Halitosis is caused majorly due to inadequate oral/dental hygiene and is also an indicator of other health ailments/conditions normally termed as bad breath. After tooth decay and gum disease, Halitosis is the 3rd most common condition for which dental treatment is sought. Bad Breath affects 1 in 4 individuals, almost 25% of the population. It is an unpleasant condition that affects both genders of all ages. Halitosis can also cause psychological issues in individuals, as it can adversely affect socio-relations with other people. Halitosis results due to volatile molecules formed because of pathological/non-pathological reasons having an oral/non-oral origin. These volatile compounds are inclusive of amines, sulphur compounds, aliphatic compounds, aromatic compounds, nitrogen-containing compounds, amines, short-chain fatty acids, ketones and alcohol/phenyl compounds.
The various causative agents of halitosis include
- Oral Unhygiene:
Poor dental hygiene causes a bacterial plaque to accumulate on the teeth and tongue causing caries and periodontal ailments (such as gingivitis and periodontitis). Inflamed periodontal and gingival tissues typically lead to oral malodours and plaque-associated periodontal ailments intensifying the Halitosis.
Dentures that are left uncleaned routinely or improperly can also allow bacteria to dwell leading to bad breath.
- Dryness in Mouth:
One of the key factors causing Halitosis is inadequate saliva flow. The concentration of sulphuric compounds tends to increase because of the reduced quantity of saliva (Xerostomia). Saliva acts as a natural cleansing agent and maintains the bacterial level in the mouth, resulting in bad breath.
- Dietary products:
Edibles such as garlic, onion, spicy food can cause an unpleasant smell in the mouth. Upon digestion, the broken-down food in the form of blood is carried to the lungs, affecting the breath. At times, the food particles get stuck into the tooth causing them to decay and consequently emit a bad breath.
Also, diet less in carbohydrates and fasting can lead to Halitosis. As it causes fat synthesis producing chemicals such as Ketones, which give breath a strong smell.
- Drugs/Medications:
Certain types of medicines/drugs can reduce saliva, thereby giving rise to foul odor. Few medicines tend to produce odors as they break down and emit chemicals into the breath. Drugs such as nitrates, chemotherapy medicines, certain tranquilizers (like phenothiazines) cause unpleasant smell in the mouth. Also, the consumption of vitamin supplements in huge doses can lead to bad breath.
Other medications such as antipsychotics, anti-depressants, diuretics, anti-hyper sensitives can also cause this condition. Salivary gland ailments (like Sjogren’s syndrome, Diabetes) may also result in smelly breath.
- Tonsil Stones:
Tonsil stones medically termed as ‘Tonsil calculi’ or ‘Tonsilloliths’ get formed when debris (such as dead cells, food, and other foreign substances get trapped on the tonsils) forming hard stones. Tonsil stones provide habitat for anaerobic bacteria that produce odorous sulfides, making the breath extremely unpleasant.
Thus, the source of Halitosis happens to be a dental cavity in 90% of patients, 9% include non-oral causes such as hepatic disease, respiratory tract, urinary tract, gastrointestinal, hematological/endocrine system ailments, and 1% are due to drugs/diet. Other rare conditions that can cause Halitosis are Aspiration Pneumonia, Bronchiectasis, Ketoacidosis, and Bowel obstruction.
Symptoms
Particular breath odour can differ based on the causative conditions. Generally, it is a bit difficult to self-assess the condition and is better to ask a relative/friend about the mouth odour. One can check by licking the waist and allowing it to dry and then smell it. If there is a bad aroma on the wrist area, there is a likelihood of having the condition. However, individuals at times are concerned about their breath, even if there is little or no mouth odour.
Any natural remedies to combat foul odour?
- Adequate Hydration:
Dry mouth can result in Halitosis as well as other oral ailments. The condition occurs when salivary glands are functioning improperly and not producing sufficient saliva to flush off the food debris from the mouth, which enables to monitor the oral bacterial level. As medication and certain dietary intakes can cause dry mouth, adequate hydration is essential. UFNB (United States Food and Nutrition Board) recommends 2.7 liters of water per day for women and 3.7 liters of water per day for men. These could be inclusive of water from food and beverages.
- Green Tea: Green Tea is made from the leaves of the Camellia Sinensis plant, which is rich in anti-oxidants. Polyphenols in green tea enable in combating Halitosis by eradicating odorous sulphuric compounds. Dental cavity/decay, inflammation and oxidative stress caused due to cigarette consumption are minimized due to the presence of polyphenols. Additionally, Green tea contains an abundance of EGCG (Epigallocatechin-3-gallate) which have multiple health benefits. As per a laboratory experiment conducted in the year 2013, EGCG induces gum cells to release an anti-microbial compound chemically targeting Porphyromonas Gingivalis, a bacterium that causes gum disease and resultant bad breath.
According to a laboratory study conducted in the year 2015, Green Tea also inhibits the growth of Solobacterium Moorei, a bacterium known to promote Halitosis. Dip the green tea bag in a cup of hot water for 1 to 2 minutes and then remove it. Add honey to naturally sweeten and consume 1-3 cups daily. It will help to cleanse the odor-inducive bacteria from the mouth.
- Cinnamon Essential Oil:
This oil is extracted from the leaves or bark of the cinnamon tree. It exhibits strong antibacterial properties against Solobacterium Moorei and was also found effective in deducing Volatile Sulphuric Compounds (VSC’s). VSC’s are the chemicals that change into gases accounting for bad breath. Adding Cinnamon oil to dental products can help in managing bad breath. Research studies have also confirmed no adverse effects of using the oil. However, this essential oil should not be used on the skin or swallowed. - Miswak Chewing Stick:
Miswak/Siwak is an herbal pencil-sized stick having a length of 15 to 20 cm and a diameter of 1 to 1.5cm sourced from the Toothbrush tree (Salvadora persica). These sticks have been conventionally used in Arabian and African countries, India and Pakistan as a popular dental hygiene aid. Even, the WHO (World Health Organization) has encouraged and promoted the use of Miswak sticks as an effective aid for dental hygiene. Researchers highlighted the importance of Miswak extracts/sticks to have therapeutic tendencies in treating gingival diseases.
As per studies, miswak extracts were found to be effective against bacteria such as Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and H. influenza that tend to hamper the oral health. Miswak also restricts the formation of dental plaque, which primarily consists of different aerobic and anaerobic bacteria. These bacteria are the key etiological agents for the initiation and advancement of periodontal diseases, which leads to oral malodour. Aqueous miswak extracts exhibited an anti-microbial effect against several pathogens. Miswak sticks also enhance saliva production, enabling to cleanse off the bacterial impurities.
These environmentally friendly sticks are 100% natural remedies to treat bad breath. The miswak sticks are available in online shops.
- Pro-biotics:
Research claims the consumption of yogurt to be as effective as chewing xylitol gum, in the prevention of tooth decay and bad breath. Probiotics are live bacteria that tend to be beneficial. Yogurt contains probiotics that help in reducing the bad oral bacteria and improve mouth odour. As per a study conducted in the year 2017, the consumption of pro-biotics considerably reduced the saliva amount of Streptococcus Mutants. The bacteria are a major contributor to tooth decay and bad breath. Thus, consumption of pro-biotics daily can help in combating bad breath.
- Neem Extracts:
Neem (Azadirachta indica) has been known since ancient times for its medicinal properties and widely used in the Indian sub-continent. Nimbidin, Nimbin, Nimbolide, Gallic acid, Margalone, Catechin, Epicatechin, and Azadirachtin are the key components that impart anti-microbial properties to it. Neem works effectively against dental plague-related bacteria such as S.mutans, S. salivarius, S. sanguis, S. mitis, S.oralis, S. intermedius, S.sobrinus, S. anginosus and L.acidophilus.
Due to this, neem bark is used in dentistry for treating gingival ailments and maintaining dental health naturally. Twigs of neem are used as teeth cleanser, oral deodorant, and tooth-ache releaser. Thus, brushing routinely with neem-based toothpaste minimizes the accumulation and deposition of plaque, prevents dental caries and boosts the immunity for overall dental health. Also, regular use of mouth-wash containing Neem extracts tends to reduce gingival ailments, thus preventing Halitosis.
Chewing spices such as cloves, dill, cardamom, anise seeds, and cinnamon sticks tend to eradicate the bacteria that grow on the tongue, thus minimizing oral malodour. Also, making certain changes in lifestyle such as using tea-tree based/herbal toothpastes, refrain from using tobacco-based products, flossing regularly, using mouth-rinsers/breath-fresheners and oral irrigators, cleaning dentures, using tongue cleaner to scrape-off the plague build-up, avoiding oral de-hydration and taking diet exclusive of garlic, onion, and spicy food and rich in green vegetables.
However, if the odour is persistent despite the remedies deployed, an individual should consult a doctor to diagnose the underlying conditions.
Freshen your breath naturally!
Sirisha B 
Raju Ch