Halitosis – How to combat bad breath? Has a relative ever complained about it or advised you to find a way to solve it? Have you ever felt insecure having to talk close to people or inside an elevator? Do you believe you are able to perceive your own breath to know what it is?
I hate to disappoint you, but a few seconds are enough for your nose to get used to several different smells and simply not report anything to your brain, and this is called olfactory fatigue. However, it's natural that we can't tell.
Although this subject may seem easy, it's not! There's enough discussion about it to warrant books. So I invite you to take a practical approach to the most common situations that can be solved or alleviated with simple measures to combat bad breath.
Halitosis – How to combat bad breath? What is halitosis?
The word halitosis originates from "Halitos" – exhaled air – and "Osis" – disease. However, it's important to note that not all bad breath is caused by illness. Waking up in the morning, going hours without eating, prolonged periods without drinking water, and inactivity are conditions that can produce stronger breath odor, easily reversed with proper hygiene, hydration, and diet.
Our lungs release unpleasant substances when we go too long without eating. This happens because the body starts to draw energy from fat waste, which, when metabolized, releases volatile substances rich in sulfur.
Remember that bad breath is not a disease itself; it's a symptom that something isn't working quite right. However, it can be a symptom of an underlying disease or simply a temporary physiological condition.
Where should I look first?
The first place to investigate as a possible cause of bad breath is the oral cavity. The presence of cavities can cause food debris and dead cells that flake off from the mucous membranes of the cheeks and tongue to accumulate. If these cavities are deep, they can allow bacteria to enter the canals and cause infections that release volatile products with a rotten smell.
A tooth with canals contaminated by bacteria suffers from true putrefaction of the pulp tissue. The dental pulp – popularly known as the dental nerve – is, under healthy conditions, a living tissue with cells, blood, and nerve fibers, and can be invaded by bacteria and their toxins. This leads to necrosis (death) of this tissue, which then releases substances such as putrescine, indole, and skatole. All of these are sulfur compounds that are extremely unpleasant to the human sense of smell.
I don't have cavities! Where is that smell coming from?
When we neglect brushing and flossing, bacteria commonly found in the oral cavity accumulate, manifesting as... Bacterial Plaque. It's that sticky, white paste that forms in the corners of the teeth where the gums meet. This paste also accumulates on the back surface of the tongue, where it's called tongue coating. The buildup of plaque on the teeth and tongue causes bad breath.
How are your gums?
Keep in mind that young people are usually more prone to developing cavities, while adults are more prone to suffering from... Periodontal diseasel. So periodontal disease can manifest as gingivitis, and when gingivitis worsens, it can develop into periodontitis.
Periodontal disease is caused by the presence of bacterial plaque. Three days of free plaque accumulation is enough to start gingivitis. However, in the case of periodontitis, it can take much longer. But what is certain is that with this health condition, the gums release pus and necrotic debris that produce a bad smell.
What if it's not in the mouth? Can it be in the exhaled air?
Absolutely! The upper respiratory tract plays a role in the breathing process and is closely related to smell and taste. Some structures in these airways can contribute to bad breath (halitosis) when they are not functioning properly. I will talk about the palatine tonsils and how different conditions, such as deviated nasal septum, nasal horns, and sinus cavities, can be related to bad breath.
1. Palatine Tonsils (Tonsils): The palatine tonsils are lymphatic glands located at the back of the throat, one on each side. They play an important role in the immune system, helping to fight infections that enter through the nose and mouth. However, the tonsils can also accumulate bacteria, dead cells, and food debris, leading to the development of an unpleasant odor, which contributes to bad breath. Similarly, recurrent or chronic tonsil infections, known as tonsillitis, can worsen the problem.
2. Nasal Septum Deviation: The nasal septum is the structure that separates the two nostrils. A deviated septum occurs when the septum is not centered, causing partial or complete obstruction of one nostril. This can result in difficulty breathing through the nose. However, the lack of airflow also makes it difficult to clean the nostrils and produces an accumulation of mucus and unpleasant odor.
3. Nasal Horns and Sinus Cavities: The nasal horns are bony projections on the lateral wall of the nasal cavities. The sinus cavities are hollow spaces in the facial bones, lined with mucous membranes. Problems in these areas, such as chronic sinus infections or blockages, can result in mucus buildup, which may have an unpleasant odor and contribute to bad breath.
Mouth breathing
Remember that mouth breathing can also contribute to dryness of the mouth and gums, creating a favorable environment for the growth of odor-producing bacteria, which can cause bad breath.
Halitosis – How to combat bad breath? Systemic Diseases
Yes, several systemic diseases can contribute to the development of bad breath:
1. Diabetes: People with poorly controlled diabetes may have a fruity or sweet odor on their breath, known as ketotic breath. This occurs due to the accumulation of ketones in the body.
2. Kidney Disease: Kidney problems can result in an ammonia smell on the breath, due to the kidneys' inability to properly filter toxins from the body.
4. Liver Diseases: Cirrhosis can cause an unpleasant odor in the breath due to the accumulation of toxic substances in the body.
5. Chronic Respiratory Diseases: Bronchitis and pneumonia can contribute to bad breath due to infections and mucus buildup.
6. Sjögren's Syndrome: This autoimmune disease affects the salivary glands and can lead to dry mouth, promoting bacterial growth and causing bad breath.
7. Cancer: Cancers in the mouth, throat, lungs, or esophagus can cause bad breath due to abnormal cell growth and the accumulation of necrotic tissue.
Given so many possibilities, the best approach is to map out and eliminate each potential cause until we find a solution. The following proposals will likely resolve 90 percent of cases:
Practical measures to combat bad breath:
Halitosis – How to combat bad breath?
Drink more water: our mouths are an environment with intense shedding of cells from the cheeks, gums, and tongue. Saliva itself contains proteins that serve as food for some species of proteolytic and anaerobic bacteria. So even if you are fasting, there are bacteria feeding and producing volatile sulfurous substances. Therefore, remember that hydrating the body allows for better saliva production and the renewal of the environment.
There's even a recommendation for the amount of water that can be calculated based on a person's weight. For every kilogram of weight, 30ml of water per day is recommended. So, if you weigh 60 kilos x 30ml = drink 1.8 liters of water per day. That way, that little bottle for taking sips throughout the day works very well.
Above all, eat every three hours: when we go too long without eating, blood glucose can drop to the point where our body starts using fat reserves to produce energy. In other words, this phenomenon releases volatile fatty acids that are expelled during pulmonary exchange, therefore, the air exhaled from the lungs becomes unpleasant. Thus, people on a weight-loss diet will experience this entirely physiological phenomenon.
Halitosis – How to combat bad breath?
For those not on a diet, eat an apple: it's excellent for fighting bad breath. It induces salivation, promotes friction with the teeth and other surfaces, which helps remove plaque, dead cells, and tongue coating.
For those not on a diet, eat an apple: it's excellent for fighting bad breath. It induces salivation, promotes friction with the teeth and other surfaces, which helps remove plaque, dead cells, and tongue coating.
Remember that a diet very rich in meats, fats, as well as foods rich in sulfur: garlic, onion, broccoli, cauliflower, artichoke. Similarly, highly seasoned foods, all these conditions can cause the lungs to exhale sulfur compounds for hours.
Halitosis – How to combat bad breath?
Brush your teeth effectively: when brushing, you should strive to get the bristles to reach the small spaces that are hiding places for bacteria that produce fermentation. In another article you can learn the Bass Brushing Technique, which is extremely efficient.
Use dental floss efficiently. We have an article guiding you on this practice and a video demonstrating how to do it.
Brush your tongue: on the back of the tongue, also known as the dorsum of the tongue, it is common for a coating to form. This is the deposit of bacterial plaque on top of the papillae and natural ridges of this region. The existence of deep anatomical grooves in the tongue can aggravate the accumulation of bacteria and cellular debris from cell shedding or food residue. Acquire a tongue scraper to make this step more efficient.
You can purchase one Tongue scraper in OralBox
Halitosis – How to combat bad breath?
Toothbrushes aren't the most efficient way to do this. Try acquiring a tongue scraper. They come in various sizes and models. "V" shaped models are particularly adaptable to different tongue sizes and areas.
Use alcohol-free antiseptic solutions, or you can dilute 10-volume hydrogen peroxide half and half with water and gargle for two minutes. Or use a mixture of 1/3 hydrogen peroxide, 1/3 alcohol-free mouthwash, and 1/3 filtered water. You can prepare this solution in a bottle. This measure eliminates anaerobic bacteria from hard-to-reach areas of the tongue's surface and even the palatine tonsils.
Wash your upper respiratory tract with saline solution. Use a syringe purchased from a pharmacy. You can wash with saline solution using some pressure with the aid of this syringe. The nostrils harbor dust, cellular debris, and mucus. Rhinitis and sinusitis worsen this condition. Some individuals have the added complication of having deviated nasal septa and recesses that accumulate a lot of foul-smelling residue. Performing this operation once a day will be very helpful.
What if that doesn't solve it?
Consult a dentist to rule out cavities, periodontal disease, old dentures, and temporary crowns made of unsuitable porous materials. Poorly fitting fixed prostheses with small gaps that are impossible to clean can harbor food debris and bacteria.
Consult an ENT specialist to examine your airways. The presence of crypts in the palatine tonsils often leads to the accumulation of tonsil stones. What are tonsil stones? They are foul-smelling balls composed of food debris and dead cells that occasionally break off. In this regard, gargling with hydrogen peroxide as described above may also help.
Furthermore, consult a gastroenterologist. Cases of halitosis caused by acid regurgitation are in the minority, but they do exist.
Furthermore, don't smoke; smoking produces terrible breath.
Furthermore, alcoholic beverages can also significantly contribute to halitosis.
In short, you can start with the simplest initial steps and gradually move on to more complex solutions, using a process of elimination as you achieve results.
Author: Nivaldo Pinho Gonçalves, Periodontist, CROSC 9696.
Como sugestão de leitura, um artigo PDF bastante denso se você quiser se aprofundar no assunto : https://bdigital.ufp.pt/bitstream/10284/5604/1/PPG_%2023469.pdf