‘It’s an embarrassing condition’
By Ogechukwu Agwu
Halitosis commonly known as bad breath is an embarrassing health condition that affects approximately 30% of people around the world. Other medical terms for this condition include stomatodysodia, fetor oris, and ozostomia.
According to Dr Seun Ogundeji, Managing Director, Platinum Dental Clinic, the symptoms is a noticeable unpleasant odour present on the exhaled breath.
About 80 million people suffer from chronic halitosis, it is estimated to be the third most frequent reason people seek dental care after tooth decay and gum disease. About 70 per cent of the odour is mainly caused by bacteria below the gum line and on the back of the tongue, the remaining 10 per cent is accounted for by many systematic conditions associated with lungs, gastro intestinal tract and the tonsils.
According to the Academy of General Dentistry, in more than 90 per cent of cases, the odour originates in the mouth, throat, and tonsils. Although this is something everyone experiences sometimes, if the case does not improve after brushing, flossing, and rinsing the mouth with an alcohol free mouthwash, it may be chronic.
Ogundeji said, “experts say that at least half of us had halitosis at some point or the other in our lives. Meals with strong tasting spices such as onions or garlic may result in what some people may consider as bad breath. Some types of bad breath in one culture may not be considered as such in another. Lifestyle may also influence whether certain kinds of breath are smelly and unpleasant; a non-smoker may find a smoker’s breath unpleasant while another smoker may not. However, smoking is linked to a higher risk of dry mouth, dental and gum diseases which can cause bad breath.
“The foul oral odour is usually caused by a group of anaerobic, sulfur-producing bacteria that breed beneath the surface of the tongue and often in the throat and tonsil area. The term, “anaerobic”, literally means living without oxygen, and in fact, these bacteria do not require oxygen to live. They occur naturally in the oral environment and are essential because they assist in digestion by breaking down proteins into amino acids. Proteins are commonly found in food, mucus or phlegm, blood, and in diseased oral tissue.
“As these bacteria feast on proteins in the mouth, sulfur compounds are released from the back of the tongue and throat. The bacteria excrete waste as hydrogen sulfide, methyl mercaptan, and other odorous and bad tasting compounds known as volatile sulfur compounds. As long as the anaerobic bacteria feed on proteins and excrete volatile sulfur compounds unchecked, the breath will become worse and worse.”
Causes
Ogundeji identifies poor oral hygiene as one of the major causes of bad breath. He said, “poor oral hygiene due to improper tooth brushing or inability to clean the back of the tongue and gum bleeding has been known to be the local causative factor in halitosis. Bad breath is a social stigma which triggers social anxiety.
“Aside from poor oral hygiene there are other causes of bad breath such as food trapped between teeth, tobacco products, dry mouth, medications, and infections in the mouth and nose/throat conditions.”
Another expert, Dr Aguma Nnabuife, opines that there are many underlying causes of halitosis which can be grouped into dry mouth, food, poor dental hygiene and illness/diseases.
Dry mouth : Xerostomia, the medical term for dry mouth, provides a perfect environment for anaerobic bacteria reproduction. Long periods of speaking, smoking, drinking alcohol, and snoring are a few common underlying causes. Most people experience foul breath in the morning due to lack of saliva production while they sleep. For healthy individuals, food odours are temporary and normal salivary flow will eliminate them within several minutes. However, those who suffer from dry mouth and lack of saliva find that even minor food odors may lead to long-term issues.
Foods : Halitosis can be exacerbated by certain foods such as onions and garlic because they contain smelly sulfur compounds, while dairy, meat, and fish contain dense proteins which are used as a food source by the anaerobic, sulfur-producing bacteria. Refined and processed sugars also provide a food source for bacteria. Coffee and juices can contribute to this problem because they are acidic and provide these bacteria with an ideal breeding environment.
Poor dental hygiene : Inadequate oral care causes bacterial build-up on the teeth and gums. Teeth cannot shed their surfaces the way skin can, so micro-organisms can easily attach to the teeth and remain there for extended periods. If they are not continuously removed by adequate brushing, these bacteria develop into something called biofilm, commonly known as dental plaque. When plaque is allowed to accumulate near the gumline, it will harden and begin to destroy teeth and gum tissues due to intense bacterial activity. This leads to gum disease such as gingivitis and periodontitis, which enable proteins from bleeding gums and diseased oral tissue to fuel odour-causing bacteria. Tooth decay and poorly fitting or dirty dentures can also contribute to this problem.
Disease : According to studies, an estimated 10 per cent of all halitosis cases are caused by certain illnesses. Individuals who suffer from diabetes, lung disease, kidney disease, cancer, liver disease, respiratory tract infections, or metabolic disorders often experience chronic foul breath due to dry mouth. Sinusitis, pneumonia, bronchitis, postnasal drip, and polyps affect the airways and may also contribute to the problem. Other common illnesses associated with bad breath include nasal odor and tonsil stones, yeast infections of the mouth, and gum disease. Certain drugs such as antidepressants, high blood pressure medications, and antihistamines can factor into dry mouth because they reduce saliva production.
Symptoms
Halitosis is a medical condition that lowers self-esteem and affects everyday life and personal relationships. People with chronic or recurring bad breath often lose their self-confidence. It can be difficult to know if one have this problem, because it is often challenging to pick up on one’s own scent. This is very challenging because sometimes, family members and colleagues may not feel comfortable telling the person. One of the best ways to find out if one has foul breath is to lick the inside of your wrist, wait five seconds, and take a whiff. An offensive breathe tells us that something is wrong.
Most symptoms of halitosis depend on the underlying cause. The most common symptoms include postnasal drip, a bitter metallic taste, a white coating on the tongue, and thick saliva. Many individuals who have foul breath associated with dry mouth can experience difficulty speaking or swallowing, a burning sensation in the mouth, or dry eyes. Fever, sore throat, persistent cough, and swollen lymph nodes in the neck indicate respiratory tract infections, which can also be a contributing factor.
However, the best way to truly identify the source of chronic halitosis is to visit a dentist or doctor for a professional diagnosis. When you are ready to tackle this situation, be sure to be open and honest with the health care professional performing the examination. It is important for him or her to understand all the health problems you are experiencing in order to determine the underlying cause and recommend appropriate treatment.
Getting proper treatment
For more than a century, pharmaceutical companies have attempted to alleviate halitosis by using mouthwash that contained alcohol. This is the exact opposite of what should be done because alcohol is a drying agent. Clinicians have learned a good deal in the ensuing years, and in most cases, this condition can be successfully treated. Like the symptoms, treatment depends on the underlying cause.
It is important to keep in mind that one cannot eliminate the bacteria from the tongue that cause bad breath. Consequently, scraping or brushing the tongue is a temporary remedy at best, and is typically frustrating for those who believe tongue scraping or tongue brushing is a permanent solution. The bacteria that cause this are part of the normal oral flora and are essential to breaking down proteins, a key step in normal digestion.
A much simpler and clinically-proven method to treat bad breath is to interrupt the bacteria’s chemical production of odours by introducing oxygenating compounds to your oral environment. Oxygen is the natural enemy of the bacteria that cause this problem because they are anaerobes and cannot function in the presence of oxygen.
In general, a dentist will recommend mouthwashes and toothpastes that contain oxygenating agents such as chlorine dioxide or sodium chlorite to neutralize volatile sulfur compounds and help control odour-causing bacteria found in the mouth.
If you experience mouth dryness, your dentist will recommend a saliva substitute to moisten the mouth throughout the day. Some effective, natural ingredients to look for in oral care products are zinc gluconate, aloe vera, green tea, tea tree oil, xylitol, CoQ10, glycyrrhizic acid and oral probiotics like K12 and M18.
You can also try some home remedies. This involves the practice of a few, simple, self-care techniques to help minimise halitosis. These remedies include :
Advanced oral care products : Use oral care products such as mouthwashes and toothpastes that have been shown to be effective in fighting bad breath.
Proper oral care: Brush and floss your teeth at least twice a day. Be sure to get a toothbrush with soft bristles (to avoid damage of tooth enamel or gums) and also use fluoride toothpaste. Brushing and flossing helps to remove any food and plaque which can be used as a fuel source by the anaerobic, sulfur-producing bacteria that are at the root of this problem.
Stimulate your salivary flow : Prevent dry mouth with chewing gum, lozenges, or mints that are sugar free. Look for Xylitol, a non-sucrose sweetener, which in recent years has been shown to have anti-cavity properties.
Eat fibrous fruits and vegetables : One of the best ways to remove bacteria in the mouth is to eat an apple a day. It helps moisten the mouth, too.
Take a dietary supplement : Vitamin C, Vitamin D, Vitamin E, and Vitamin B are effective at helping your body eliminate excess mucus and toxins naturally.
Drink more water : Dehydration is one of the most common causes of bad breath. Many people drink far too little water throughout the day to ward off the bacteria in the mouth that are most responsible for causing bad breath. Tiny microbes in the mouth actually feed on loose food particles throughout the day, releasing odour, causing by-products that ends up making the breath stink.
Prevention
It’s no news that prevention is generally better than cure. By inculcating the right habits one can effectively prevent this condition. Consider the following;
Eat foods rich in fiber : High fiber foods help prevent halitosis. Avoid eating heavily processed foods that contain refined carbohydrates such as cookies, cakes, sweets and ice cream.
Use mouthwash: Some mouthwashes or oral rinses are effective at preventing bad breath. However, you should never use alcohol based mouthwashes because the alcohol makes the mouth very dry, which will actually make the problem worse.
Drink green and black teas: They contain polyphenols that help eliminate sulfur compounds and reduce oral bacteria.
Avoid drying medication: Try not to take antidepressants, diuretics, pain relievers, and antihistamines unless it is absolutely medically necessary. These drugs inhibit saliva flow and can cause chronic dry mouth.
Avoid products with sodium lauryl sulfate or alcohol : Do not use any oral hygiene products that contain sodium lauryl sulfate or alcohol because the alcohol makes the mouth very dry, one of the most common causes of bad breath.
Clean your mouth after eating meat, fish or dairy products : Practicing consistent and thorough oral hygiene is an effective prevention tool.
Stop smoking : Studies have shown that smokers are at higher risk of developing periodontal disease and dry mouth. Furthermore, people who smoke may also engage in other habits that promote this condition such as dieting, drinking alcohol, and suffering from chronic anxiety conditions that require exacerbating prescription medications.
Breath through your nose instead of your mouth: Try to address any snoring or sleep apnea issues that could be affecting your breath and causing dry mouth.
Drink water: Keep your mouth moist by drinking plenty of water.
Clean your dentures at least once a day : Practice the same, proper oral care that you would with your original teeth.
Eliminate dairy products from your diet: Lactose intolerance can be an underlying cause of halitosis.
TIPS ON HEALTHY LIVING : Symptoms of stress (1)
Life can, from time to time, be extremely challenging, placing excessive demands on the body and mind. When this happens, the human system may respond to this by stress, which is its natural response to a threat or demand of any kind. It is important to note that not all stress is harmful; in fact, in some situations it may increase productivity and response to stimuli, as long as it is within one’s comfort zone. However, if stress begins to overwhelm the system, it can be detrimental to one’s physical, emotional and cognitive health.
The following symptoms are common in people who are suffering from stress overload; if one is suffering from them, measures must be taken to de-stress and rejuvenate the senses.
Loss of mental agility
Stress tends to affect the cognitive ability of the brain. Its overload typically causes loss of mental agility in several ways, since the release of stress hormones is capable of affecting the functioning of certain brain areas rather negatively. Therefore, when an individual is stressed, they may experience memory loss, confusion and lack of concentration.
Change in appetite
Most people tend to witness a change in appetite when they are stressed. While about 10 per cent suffer a loss in appetite, 90 per centtend to overeat. Those falling in the former category are victims of acute stress, whereby the body prioritise actions other than eating thus suppressing hunger.
Change in sleep patterns
When one falls asleep, the body switches from functioning with the active sympathetic nervous system to the calmer parasympathetic nervous system. However, in a state of stress, this process of transition does not take place and the sympathetic nervous system remains active. As a result, sleep may be elusive for the body and mind are not adequately relaxed. And even when it does come, the sleep may be very disturbed and unsatisfactory.
Loss of libido
Many individuals who are under a lot of stress, either professionally or personally, claim to suffer from a loss of libido, which further adds to their stress levels. When stress levels are chronically high, the stress hormone secretions affect the hormones that are responsible for one’s sexual response. Thus, those who are overly stressed may lose interest in sexual activity, feeling too exhausted or anxious for the same..
Aches and pains
The body’s reaction to acute stress is the production of “fight or flight” hormones which, in order to prepare the body against an imminent threat, cause the muscles to tense, blood vessels to constrict, heart to beat faster and digestive tract to slow down. When acute stress transforms into chronic stress over time, the effect of the stress hormones is not reversed and muscles remain tense. As a consequence, individuals suffer from headaches, migraines, neck and shoulder pain, as well as shooting pains in the back
Tooth pain
An aching tooth, without any common tooth decay or gum infection sign is most likely a stress related trigger. You shouldn’t always blame your chocolate cravings for the pain in the gums or jaw. A lot of people suffering from this may not accept the fact that they are suffering from stress and pretend as if everything is normal.
Hair loss
It is believed that stress can make one go gray, that is, it can result in hair loss. Men and women experiencing physical or mental stress can shed one-half or three-quarters of their hair, most commonly during or after a shower. As stress can put the hair follicles in a resting stage, you may experience loss of scalp hair over the period of time.
Atypical behaviour
Stress overload alters the suffering individual’s general demeanour and behavioural tendencies to a great extent. When hormone levels change due to stress, the production of various substances that govern mood also stand altered. Typically, stressed individuals are short-tempered, irritable, unpredictably moody, constantly anxious, restless too and sometimes indulge in substance abuse. Such uncharacteristic behaviour rarely goes unnoticed, especially by family and friends who can immediately recognise the change in behaviour. Such changes in one’s disposition can have grave consequences vis-a-vis one’s personal and/or professional life. It is then necessary for those suffering from chronic stress to adopt lifestyle changes, seriously pursue stress management activities and consciously attempt to keep their mind uncluttered and relaxed.
Bizarre and recurring dreams
A prominent sign of stress is bizarre and unusual dreams. Usually, dreams get extremely positive as you sleep and when you wake up, you are naturally in a good mood. However, when a person is stressed, one wakes up more than often, and experiences the same, odd dreams every night.
Recurring imagery in your dreams can put you in an upsetting and tiring position, thereby influencing other domains of your life and family, adversely. So, if you have been dreaming a lot lately and majorly if they’re weird, check your daily routine and assess if there is any particular trigger. Also, try and aim for a good night sleep of 7-8 hours each night, and cut off caffeine intake close to bedtime.
Eyelid twitching
A lot of people do not realize that eyelid twitching is something that might be closely linked to the stress level. However, eyelid spasm can also be caused due to stress. While twitching isn’t accompanied with any pain, it can be extremely exasperating, and can continue for a few minutes or for some weeks.
It is important to keep track of your spasm, as and when they occur whenever you experience it – there can be a pattern that associates with the stress levels. The best part is, it is possible to control eye twitching caused due to stress and put an end to it.