accumulate food and if not well cleaned can lead to denture stomatitis ultimately leading to bad breath.

Some other intra oral causes are dry mouth, smoking, alcohol intake and some spices such as garlic and onions.

Extra oral causes

Chronic infection of the sinus can be a source of halitosis especially when patient has not sort medical help. In such cases, when the sinusitis resolve then the halitosis also resolves.

Respiratory conditions such as bronchitis and bronchial carcinoma can be contributory to clinical presentation of bad breath.

Gastrointestinal conditions such as reflux and pyloric stenosis can also be a finding in presentation of halitosis when other major oral causes have been excluded.

One common metabolic cause of bad breath is diabetic ketoacidosis. Therefore patients with uncontrolled diabetes can present with halitosis. Other diseases that can be a source of bad breath includes but not limited to the following; renal failure and hepatic failure.

Psychogenic causes

Some patients complain of mouth odour in the absence of none. They can imagine it because of psychogenic reasons. This can present as a real clinical dilemma since no evidence of oral malodour can be detected even with objective testing. This type of oral malodour can be attributable to a form of delusion or monosymptomatic hypochondriasis: self-oral malodour, halitophobia.

Other peoples’ behaviour or perceived behaviour such as apparently covering the nose transiently or covering the face is typically misinterpreted by the patients as an indication that their breath is indeed offensive. Such patients may have tendencies towards latent psychosomatic illness.

Many of these patients therefore adopt behaviours to minimise their perceived problems. Some of which includes; covering the mouth when talking, avoiding or keeping a distance from other people, avoiding social situations, using chewing gum, mints, mouthwashes or spray, and frequent brushing. Thus in such patients, the oral hygiene is usually superb.

Medical help may be required to manage such patients when they present in the surgery.  However such patients unfortunately fail to recognise their own psychological conditions, never doubt they have mouth odour and thus often reluctant to visit a psychological specialist.

Transient cause

Most individuals have mouth odour especially when just waking up from sleep. This kind usually goes away immediately after brushing. Spicy foods such as garlic and onions have also been known to cause a transient mouth odour immediately after consumption.

The diagnosis of oral malodour is usually subjective by simply smelling exhaled air from the mouth and nose and comparing the two. This is called the organoleptic method. Odour from the mouth and not from the nose is usually of oral and pharyngeal origin. Odour from the nose and not from the mouth is from the sinuses or nasal passages.

The management of oral malodour depends on the findings during examination. Scaling and polishing can get rid of built up calculus and plaque in the mouth. Filling of cavities and treating periodontal diseases can also alleviate oral malodour.

Key points

*Treat identifiable causes

*Avoid spicy foods like garlic and onions especially when raw

*Avoid habits such as alcohol consumption and smoking

*Eat good breakfast including fruits

*Brush teeth after meal or at least twice daily

*Brush tongue regularly

*Use mouth rinses

*Keep your dentures clean

*Regular dental visits is key to keeping oral malodour at bay.