Halitosis or bad breath is an oral health condition characterized by unpleasant odors emanating consistently from
the oral cavity on exhaling air. There are numerous causes of halitosis but primarily they are divided into local and systemic causes. Local cause of Halitosis is a result of degradation of food particles by microorganisms into fermentable
by-products. The bacterial interactions are most likely to occur in the gingival crevices (gums) and periodontal pockets and from the posterior dorsal tongue. 

Other causes of local bad breath include:

Deep carious lesions (dental decay), Recent dental extraction sockets ,Interdental food packing , improper maintenance of Acrylic dentures, Oral infections, Oral ulceration, Fasting, Stress/anxiety, Menstrual cycle , Smoking , Alcohol, Volatile foodstuffs – e.g. onion, garlic, durian, cabbage, cauliflower and radish , Medication leading to dry mouth, sinusitis,
tonsils etc.

Systemic causes:

There are a few medical conditions that may cause foul breath odor Bad breath caused by chronic liver failure, Lower respiratory tract infections , Renal infections and renal failure, Cancer, Diabetes mellitus and other metabolic conditions.

How to diagnose halitosis?

Self diagnoses as well as professional diagnosis are the techniques to diagnosis halitosis. Self diagnosis can be done by lightly scraping the posterior back of the tongue with a plastic disposable spoon and to smell the drying residue. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on tongue swabs are now available. Professional diagnosis involves regular check-ups by a Dentist as well as a Physician for both local as well as systemic causes and their treatment.

Treatment modalities for halitosis:

The treatment includes mechanical approach as well as chemical approach for local causes and pharmacological as well as psychological approach for the systemic causes.

The mechanical approach involves thorough brushing and flossing of teeth twice a day with application of fluoride tooth-paste, cleansing of tongue. A periodic visit to dentists and hygienists is highly recommended for cleansing of teeth. This approach helps in removal of plaque, tartar and calculus from teeth, tongue and gums.

The chemical approach involves use of mouthwashes. Often used active ingredients in these products are chlorhexidine
(CHX), essential oils (EOs), triclosan and cetylpyridinium chloride (CPC). 
Mouthrinses can also reduce
halitosis by chemically neutralizing odor compounds.

Most of the local halitosis is reduced after brushing and flossing and use of mouthwashes for 8-10 days.

For systemic halitosis, you should consult a physician who will diagnose the underlying cause and prescribe
certain medications for their cure.

Thus it is clear that a successful treatment of halitosis involves an appropriate diagnosis, professional therapy,
mechanical plaque control, including tooth brushing and tongue cleaning, possibly combined with the use of an effective antimicrobial mouthwashes as well as prompt diagnosis and treatment of the underlying systemic conditions or

Dr. Mayur Chaudhary