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Halitosis and Bad Breath
What Causes Bad Breath?
Unpleasant oral odors are caused mainly by the gaseous sulfur-containing by-products from the bacterial breakdown of proteinaceous substrates, such as impacted food particles and sloughed off oral cellular debris. This process is most prominent on the back of the tongue. The tongue geography provides an excellent putrefactive habitat for the strains of microbes that are able to metabolize proteins as an energy source.
In a healthy mouth these substrates are carried away by the saliva, swallowed and digested fast enough so that there is little chance for them to putrefy in the mouth and cause halitosis. Inflammation of mucosal tissues can cause cells to be shed at a faster rate than the saliva can cleanse. Bacterial action then hydrolyzes the proteins from these substrates to amino acids.
The three sulfur-containing amino acids include methionine, cysteine and cystine -- the main precursors to volatile sulfur compounds. These gaseous substances, which are responsible for malodor, consist primarily of hydrogen sulfide, dimethyl sulfide, methyl mercaptan and sulfur dioxide. Volatile sulfur compounds are very toxic substances and can further damage already inflamed oral tissues.
Why Should I Be Concerned?
One of the early warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Bad breath may also be the sign of a medical disorder, such as post-nasal drip, respiratory infection, diabetes, gastrointestinal, liver or kidney problems.
What Types of Products Can Be Beneficial in Treating Halitosis?
Tongue scrapers are very effective by removing the plaque coat that forms on the surface of the tongue. The tongue's surface contains crevices, which can trap dead cells and bacteria. It is generally believed that bad breath occurs most readily in the absence of oxygen. The plaque coat forms an anaerobic (without oxygen) environment, in which the bacteria may then release volatile sulfurous gases, the components of bad breath. Use of tongue scrapers to effectively remove the plaque coat can help to maintain a clean environment in the mouth. Oral rinses are one of the therapeutic approaches in the treatment of halitosis.
However, knowledge and understanding of this condition is in its infancy, and there are presently only limited products on the market geared specifically to the eradication of oral malodor. In addition, there is a paucity of clinical trials to substantiate the efficacy of these products for the condition of halitosis.
Certain mouth rinses can help to reduce oral malodor. However, most commercial mouth rinses provide a short-term effect by basically masking odors. Prevention of malodor that lasts beyond 30 minutes after rinsing is a result of the antiseptic compounds, but often these substances do not provide long-lasting effects. Most commercial mouth rinses contain alcohol, which can decrease the flow of saliva in the mouth. This dry mouth condition can induce a temporary oral malodor, similar to morning breath, a condition many people experience, caused by decreased saliva flow during the night. Healthy saliva flow is important as saliva lubricates and oxygenates the oral cavity, aids in digestion, acts as a buffering agent and provides antimicrobial properties.
Finally, a chronic dry mouth (xerostomia) condition can be treated with an alcohol-free mouthwash and medications which stimulate the salivary gland to produce more fluid.
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