Halitosis cause and treatment
March 9 2017 by Ray Sahelian, M.D.

Halitosis is the term for persistent bad breath. Halitosis can cause embarrassment, create social and psychological barriers , and even affect marriages. Keeping and chewing fennel seeds in the mouth can help with bad breath.

Cause of halitosis, why does it happen
Halitosis can be caused by a a variety of factors and conditions, some of which are behaviors that can be avoided to reduce bad breath. Halitosis is caused by mainly volatile sulfur compounds as a result of bacterial breakdown of protein and can be quantitatively and qualitatively measured in the expired oral breath. In eighty to ninety percent of cases, bad breath originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth on the posterior third of the dorsal surface of the tongue. In the remaining ten to twenty percent of cases, chronic bad breath is caused by systemic disorders such as hepatic, pancreatic and nephritic insufficiencies, trimethylaminuria, upper and lower respiratory tract infection, medication and cases where gastric content may generate oral malodour. The methods of detecting or diagnosing halitosis are organoleptic or human sense of smell, sulfide monitoring and gas chromatography. All of these methods have limitations and disadvantages.

Common cause of halitosis:
The types of food you eat can cause halitosis, so reduce foods like garlic and onions when you plan to be in public. Not eating can also cause halitosis, so don't skip meals for prolonged periods if you are planning to be close to people.
Poor dental hygiene can lead to halitosis, so brush, floss and use mouthwash frequently to keep your breath fresh.
Dry mouth can exacerbate halitosis, so stay well hydrated, and try sucking on sugar-free candies to stimulate saliva production.
Smoking can be another cause of halitosis.
If you have persistent halitosis, consult with your doctor to determine if it is being caused by a medical condition, such as a respiratory infection, sinusitis, liver or kidney disease.

Lung problems and halitosis
Chronic lung infections and lung abscesses can produce halitosis.

Gastrointestinal disorders and bad breath
Chronic reflux of stomach acids (gastroesophageal reflux disease, or GERD) and a slight protrusion of the stomach into the chest cavity (hiatal hernia) also can produce halitosis.
Eradication of gastric H. pylori significantly alleviates halitosis and coated tongue, the two oral conditions that may be considered as extragastric manifestations of this common chronic bacterial infection.

Halitosis Treatment - Bad Breath Cure - How to Get Rid of Bad Breath
A bad breath remedy involves maintenance of plaque control, elimination of active periodontal disease and cleaning the tongue on a routine basis. Floss your teeth on a nightly basis. Oral rinsing with a mouthwash could be indicated in some instances, as a temporary measure. Avoiding foods that cause bad breath, such as garlic and onions, is another option to stop bad breath.

J Int Soc Prev Community Dent. 2013. Evaluation of the use of a peppermint mouth rinse for halitosis by girls studying in Tehran high schools. Oral malodor is one of the most common complaints among dental patients. It often creates serious personal and social embarrassment for the afflicted individual. Therefore, a dentist must be able to diagnose the etiology of halitosis and treat it or refer an individual to a specialist. The aim of this study was to evaluate the prevalence of halitosis and the effect of a peppermint mouth rinse on it. This study was performed in two steps. At the first step, in a cross-sectional study, 504 students who were 14-18 years old were examined to define the students who suffered from halitosis, and then at the second step, the selected 84 students with halitosis were divided into two groups randomly. A total of 43 students in group 1 received a peppermint mouth rinse and 41 students in another group were given placebo. The students in two groups washed their mouth with 15-20 ml of the given solutions three times in a 1-week period (after breakfast, after lunch or on returning to home, before sleeping) and didn't eat anything for 30 min after rinsing. After 1 week, the students were examined again. The prevalence of halitosis was 24% totally. In the mouth rinse group, after 1 week 23 students didn't exhibit halitosis, and 11 students in the placebo group were halitosis positive. A chi-square test showed that this difference was significant. Based on the results of this study, it can be said that a peppermint mouth rinse can reduce halitosis.

J Indian Soc Periodontol. 2013. How to deal with morning bad breath: A randomized, crossover clinical trial. The absence of a protocol for the treatment of halitosis has led us to compare mouthrinses with mechanical oral hygiene procedures for treating morning breath by employing a hand-held sulfide monitor. To compare the efficacy of five modalities of treatment for controlling morning halitosis in subjects with no dental or periodontal disease. This is a five-period, randomized, crossover clinical trial. Twenty volunteers were randomly assigned to the trial. Testing involved the use of a conventional tongue scraper, a tongue scraper joined to the back of a toothbrush's head, two mouthrinses (0.05% cetylpyridinium chloride and 0.12% chlorhexidine digluconate) and a soft-bristled toothbrush and fluoride toothpaste for practicing oral hygiene. The products and the periods were compared with each other using the Friedman's test. When significant differences were determined, the products and periods were compared in pairs by using the Wilcoxon's test and by adjusting the original significance level for multiple comparisons by using the Bonferroni's method. he toothbrush's tongue scraper was able to significantly reduce bad breath for up to 2 h. Chlorhexidine reduced bad breath only at the end of the second hour, an effect that lasted for 3 hours. Mechanical tongue cleaning was able to immediately reduce bad breath for a short period, whereas chlorhexidine and mechanical oral hygiene reduced bad breath for longer periods, achieving the best results against morning breath.

Int Dent J. 2015. The efficacy of two oral hygiene regimens in reducing oral malodour: a randomised clinical trial. This study compared the efficacy of two oral hygiene regimens in reducing oral malodour and the proportions of bacterial species involved in the production of volatile sulphur compounds Seventy subjects who participated in a halitosis-induction phase were randomised into two groups: brushing with regular fluoride toothpaste alone (control group) or brushing with regular fluoride toothpaste followed by rinsing with a 0.075% cetylpyridinium chloride (CPC) mouthwash (CPC group). Subjects followed their assigned oral hygiene regimen for 21 days.  Brushing followed by rinsing with a 0.075% CPC mouthwash provided statistically significantly greater reductions in oral malodour, measured organoleptically and instrumentally, and in the proportions of red-complex species when compared with brushing alone.

J Vet Dent. 2015.The Negative Effects of Volatile Sulphur Compounds. Oral malodor has been studied extensively in humans but not necessarily to the same degree in our veterinary patients where malodor constitutes a significant problem. Breath malodor may originate from the mouth, or from an extra oral source, originating from other organ systems such as gastrointestinal, respiratory, or even systemic disease. Oral malodor is a result of microbial metabolism of exogenous and endogenous proteinaceous substrates leading to the production of compounds such as indole, skatole, tyramine, cadaverine, puterescine, mercaptans, and sulphides. Volatile sulphur compounds have been shown to be the main cause of oral malodor. Although most clients perceive oral malodor to be primarily a cosmetic problem, there is an increasing volume of evidence in human dental literature demonstrating that volatile sulphur compounds produced by bacteria, even at low concentrations, are toxic to tissues and play a role in the pathogenesis of periodontitis.