Fast Five Quiz: Embarrassing Medical Conditions

George D. Harris, MD, MS

Disclosures

June 27, 2019

The best way to treat bad breath (halitosis) is to instill patients with good oral hygiene practices. Although patients often balk at using dental floss, compliance improves once the connection is made between flossing and fresh breath (eg, just by asking the patients to smell their own floss after each passage). In addition to mechanical means and normal oral hygiene procedures, oral malodor (bad breath) is reduced by the use of active chemical agents. Such agents include active antimicrobial compounds that are delivered via mouth rinses, dentifrices, or lozenges. Mechanical reduction of halitosis can also be achieved by reducing the intraoral bacterial count by disrupting the tongue biofilm, thus decreasing the production of volatile sulfur compounds or volatile organic compounds. Common methods include tongue brushing, tongue scraping, and chewing gum. Gentle but effective deep tongue cleaning should be an important daily routine.

In most cases, bad breath (halitosis) comes from the mouth itself. The simplest way to distinguish oral from nonoral etiologies is to compare the smell coming from the patient's mouth with that exiting the nose.

Saliva plays a big role in halitosis elimination. The degree of halitosis during the day is inversely related to saliva flow. When saliva flow is lowest during the night, after fasting and owing to insufficient water intake, halitosis becomes more intense. Conversely, mastication increases saliva flow, with concomitant cleansing of the oral cavity and reduction in malodor. One of the most common bacteria found among people with fresh breath is Streptococcus salivarius; this bacterium is often absent in individuals with halitosis or is found at extremely low levels.

Among the nonoral etiologies of bad breath (halitosis), the nasal passages predominate. In such cases, the telltale odor can be smelled most strongly from the nose, rather than the mouth. Nasal odor may be indicative of nasal infection or a problem affecting airflow associated with thick mucus secretions. Typical nasal malodor (rhinohalitosis) usually has a slightly cheesy character and differs appreciably from other types of bad breath.

Read more about halitosis.

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