Bad Breath Can Be Viewed As A Health Risk ?

Although bad breath is generally not viewed as a health risk, if left unchecked it can be the kiss of death for individuals whose jobs and personal relationships put them in close proximity to others. Current research and new technologies can help dental hygienists understand how diet, medication and certain systemic conditions may cause oral malodor—as well as assist them in detecting, measuring and helping treat oral malodor in their patients.
Approximately 90% of the causes of bad breath develop in the oral cavity, with most cases originating from decaying particles of food and certain chemical components in saliva.1 The decay process breaks down proteins and other organic materials into simpler matter, leaving behind sulfuric acids and fatty acids that create lingering odors. Poor oral hygiene can allow bacterial plaque to accumulate on the teeth and tongue. In addition, subgingival and proximal areas—as well as restorations that have fallen into disrepair—have been pinpointed as sources of bad breath when oral hygiene is not maintained. While age is not a risk factor for oral malodor, gender does play a role, as the condition is three times more common among men than women.

A DEEPER LOOK
Oral malodor is identified as either nonpathogenic or pathogenic. The former typically relates to normal body functions, such as "morning breath" that results from lack of salivary flow during sleep. Smoking and food debris are also nonpathogenic triggers. Pathogenic causes may include periodontal diseases, xerostomia or wearing dentures overnight. Radiation therapy is another pathogenic cause of mucositis-related malodor, as are Sjögren's syndrome and cleft lip/palate.
Some causes of bad breath are nonoral in nature. For example, many common drugs—from antidepressants to pain relievers—can cause xerostomia, which increases the risk of oral malodor.3 Diuretic agents, muscle relaxants, antihypertensive medications, antihistamines, anticholinergic agents and analgesics can also lead to xerostomia.

THE NOSE KNOWS
Clinicians may assess oral malodor simply by smelling the air exhaled from the patient's nose and mouth. Generally, malodor exiting the mouth is produced by oral or pharyngeal causes. Several technologies have been developed to detect and measure oral malodor. One is a handheld device—referred to as the "electronic nose"—that samples a patient's breath via a chemical sensor that tests for volatile sulfur compounds (VSC). A second technology, known as gas chromatography (GC), uses a needleless syringe to capture an air sample from deep inside the mouth. The sample is injected into the portable GC device and analyzed for VSC that typically include hydrogen sulfide, methyl mercaptan and dimethyl sulfide. Some clinicians may use a portable sulfide meter that analyzes patients' breath after they have exhaled through a tube for 30 seconds. This device, however, may yield readings that underestimate the strength of some types of oral malodor.4
Diagnosing oral malodor is not always a simple matter. Transient oral malodor can be treated with little more than good advice and cosmetic measures, while pathologic oral malodor requires clinical treatment and individualized oral hygiene strategies.

TIPS FOR TREATING ORAL MALODOR
Once systemic conditions are ruled out as the cause, clinicians should review the patient's oral health history and self-care practices. One strategy to overcome oral malodor is to minimize the proteinaceous debris present in the oral cavity, thereby eliminating the source of bad breath.5 Tongue scraping is a highly effective tactic because bacteria that produce offensive breath are most likely to collect on the lingual dorsum, and this is also where most food debris accumulates. Tongue cleaning works by reducing the substrata for putrefaction.6 Patients are typically unfamiliar with this form of self-care, however, and dental hygienists can help by educating patients about proper technique. Clinicians can also recommend the use of fluoride toothpaste and antimicrobial mouthrinses to kill oral bacteria.
In terms of professional care, toothbrushing, followed by tongue cleaning with a high-speed vacuum ejector, and irrigation with a mouthrinse, is an effective strategy for reducing odor-causing bacteria entrenched in the tongue.7 In cases where oral malodor is triggered by periodontitis, scaling and root planing may help ease gingival inflammation, while also reducing plaque and the volume of odor-causing microbes in the oral cavity.

GET CLOSE
The incidence of oral malodor is widespread. Setting aside possible systemic causes, the most effective treatment strategies focus on controlling and reducing the microflora that underlie the condition. Fortunately, some treatments directed at controlling the microbiota associated with dental caries may also prove helpful in eradicating the bacteria that cause bad breath.
With the guidance of a well-informed dental hygienist, most patients can easily address oral malodor via methods that are affordable, effective and preserve their ability to confidently interact with others.