Term halitosis is derived from Latin word “ halitus” which means “breath” and Greek suffix “osis” which means “ the condition”. In general, halitosis is the medical term for “ bad breath”.

Breath malodor should not be confused with the oral malodor that is caused after taking food items like onion or garlic or malodor that occurs in early morning hours on awakening. It goes by itself on maintaining oral hygiene. But if breath malodor persists , it  reflects some pathology and doctor should be consulted.

Halitophobia or Pseudo halitosis is reffered as the condition when patient persistently complains of bad breath but it is not perceived by others. Such patients require proper counseling from psychiatrist.

Root cause for halitosis :- halitosis is mainly caused by anaerobic bacteria present in oral cavity. These bacteriae survive by taking food from oral cavity and excreting waste products. Their waste product mainly consists of volatile sulfide compounds (vsc) which is mainly hydrogen sulfide and smells like rotten eggs. Other compounds present in their waste product are:-

Cadaverine smells like corpses

Putrescine smells like decaying meat

Skatole smells like human fecal matter

Isovaleric acid smells like sweaty feet

These anaerobic bacteria mainly depend on protein diet like meat, eggs, fish, pulses, milk products etc. Whenever we take protein diet these bacteria also get their food and  they breakdown the proteins present in food items with the help of enzymes, producing the waste products (mainly VSC). Thus causing bad breath. Even in the absence of protein diet these bacteria get the food from proteins present in saliva, remnant food debris, plaque, and dead cells present in oral cavity.

Volatile fatty acids such as valerate, butyrate etc also cause malodor. These molecules are released in blood in presence of any systemic disorder like hormonal problem, kidney disorder, or stomach disease, intestinal diseases, etc. Ultimately via blood these molecules reach lungs and are exhaled. Thus producing bad breath.

Halitosis is of two types :- Physiological and pathological halitosis.

Physiological halitosis is of short duration and mainly occurs due to certain food items ( like onion, garlic) or medicines which produces bad breath.

Now question arises how these foods cause bad breath??

It happens like this:   When we eat these food items they get broken down into small molecules by our digestive system. These molecules have unpleasant odor which are released in blood. Via blood they reach our lungs and when we exhale, these molecules with offending smell are also released. Thus producing bad breath.

However, this type of halitosis resolves by itself on complete consumption of food item and once  all the molecules are excreted. It can be avoided by avoiding intake of food item which cause bad breath.

Smoking……

Pathological halitosis occurs due to some pathology or disorder. It does not resolve until the pathology is corrected.

This includes…..

Local factors

a)      Food impaction :- food gets accumulated in the deep carious tooth or the gap between two adjacent teeth. This accumulated debris serves as food  for bacteria which act on it and produce foul smell leading to oral malodor.

b)       Dental conditions :- certain dental pathologies like grossly carious tooth with severe infection or abcess can be the cause of oral malodor. Partially erupted wisdom tooth can also cause bad breath. As food gets accumulated around it and this area is very difficult to clean.

c)      Unclean dentures :-  regular denture wearers need to take care of their dentures. It should be properly cleaned with soap solution after meals and should be kept in water in night. If dentures are not properly handled food gets accumulated on it and these debris cause bad breath.

d)      Xerostomia:- it’s a medical term for dry mouth.

Saliva is an excellent mouth rinse. It helps in cleaning debris and keeps the mouth wet. When salivary flow decreases mouth gets dry and cleansing action decreases which makes bacteria more active and thus producing bad breath.  This is the why we feel bad odor when we wake up in morning or during fasting. As salivary flow decreases during sleep or starvation.

e)      Periodontal or gum problems:- periodontal diseases mainly starts with plaque accumulation. As the plaque gets accumulated between the tooth and gums it leads to damage to bone surrounding that tooth. As a result gap is created between the tooth and the gums. This gap known as periodontal pocket is a perfect shelter for anaerobic bacteria which survive there and produce foul smell leading to bad breath.

f) Tongue coatings :- surface of tongue is very irregular. These innumerable depressions and elevations on tongue surface serve as ideal niche for bacteria to adhere and flourish. Remnant food debris also get accumulated in these irregularlities which is very difficult to clean. So these bacteria act on the food accumulated producing foul smell. That’s why it is advised to clean the tongue properly with a tongue scrapper daily.

Systemic factors

a)      ENT problems like sinusitis, pharyngitis, tonsillitis, etc. in all these conditions there is increased inhabitation of bacteria in oral cavity which leads to bad breath.

b)      Pulmonary infections like T.B. , pneumonia, bronchitis are also associated with halitosis.

c)      GIT diseases like regurgitations, gastric hernia etc.

d)      Hormonal cause  :-  it is observed in most of the women that foul breath is felt in perimenstual period. Also a typical type of breath odor is experienced with increase in progesterone level.