Halitosis or bad breath

Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. Halitosis is not infectious. About 2.4% of the adult population suffers from bad breath.

Causes of halitosis

Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:

• Dental factors – such as periodontitis (infection around the teeth) or poor oral hygiene
• Dry mouth – caused by medicines, alcohol, stress or a medical condition
• Smoking – which starves the mouth of oxygen.

Less common causes of halitosis include:

• Acid and bile reflux from the stomach
• Post-nasal discharge – for example, due to chronic sinusitis
• Kidney failure, various carcinomas, metabolic dysfunctions, and biochemical disorders, together account for only a very small percentage of halitosis suffers
• Foods - such as onions, garlic or cauliflower, which induce certain odours. However, these effects are only short-lived.

Symptoms of halitosis

The features of halitosis can include:

• A white coating on the tongue especially at the back of the tongue
• Dry mouth
• Build up around teeth
• Post-nasal drip, or mucous
• Morning bad breath and a burning tongue
• Thick saliva and a constant need to clear your throat
• Constant sour, bitter metallic taste.

Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.

Treating halitosis

There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis.

Gentle but effective tongue cleaning may also be required. A variety of tongue brushes and scrapers have been produced in recent years. The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue, keeping in mind that the hardest to reach back portion smells the worst.

People with chronic sinusitis may find the regular use of a saline nasal spray helpful. A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help. Speak to your dentist, doctor or chemist to identify the cause of your halitosis and to find the most effective treatment for you.

Where to get help

• Your doctor
• Dentist
• Your local chemist

Things to remember

• Halitosis is caused by sulphur-producing bacteria in the tongue and throat.
• The major causes include a dry mouth caused by certain foods, smoking, poor oral hygiene and a coated tongue.
• The treatment of halitosis will depend on the underlying cause.