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yang tidak enak, dan tidak menyenangkan serta menusuk hidung. Bau mulut bukan merupakan suatu penyakit, melainkan suatu gejala adanya kelainan/penyakit yang tidak disadari. Bau mulut merupakan akibat dari proses perubahan bahan dalam rongga mulut yang mengandung ikatan sulfur. Penyebab Halitosis Bau mulut biasanya disebabkan oleh masalah dari rongga mulut itu sendiri. Namun tidak menutup kemungkinan bau mulut berasal dari luar mulut, seperti hidung, faring, paru-paru dan lambung. Normalnya, bau dari rongga mulut tidak tetap, tetapi berubah dari waktu ke waktu sepanjang hari dan dipengaruhi oleh factor : usia, jenis kelamin, keadaan perut lapar dan menstruasi. Bau mulut akan terjadi pada seseorang yang sehat bila rongga mulut tidak melakukan aktivitas selama kira-kira 1-2 jam. Misalnya pada keadaan puasa, bangun tidur, orang yang menggunakan gigi palsu yang jarang atau tidak pernah dibersihkan. Jika bau nafas yang sebelumnya normal berubah menjadi halitosis, maka penyebabnya adalah: 1. Makanan (misalnya bawang mentah, bawang putih, kol, jengkol, pete) 2. Vitamin (terutama dalam dosis tinggi) 3. Kebersihan gigi yang jelek 4. Gigi karies 5. Merokok 6. Alkohol 7. Peradangan 8. Sindroma Sjgren 9. Benda asing di hidung (biasanya terjadi pada anak-anak) 10. Obat-obatan (paraldehid, triamteren dan obat bius yang dihirup, suntikan insulin). Penyakit-penyakit yang bisa menyebabkan bau mulut: Gingivitis ulseratif nekrotisasi akut, Mukositis ulseratif nekrotisasi akut, Gangguan ginjal, Gangguan hati, Penyumbatan usus,
Penyakit Periodontal, Bronkiektasis, Diabetes mellitus, Kanker kerongkongan, Karsinoma lambung, fistula gastrojejunokolik, Ensefalopati hepatikum , Ketoasidosis diabetikum, Abses paru, Ozena, Faringitis, Divertikulum Zenker. Diagnosa Diagnosis ditegakkan berdasarkan gejala dan hasil pemeriksaan fisik yang menyeluruh pada mulut dan hidung. Biakan tenggorokan dilakukan jika terdapat luka di tenggorokan atau di mulut.
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Pemeriksaan lainnya yang mungkin dilakukan adalah: 1. Halimeter : Yaitu suatu test untuk mengetahui kadar sulfur didalam mulut. 2. Gas kromatografi : Untuk mengukur kadar tingkatan molecular ketiga factor utama VSCs di dalam mulut (sulfida hidrogen, metil mercaptan, dan dimethyl sulfida). 3. BANA test ; Test ini digunakan untuk mengetahui adanya bakteri penyebab bau mulut yang berasal dari ludah. 4. - galactosidase test 5. Endoskopi 6. Rontgen perut 7. Rontgen dada Pengobatan Pengobatan khusus bau mulut tergantung kepada penyakit yang menyebabkan terjadinya bau mulut tersebut. Akan sangat membantu jika kita mengunjungi dokter gigi untuk memastikan penyebabnya, untuk kemudian dicari solusinya. Daun parsley segar atau permen mint bisa menghilangkan bau mulut yang bersifat sementara. Rajin membersihkan pangkal lidah akan membantu mengurangi bau mulut. Pencegahan 1. Periksakan gigi ke dokter gigi secara teratur. 2. Bersihkan sela-sela gigi dengan dental floss, pilih yang netral tanpa pengharum. Cek baunya. Bersihkan lagi kalau berbau. 3. Gosok gigi dan bersihkan gusi secara teratur. 4. Banyak minum.
5. Berkumur dan gosok gigi setelah makan atau minum produk susu, ikan, dan daging. 6. Malam hari, rendam gigi palsu dalam cairan antiseptik, kecuali bila dokter gigi melarang. 7. Tanyakan kepada dokter gigi, obat kumur mana yang secara klinis telah terbukti efektivitasnya dalam melawan bau mulut. Paling baik menggunakannya di saat menjelang tidur malam. 8. Hindari makanan yang berbau menyengat misalnya bawang putih, bawang merah, petai dan lain-lain 9. Tidak merokok karena mempertinggi risiko timbulnya bau mulut. 10. Bisa dengan mengkonsumsi : Tumbuh-tumbuhan, Yogurt, Sayur dan buah renyah
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Bau mulut dalam bahasa medis disebut sebagai Halitosis atau Fetor Ex Ore. Istilah Halitosis digunakan apabila kondisi bau mulut yang ada berhubungan dengan keadaan tubuh secara umum (sistemik), sedangkan Fetor Ex Ore digunakan apabila bau mulut berasal dari faktor-faktor yang ada dalam rongga mulut itu sendiri.
Bau mulut dapat terjadi karena beberapa faktor, antara lain faktor lokal yang ada di dalam rongga mulut, faktor di luar rongga mulut, faktor fisiologis, dan faktor psikis. Di dalam rongga mulut terdapat zat yang disebut volatile sulfur compound (VSCs). Zat ini mengandung hidrogen sulfid, metil mercaptan, dan dimetil disulfid yang merupakan produk bakteri atau flora normal rongga mulut. Pada orang yang menderita bau mulut, kadar VSCs di dalam mulutnya mengalami peningkatan. Peningkatan kadar VSCs dalam mulut disebabkan oleh adanya peningkatan aktivitas bakteri anaerob yang menyebabkan bau VSCs tercium indera penciuman. Aktivitas bakteri anaerob itu terjadi apabila rongga mulut mengandung sedikit oksigen, terutama saat mulut kering di mana aliran liur atau saliva rendah. Kondisi bau mulut ini dapat diperberat apabila seseorang memiliki
kebersihan mulut yang rendah. Rendahnya kebersihan mulut ini biasanya ditandai oleh dua hal yaitu banyaknya gigi yang berlubang atau karang gigi yang menumpuk. Bila ada gigi yang berlubang maka sisa-sisa makanan akan tertinggal di dalam lubang dan di selasela gigi yang pada akhirnya akan membusuk dan menyebabkan bau mulut. Demikian pula dengan karang gigi yang menumpuk karena sejatinya pada karang gigi banyak terdapat bakteri-bakteri yang produk metabolismenya juga dapat menyebabkan bau mulut.
Selain faktor di dalam rongga mulut, bau mulut juga dapat disebabkan oleh faktor di luar rongga mulut. Penyebabnya dapat berasal dari hidung, jantung, atau karena penyakit tertentu, misalnya kencing manis, infeksi paru-paru, serta infeksi lambung atau usus. Infeksi karena kanker atau radang amandel kronis juga bisa membuat napas tak sedap. Penyebab lain adalah asam lambung tinggi, misalnya pada penderita maag. Bau mulut timbul karena asam dan basa tidak seimbang. Pada penderita maag, misalnya, asam lambungnya meningkat. Begitu maag kumat, otomatis tingkat keasaman mulut naik ke atas tenggorokan, sehingga timbul bau mulut.
Pada saat berpuasa, bau mulut dapat terjadi karena beberapa hal. Penyebab pertama adalah karena tidak aktifnya pengunyahan pada saat berpuasa. Hal ini memiliki implikasi berkurangnya produksi kelenjar liur. Dengan demikian, produksi zat-zat VSCs seperti yang telah disebutkan di atas akan meningkat dan menimbulkan timbulnya bau yang tak sedap. Penyebab kedua adalah konsumsi makanan atau minuman yang menimbulkan bau tajam seperti bawang putih, bawang merah, petai, jengkol, dan lainlain pada saat sahur. Penyebab yang ketiga adalah karena adanya faktor lokal dalam rongga mulut berupa gigi berlubang atau karang gigi.
Untuk mengatasi bau mulut pada saat berpuasa maka disarankan untuk minum lebih banyak air putih pada saat sahur. Konsumsi makanan berserat dan buah seperti buah semangka atau bengkuang juga dianjurkan karena memiliki sifat sebagai cleaner atau pembersih dalam perut. Jadi, selain untuk gigi, juga untuk kesehatan. Menggosok gigi setelah sahur dibantu dengan berkumur-kumur cairan antiseptik mulut juga dapat membantu mengurangi bau mulut. Selain itu, apabila diketahui ada gigi yang berlubang atau karang gigi, segeralah pergi ke dokter gigi untuk menambal dan membersihkannya. Puasa identik dengan bau mulut??? Tidak lagi tentunya! Semoga puasa Ramadhan kali ini dapat membawa banyak keberkahan.
Halitosis secara umum terjadi sebagai hasil dari dekomposisi bakteri pada makanan, sel, darah maupun beberapa komponen dari saliva. Namun, 90 % penyebabnya berasal dari dalam mulut. Protein serta senyawa kimia lain yang ada pada material tersebut dipecah menjadi komponen yang lebih sederhana seperti asam amino dan peptide, beberapa substansi yang mudah menguap (asam lemak dan sulfur) dihasilkan dari proses dekomposisi tersebut. Beberapa diantaranya yaitu asam propionic (bau muntah), asam butirat (berbau mentega tengik), asam valerat, aston, asetaldehid, ertanol, propanol dan diacyl. Hasil lain dari dekomposisi ini berperan pada metabolisme bakteri di mulut, dan lebih jauh membusuk menjadi bahan yang dikenal dengan istilah VSC
WIKI MULUT Terdapat lebih dari 600 jenis bakteri ditemukan di dalam rongga mulut, beberpa diantaranya dapat menghasilkan bau busuk saat dilakukan inkubasi di laboratosium. Bau busuk ini terutama hasil dari pemecahan secara anaerob dari protein menjadi asam amino, dan lebih jauh lagi pemecahan beberapa asam amino yang menghasilkan bau busuk.Sebagai contoh pemecahan cystein, dan methionin menhasilkan hydrogen sulfide dan methyl mercaptan. Sulfur telah terbukti berhubungan dengan adanya bau mulut. Bagian lain dari mulut juga ikut andil pada bau mulut, namun tidak sesering pada bagian bawah lidah. Daerah daerah ini juga berperan: inter dental, sub gingival niche, abses, gigi palsu yang tidsk bersih dll. LIDAH Lokasi yang paling sering berhubungan dengan bau mulut ialah lidah. Sejumlaj besar bakteri ditemukan di posterior dorsum dari lidah yang mana pada daerah tersebut tidak terganggu oleh aktivitas normal. Daerah ini biasanya relatif kering dan kurang bersih
sehingga populasi bakteri dapat tumbuh subur dari sisa-sisa makanan, sel epitel yang telah mati dan postnasal drip. Struktur lidah bagian ini mejnadi tempat yang ideal bagi bakteri anaerob untuk tumbuh subur di bawah lapisan yang terbentuk dari sisa-sisa makanan, sel epitel yang telah mati dan postnasal drip. Hasil respirasi anaerob dari bakteri ini dapat menghasilkan bau indol, skatole, polyamine atau telur busuk dari VSCs (volatile sulfur compounds) seperti hidrogen sulfid, methyl mercaptan, allyl methyl sulfide dan dimethyl sulfide. MEMBERSIHKAN LIDAH Keebanyakan alasan membersihkan lidah adalah untuk menghilangkan bau mulut seperti dengan menggunakan mints, mouthwash, permen karet dll. Hal ini hanya bersifat sementara dan tidak mengatasi sumber bau mulut. Untuk mengatasinya, bakteri, sisa makanan harus dibersihkan. Beberapa menggunakan tounge cleaner (tounge scarper) atau sikat gigi. Namun biasanya tounge cleaner lebih efektif dalam membersihkan dibanding sikat gigi yang terkadang justru meratakan akumulasi bakteri GUSI Terdapat beberapa kontroversi mengenai ada tidaknya peran penyakit periodontal menyebabkan bau mulut. HIDUNG Sumbr terbanyak kedua yang menyebabkan bau tidak sedap yakni hidung, namun bau tidak sedap yang berasal dari hidung ini berbeda dari bau yang berasal dari mulut. Yang berasal dari hidung biasanya karena sinusitis, benda asing. TONSIL Bau busuk yang berasal dari tonsil hanya sekitar 3-5 % kasus. Biasanya karena tonsilolith yang menyebabkan bau busuk yang sangat. PERUT Perut juga dapat sebagai penyebab bau tak sedap (kecuali sendawa). Esofagus merupakan tabung yang kolaps dan tertutup, ketika ada bau busuk dai dalam perut mengindikasikan masalah kesehatan seperti adanya reflux atau fistula antara lambung dan esofagus. Penyakit Sistemik Ada beberapa kondisi dari penyakit sistemik yang dapat menyebabkan bau mulut menjadi tak sedap, antara lain: 1. 2. 3. 4. 5. 6. 7. Fetor hepaticus: dapat terjadi pada gagal hepar kronis Infeksi traktus respiratorius bagian bawah (Infeksi paru dan bronkhial). Infeksi pada ginjal dan gagal ginjal Karsinoma Trimethylaminuria ("fish odor syndrome"). Diabetes mellitus. Metabolic dysfunction.[14]
Halitosis merupakan suatu keadaan di mana terciumnya bau mulut pada saat seseorang mengeluarkan nafas (biasanya tercium pada saat berbicara). Bau nafas yang bersifat akut, disebabkan kekeringan mulut, stress, berpuasa, makanan yang berbau khas, seperti petai, durian, bawang merah, bawang putih dan makanan lain yang biasanya mengandung senyawa sulfur. Setelah makanan di cerna senyawa sulfur tersebut diserap kedalam pembuluh darah dan di bawa oleh darah langsung ke paru-paru sehingga bau sulfur tersebut tercium pada saat mengeluarkan nafas.
Selain itu juga kebersihan mulut yang sangat kurang sempurna karena kebanyakan kita menyikat gigi hanya sekitar 40 detik, menurut literature diperlukan sedikitnya 3 menit untuk membersihkan gigi dan meng eliminasi bakteri merugikan yang berperan dalam produksi senyawa sulfur. Bau nafas pagi hari hampir pada semua orang dewasa, merupakan contoh bau nafas yang bersifat sementara (karena kekeringan mulut selama tidur). Bau nafas khronis dilaporkan menimpa 25 % populasi penduduk di berbagai macam kalangan. Keadaan ini dapat berpengaruh dalam hubungan personal atau bahkan dapat menyebabkan bencana terhadap hubungan bisnis.
Beberapa penelitian telah di lakukan untuk mengetahui bakteri-bakteri spesifik penyebab bau mulut tersebut. Di dalam mulut normal diperkirakan rata2 terdapat sekitar 400 macam bakteri dengan berbagai tipe. Meskipun penyebab bau mulut belum diketahui dengan jelas, kebanyakan dari bau tersebut berasal dari sisa makanan di dalam mulut. Masalah akan muncul bila sebagian bakteri berkembang biak atau bahkan bermutasi secara besar2an. Kebanyakan dari bakteri ini bermukim di leher gigi bersatu dengan plak dan karang gigi, juga di balik lidah karena daerah tersebut merupakan daerah yang aman dari kegiatan mulut sehari-hari. Bakteri tersebut memproduksi toxin atau racun, dengan cara menguraikan sisa makanan dan sel-sel mati yang terdapat di dalam mulut. Racun inilah yang menyebabkan bau mulut pada saat bernafas karena hasil metabolisme proses anaerob pada saat penguraian sisa makanan tersebut menghasilkan senyawa sulfide dan ammonia.
Bau mulut juga dapat di sebabkan oleh penyakit diabetes, penyakit ginjal, sinusitis, tonsillitis, kelainan fungsi pencernaan, penyakit liver, alkohol dan juga berbagai macam obat-obatan yang dapat menyebabkan kekeringan mulut.Perawatan yang dilakukan, berdasarkan penyebab bau mulut tersebut, bila perlu dilakukan pemeriksaan mikrobiologi untuk melihat bakteri penyebab, sebaiknya hubungi dokter gigi untuk pemeriksaan lebih lanjut.
Penggunaan penyegar nafas, permen karet dan obat kumur, biasanya bersifat asimptomatis dan sangat terbatas kerjanya hanya sementara saja, pada saat efek dari penyegar nafas hilang bau mulut akan kembali tercium. Read more: file:///C:/Documents%20and%20Settings/Administrator/My %20Documents/Downloads/GILUT/Halitosis/HALITOSIS%20_%20Bau%20Mulut %20_%20Dokter%20Sehat.htm#ixzz0Ys0VjeYU
Halitosis
Halitosis, or bad breath, may be acute or chronic, depending on the underlying cause. It may indicate the need for improved dental hygiene or may be a symptom of an underlying infection or chronic disease. Oral causes constitute about 90% of the etiologies of halitosis, whereas nasal causes constitute nearly 10%; thus, other etiologies are relatively uncommon.
Differential Diagnosis
Head and neck etiologies Foods (e.g., onion, garlic) Dental conditions (periodontal disease, gingivitis, denture odor, dental abscesses, food particles not cleaned from teeth) Postnasal drip Dry mouth (xerostomia): Mouth breathing, side effect of medications, salivary gland disease, dehydration Nasal foreign body Gastroesophageal reflux disease Chronic sinusitis Allergic rhinitis Tonsillar disease (e.g., streptococcal pharyngitis) Zenker's (pharyngoesophageal) diverticulum: Presents as dysphagia, regurgitation, cough, and extreme halitosis Tobacco or alcohol use Systemic etiologies Diabetes mellitus, especially with ketoacidosis Uremia Pulmonary disorders (e.g., bronchiectasis, pneumonia, neoplasms, tuberculosis) Trimethylaminuria (fishy breath odor)
Careful dental and medical history, including dental hygiene habits and dietary history Note associated symptoms that suggest systemic etiology (e.g., cough, nasal congestion) Odor after sleeping, dieting, or exercising suggests xerostomia Odor upon talking suggests postnasal drip Bleeding gums suggests periodontal disease Dental examination to rule out treatable dental causes (e.g., periodontal disease) Physical examination should include careful oral, nasal, sinus, neck, pulmonary, and abdominal examinations Assess odor from mouth and nose separately Small malodorous whitish stones on tongue suggest tonsilloliths Place dentures into plastic bag for several minutes and then smell to evaluate for denture odor Spoon test involves scooping mucous/saliva from back of tongue and evaluating for malodor; if present, suggests postnasal drip Nasolaryngoscopy if nasal cause is suspected but specific cause cannot be identified Zenker's diverticulum is diagnosed by contrast barium swallow
Treatment
Maintain good oral hygiene (e.g., brush teeth at least twice per day, floss daily, treat underlying periodontal disease) Avoid exacerbating medications or foods Tongue cleaning with toothbrush Gargle with chlorhexidine mouthwash twice a day for a week to assess improvement Treat postnasal drip (e.g., antihistamines, nasal steroids, polyp removal) Treat sinusitis with appropriate antibiotics Decrease or eliminate alcohol and tobacco use Zenker's diverticulum may require surgical resection if symptomatic Treat other underlying medical diseases (e.g., diabetic ketoacidosis, uremia, GERD)
Book Title: In a Page: Signs and Symptoms Author(s): Scott Kahan, Ellen G. Smith Year of Publication: 2004
Halitosis
Halitosis is a relatively infrequent pediatric chief complaint; however, it frequently emerges as part of the HPI. Acute causes are usually upper respiratory infections (such as stomatitis, tonsillitis, or sinusitis), whereas chronic halitosis is more likely to be due to dental issues. However, chronic sinusitis may cause halitosis either from the presence of bacterial colonies or from secondary mouth breathing.
Differential Diagnosis
Upper respiratory Stomatitis: Painful ulcerated lesions on oral mucosa and gingiva; coxsackie virus is commonly called hand-foot-and-mouth disease; herpangina refers to herpetic lesions on the soft palate and posterior pharynx; trench mouth refers to necrotizing gingivostomatitis with pseudomembrane caused by spirochetes or fusiform bacteria Sinusitis: Acute or chronic; pathogens are Streptococcus pneumoniae, hemolytic strep, Haemophilus influenzae, and Moraxella catarrhalis; maxillary sinuses are most frequently involved Pharyngitis/tonsillitis/tonsillar abscess: Group A strep Pulmonary disorders Pulmonary abscess Bronchiectasis Gastric disorders GERD Bezoar Dental etiologies Poor oral hygiene: Bacterial accumulation on the teeth or tongue; gingival inflammation; food concretions within tonsillar crypts Dental abscess: May be sequela of baby-bottle tooth decay, untreated dental caries, dental fracture, or poor hygiene Orthodontic devices Chronic mouth breathing Seen in children with nasal polyps, adenoid hypertrophy, allergic rhinitis, and chronic sinusitis Rarely due to a nasopharyngeal tumor such as a hemangioma or fibromas Resultant dryness causes alteration of the oral mucosa and resultant bad breath; taste and smell may be affected
Nasal foreign body Seen most often in the toddler/preschool age group History of foreign body placement is not always forthcoming Usually accompanied by unilateral nasal discharge
History Onset, duration, severity of symptoms Accompanying signs and symptoms, especially fever, nasal congestion, nasal discharge, sore throat, cough, tachypnea History of recurrent pneumonia History of GI upset, digestive problems Dental history and frequency of dental care Physical exam Examination of the oral cavity for dental hygiene, dental caries, gingival swelling, orthodontic devices that are poorly fitting or poorly maintained HEENT examination including nasal cavity, oral lesions, tonsillar hypertrophy, asymmetry, exudate, or concretions General medical evaluation including respiratory and GI systems Labs Throat culture if streptococcal pharyngitis is suspected Radiology X-ray or CT of sinuses for mucosal thickening or air-fluid levels Lateral X-ray for adenoid hypertrophy Chest X-ray if pulmonary lesion is suspected Studies Endoscopy may be required for suspicion of GERD or bezoar
Treatment
Scrupulous oral hygiene Stomatitis is usually treated supportively with acetaminophen and oral hydration (Popsicles) Viscous lidocaine should be used sparingly, if ever Herpetic lesions may be treated with oral acyclovir Trench mouth is treated with penicillin Streptococcal pharyngitis is treated with penicillin Sinusitis requires longer duration of antibiotic therapy Bronchiectasis and pulmonary abscess are treated with systemic antibiotics and nonsurgical or surgical drainage Adenoidectomy and treatment of concurrent allergies and sinusitis rectifies most mouth breathing
GERD is treated with H2 blockers and promotility agents Endoscopy may be therapeutic and diagnostic for bezoar Removal of nasal foreign body is usually sufficient treatment
Book Title: In A Page: Pediatric Signs and Symptoms Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Year of Publication: 2007 Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright 2007 Lippincott Williams & Wilkins.
Halitosis
Mark Douglas Andrews
Halitosis (fetor oris) is a common problem, usually thought to be merely a social handicap related to poor oral hygiene or disease of the oral cavity. However, it can represent a marker for a more serious systemic illness that requires diagnosis and treatment (1). In modern society, oral malodor has been continually stigmatized, giving rise to a commercial market for mouthwash and mouth fresheners exceeding $800 million annually (2). Despite this publicity, patients only occasionally present with a primary complaint of halitosis and generally are unaware of the problem, but at some time more than half the population will be affected. Unfortunately, physicians and dentists remain relatively indifferent and unconcerned about this health issue.
Approach
Persistent or abnormal halitosis (usually noted by persons around the patient) exceeds in severity the more common and benign morning halitosis. The important initial task is to categorize the halitosis as either localized to the oral cavity or originating systemically. In addition, causes of halitosis can be subcategorized into common pathologic and nonpathologic types. The cause of halitosis can be attributed to bacterial activity in disorders of the oral cavity in 80% to 90% of patients, with the remaining 10% to 20% of cases attributed to nonoral or systemic sources (2,3). A. Nonpathologic causes
1. Morning breath is caused by decreased salivary flow during sleep associated with increased fluid pH, and resulting elevated gram-negative bacterial growth and volatile sulfur compounds production (4). 2. Xerostomia, regardless of cause (e.g., sleep, diseases, medication side effects, mouth breathing), can contribute to halitosis. Age-related changes in salivary gland physiology result in a gradual decline in saliva quantity and quality. 3. Missed meals. Dieting or missed meals can lead to halitosis secondary to decreased salivary flow and absence of foods mechanical action on the tongue surface to wear down filiform papillae. 4. Tobacco or alcohol use is usually considered to be a contributing cause of halitosis. 5. Food sources. Metabolites from ingested food are absorbed into the circulatory system and then excreted through the lungs, thereby contributing to halitosis. Onions, garlic, alcohol, pastrami, and other meats are common offenders. 6. Medications. Drugs with anticholinergic side effects can cause xerostomia, especially in the elderly. An assortment of other agents can have a role in the production of offensive breath by a diversity of mechanisms. These agents include amphetamines, anticholinergics, antidepressants, antihistamines, decongestants, antihypertensives, anti-Parkinsonian agents, antipsychotics, anxiolytics, chemotherapeutic agents, diuretics, narcotic analgesics, and radiation therapy. B. Pathologic causes 1. Local oropharynx. Chronic peridontal disease and gingivitis are the most common sources caused by the promotion of bacterial overgrowth. Stomatitis and glossitis caused by systemic disease, medication, or vitamin deficiencies can lead to trapped food particles and desquamated tissue. An improperly cleaned prosthetic appliance can be a local contributor as can primary pharyngeal cancer. Also important are conditions associated with parotid dysfunction (e.g., viral and bacterial infections, calculi, drug reactions, systemic conditions including Sjgrens syndrome). 2. Gastrointestinal tract. Important sources include gastroesophageal reflux disease (GERD), gastrointestinal bleeding associated with a decayed odor, gastric cancer, malabsorption syndromes, and enteric infections. 3. Respiratory tract. Chronic sinusitis, nasal foreign bodies or tumors, postnasal drip, bronchitis, pneumonia, bronchiectasis, tuberculosis, and malignancies may be causative.
4. Psychiatric causes are less common, but a complaint of halitosis can represent a delusional syndrome associated with somatization, depression, organic brain syndrome, or schizophrenia. Halitophobia refers to imaginary halitosis (3). 5. Systemic sources include diabetic ketoacidosis (sweet, fruity, acetone breath), renal failure (ammonia or fishy odor), hepatic failure (fetor hepaticusa sweet amine odor), high fever with dehydration, and vitamin or mineral deficiencies leading to dry mouth.
History
A focus on the characteristics of the bad breath is critical, although the patient is often unable to self-diagnosis or describe accurately because of olfactory desensitization. Is the odor transient or constant? A constant odor suggests chronic systemic disease or serious disorders of the oral cavity. What are the precipitating, aggravating, or relieving factors? What are the patients smoking habits, medications, dietary preferences, and brushing and flossing routines?
Physical examination
A. Physical examination should be undertaken with an emphasis on the evaluation of the oral cavity, particularly looking for ulceration, dryness, trauma, postnasal drainage, infections, cryptic tonsils, or neoplasms. B. Techniques for localizing the odor source (systemic versus oral cavity). 1. Seal lips and blow air through the nose. If fetid odor is noted, this is suggestive of a systemic source. 2. Pinch nose with lips closed. Hold respiration and exhale gently through the mouth. Odors detected in this fashion, generally are local in origin.
Testing
For most patients with complaints of halitosis, clinical laboratory testing and diagnostic imaging are unnecessary and should only be pursued on the basis of specific findings indicated by the history and physical examination. The Schirmers test may be useful in identifying xerophthalmia and associated xerostomia seen with Sjgrens syndrome and some other rheumatologic conditions (Chapter 12.1). If indicated, radiologic studies and imaging procedures of the sinuses, thorax, and abdomen may be used to identify infectious processes, neoplasms, and GERD with its complications.
Halitosis
Halitosis describes any breath odor thats unpleasant, disagreeable, or offensive. Certain types of halitosis characterize specific disorders for example, a fruity breath odor typifies ketoacidosis. (See also specific breath odor types.) Other types of halitosis include putrid, foul, fetid, and musty breath odors. Halitosis may result from a disorder of the oral cavity, nasal passages, sinuses, respiratory tract, or esophageal diverticula. It may also stem from a GI disorder and be associated with belching, regurgitation, or vomiting, or it may be an adverse effect of an oral or inhaled drug. Other causes of halitosis include cigarette smoking, ingestion of alcohol and certain foods (such as garlic and onions), and poor oral hygiene especially in patients with an orthodontic device, dentures, or dental caries. Surprisingly, offensive skin odors for example, from foot perspiration may be absorbed locally and later expelled by the lungs, resulting in halitosis.
History
If you detect halitosis, try to characterize the odor. Does it smell fruity, fecal, or musty? If the patient is aware of it, find out how long he has had it. Does he also have a bad taste in his mouth? Does he have difficulty swallowing or chewing? Does he have reflux or regurgitation? Does he have pain or tenderness? Ask the patient if he has a problem with flatus and about his pattern and description of bowel movements. Find out if the patient smokes or chews tobacco. Have him describe his diet and daily oral hygiene. Does he wear dentures? Complete the history by asking about chronic disorders and recent respiratory tract infection. If the patient reports a cough, find out if its productive.
Physical assessment
Begin the physical examination by examining the patients mouth, throat, and nose. Look for lesions, bleeding, drainage, obstruction, and signs of infection, such as redness and swelling. Check for tenderness by percussing and palpating over the sinuses. Then auscultate the lungs for abnormal breath sounds. Auscultate the abdomen for bowel sounds; percuss, noting any tympany. Finally, take vital signs.
Medical causes
Bowel obstruction
Halitosis is a late sign of both small- and large-bowel obstruction. With a small-bowel obstruction, vomiting of gastric, bilious, and then feculent material produces a related breath odor. Other findings include constipation, abdominal distention, and intermittent periumbilical cramping pain. With a large-bowel obstruction, fecal vomiting produces
fecal breath odor. Abdominal pain is milder and more constant than that associated with a small-bowel obstruction and is usually located lower in the abdomen.
Bronchiectasis
Bronchiectasis usually produces foul or putrid halitosis, but some patients may have a sickeningly sweet breath odor. The patient typically also has a chronic productive cough with copious, foul-smelling, mucopurulent sputum. The cough is aggravated by lying down and is most productive in the morning. Associated findings commonly include exertional dyspnea, fatigue, malaise, weakness, and weight loss. Auscultation reveals coarse or moist crackles over the affected lung areas during inspiration. Digital clubbing is a late sign.
Common cold
A musty breath odor may accompany a common cold, which usually also causes a dry, hacking cough with sore throat, sneezing, nasal congestion with rhinorrhea, headache, malaise, fatigue, and aching joints and muscles.
Esophageal cancer
With esophageal cancer, halitosis may accompany classic findings of dysphagia, hoarseness, chest pain, and weight loss. Nocturnal regurgitation and cachexia are late signs.
Gastric cancer
Halitosis is a late sign of gastric cancer. Accompanying findings include chronic dyspepsia unrelieved by antacids, a vague feeling of fullness, nausea, anorexia, fatigue, pallor, weakness, altered bowel habits, weight loss, and muscle wasting. Hematemesis and melena are signs of associated gastric bleeding.
Gastrocolic fistula
With gastrocolic fistula, fecal vomiting is responsible for fecal breath odor, which is typically preceded by intermittent diarrhea.
Gingivitis
Characterized by red, edematous gums, gingivitis may also cause halitosis. The gingivae between the teeth become bulbous and bleed easily with slight trauma. Acute necrotizing ulcerative gingivitis also causes fetid breath, a bad taste in the mouth, and ulcers especially between the teeth that may become covered with a gray exudate. Severe ulceration may occur with fever, cervical adenopathy, headache, and malaise.
Hepatic encephalopathy
A characteristic late sign of hepatic encephalopathy is fetor hepaticus, a musty, sweet, or mousy (new-mown hay) breath odor. Major late effects also include coma, asterixis (flapping tremor), and hyperactive deep tendon reflexes.
Lung abscess
A lung abscess typically causes putrid halitosis, but its major sign is a productive cough with copious, purulent, often bloody sputum. Other findings include fever with chills, dyspnea, headache, anorexia, malaise, pleuritic chest pain, asymmetrical chest movement, weight loss, and temporary clubbing.
Ozena
Ozena a severe, chronic form of rhinitis causes a musty or fetid breath odor as well as thick, green mucus and progressive anosmia.
Periodontal disease
With periodontal disease, halitosis occurs with an unpleasant taste. Typically, the patients gums bleed spontaneously or with slight trauma and are marked by pus-filled pockets around the teeth. Related findings include facial pain, headache, and loose teeth covered by calculi and plaque.
Pharyngitis (gangrenous)
Halitosis is a chief sign of gangrenous pharyngitis. The patient also complains of a foul taste in the mouth, an extremely sore throat, and a choking sensation. Examination reveals a swollen, red, ulcerated pharynx, possibly with a grayish membrane. Fever and cervical lymphadenopathy are also common.
Sinusitis
Acute sinusitis causes a purulent nasal discharge that leads to halitosis. Besides a characteristic postnasal drip, the patient may exhibit nasal congestion, sore throat, cough, malaise, headache, facial pain and tenderness, and fever.
Chronic sinusitiscauses a continuous mucopurulent discharge that leads to a musty breath odor. Postnasal drip, nasal congestion, and a chronic, nonproductive cough may accompany the musty odor.
Other causes
Drugs
Drugs that can cause halitosis include triamterene, inhaled anesthetics, paraldehyde (which is excreted through the lungs), and any drugs known to cause metabolic acidosis such as nitroprusside.
Special considerations
If examination of the mouth and sinuses doesnt reveal the cause of halitosis, prepare the patient for upper GI and chest X-rays or endoscopy.
Pediatric pointers
In children, halitosis commonly results from physiologic causes, such as continual mouth breathing and thumb or blanket sucking. Phenylketonuria a metabolic disorder that affects infants may produce a musty or mousy breath odor.
Geriatric pointers
Extensive dental caries, mouth dryness, and poor oral hygiene can cause halitosis in elderly patients.
Patient counseling
To help control halitosis, encourage good oral hygiene. If halitosis is drug-induced, reassure the patient that it will disappear as soon as his body completely eliminates the drug.
has been derived from words from ancient languages. Hebraic literature (the Talmud) dating back over two thousand years ago states that a marriage license (the Ketuba) can be broken if one of the partners has breath malodor. Similar references can be found in the literature of the Greeks, Romans and early Christians.
Oral bacteria. Conditions which promote the growth of oral bacteria. Not cleaning, or not being able to clean, those areas where oral bacteria reside.
Later on our pages will describe in greater detail how bacteria cause mouth odors and outline methods for cleaning these bacteria away. Right now however, at this point in our discussion, just realize that anything that promotes the growth of oral bacterial will most likely heighten a person's problems with bad breath too.
As a contributing risk factor, the act of smoking does have a drying effect on oral tissues. Decreased moisture in the mouth limits the washing and buffering effect of saliva on oral bacteria and their waste products, thus aggravating a person's problems with bad breath. More information about breath problems associated with dry mouth conditions is discussed just below. It is also known that people who smoke are at greater risk for having problems with periodontal disease ("gum disease") than people who do not smoke. Gum disease, as it relates to bad breath, is discussed in more detail below.
Why is having a dry mouth (xerostomia) a risk factor for bad breath?
Even if you don't have much of a problem with bad breath you have probably noticed that your breath is least pleasant in the morning when you first wake up. This is because during the night a person's mouth dries up somewhat, due to the human body's natural tendency to reduce salivary flow when a person sleeps. This same souring effect is sometimes noticed by teachers, lawyers, and anyone else whose mouth has become dry after having to speak for a prolonged period of time. Additionally, people who breathe through their mouth, are fasting, or else are under stress can find that they have comparatively dry mouths and therefore persistent problems with breath odors. One explanation for this phenomenon is that the moisture found in our mouth helps to cleanse it. The presence of oral fluids encourages us to swallow. With each swallow we take we wash away bacteria, as well as the food and debris on which they feed. This same moisture also dilutes and washes away the waste products that oral bacteria produce. Additionally, saliva is a very special form of mouth moisture. It's the body's natural mouth rinse. Beyond the washing and diluting effect that any oral moisture can provide, saliva has the added benefit that it contains compounds that can kill bacteria and buffer their waste products. So, when our mouth becomes dry, all of the benefits provided by each source of oral moisture are minimized. The net result is that the conditions for bacterial growth are enhanced while the neutralization of bacterial waste products is reduced. Some people have chronically dry mouths. This condition is termed "xerostomia." Xerostomia can be a side effect of the medication a person is taking. Antihistamines (allergy and cold medications), antidepressants, blood pressure agents, diuretics, narcotics, or anti-anxiety medications are each known to produce xerostomia. Another contributing factor associated with xerostomia is a person's age. It is commonplace that as people age they find that chronic mouth dryness becomes more and more of a problem. With age our salivary glands tend to work less effectively and the composition of the saliva that they produce changes too. Both of these factors create a situation where the effects of salivary cleansing and buffering are reduced.
A factor that compounds the problems associated with mouth dryness is that people who suffer from xerostomia are more at risk for having periodontal disease ("gum disease"). As discussed in our next section, periodontal disease is a causative factor for bad breath.
, the odor coming from the mouth of a person with active gum disease can be so distinctive that a dentist will often correctly anticipate the presence of gum problems even before they begin their examination of the patient. Periodontal disease is the second most common (fundamental) cause of bad breath. Since periodontal disease is typically more of a problem for people over the age of 35 or so, the older we get the more likely that the source of our bad breath is related to conditions associated with the health of our gums. Periodontal disease is a bacterial infection located in the tissues that surround a person's teeth. Advanced forms of periodontal disease typically result in serious damage to the bone that holds teeth in place. As this bone damage occurs, deep spaces form between the teeth and gums (termed "periodontal pockets"). These pockets provide an ideal location for bacteria to live in. In many cases it is waste products coming from the bacteria that reside in these periodontal pockets, pockets which are often so deep that a person cannot effectively cleanse them, that is the cause of a person's bad breath. In addition, researchers have found that the amount of coating (as measured by weight) that is present on the tongues of people with periodontitis is greater than those in control groups. They have also found that the level of volitile sulfur compounds coming from this coating is four times greater than in people who do not have periodontal disease.
discharge and create their own smelly waste products thus adding to the problems the person is having with bad breath. As a compounding factor, people with sinus conditions will often have stuffed up noses and therefore will have a need to breathe through their mouth. The drying effect of mouth breathing can create an environment that promotes bad breath. Additionally, sinus sufferers are likely to be taking antihistamines, a type of medicine that is known to create mouth dryness.
While the most common cause of breath malodor is that caused by the accumulation of bacteria either on a person's tongue or on and around their teeth (periodontal disease), bacteria can and do accumulate on the surface of dentures and this can be the source of bad breath for some.
Skin
Fascia, Ligaments, Tendon Sheaths, Subcutaneous Tissue Arteries Arteriosclerosis Subacute bacterial Macroglobulinemia endocarditis Veins Thrombophlebitis Muscles Myositis Peripheral Multiple myeloma Nerves (Carpal Tunnel) Brachial Plexus Spinal Cord and Cervical Roots Bone Ischemic neuritis Myocardial infarction Bursitis Arthritis Pancoast tumor Pneumonia Tuberculosis Gonococcal arthritis Primary or Cervical metastatic tumors of spondylosis cord Syringomyelia Osteoarthritis
Carbuncle Ulcers Carcinoma Folliculitis Herpes zoster Felon Abscess Sarcoma Cellulitis Tendon sheath infection
Pictures
Book Title: Differential Diagnosis in Primary Care Author(s): R. Douglas Collins MD, FACP Year of Publication: 2007 Copyright Details: Differential Diagnosis in Primary Care, Copyright 2007 Lippincott Williams & Wilkins.
Curing bad breath: What approach do dentists take with their patients when treating halitosis?
Minimize the amount of food available to these bacteria. Minimize the total number of these bacteria that exist. Minimize the availability of the types of environments in which these bacteria prefer to live. Make any environment in which these bacteria do live less hospitable.
Minimize the food supply available to the bacteria that cause halitosis.
The volatile sulfur compounds that cause bad breath are actually waste byproducts created by anaerobic oral bacteria when they digest proteins. This would imply that those persons who maintain a vegetarian diet (a diet composed mostly of fruits and vegetables) should have fewer breath problems, as compared to people who have diets that are high in protein rich foods such as meat. It is important for a person to clean their mouth thoroughly after eating, and especially after eating foods that are high in protein content. This is because even after we have finished a meal minute particles of food still remain in our mouth. Much of this food debris ends up lodged between our teeth and incorporated into the coating found on the posterior part of our tongue. Since these are precisely the same locations in which the anaerobic bacteria that cause bad breath live, if a person does not clean their mouth thoroughly a food supply is provided for these bacteria over an extended period of time.
How cleaning your teeth and gums can help to cure bad breath.
Some of the oral bacteria that create the waste products that are responsible for causing bad breath live in the dental plaque that accumulates on and around a person's teeth, both at and below the gum
line. Thorough brushing and flossing technique is needed so to effectively remove this plaque and also any food debris that is left in the person's mouth after eating that could serve as a food supply by these bacteria. Take notice of the fact that we have used the term "brushing and flossing" here. It is not realistic to think that a mouth odor emanating from the areas around the teeth can be diminished unless flossing is an integral part of a person's daily cleaning routine.
reflex. Gagging is a natural reaction but with time the intensity of this reflex should diminish.
specifically designed as tongue scrapers. You will probably find that they are more effective at cleaning than your spoon is.
Halitosis treatments: Using mouthwashes and mouth rinses to get rid of bad breath.
[ Our brief overview of this subject. >> Effective treatments for bad breath. ]
Mouthwashes that contain chlorine dioxide, or its parent compound sodium chlorite, have been used in the treatment of bad breath. Research has suggested that chlorine dioxide's mechanism of action is twofold: Chlorine dioxide is an oxidizing agent (this means that it releases oxygen). Because most of the bacteria that cause bad breath are anaerobic (meaning, they prefer to live in environments devoid of oxygen), exposing them to an oxidizing agent can help to minimize their numbers.
Chlorine dioxide has the ability to neutralize volatile sulfur compounds. It also has the ability to degrade the precursor components utilized by bacteria use when making VSC's. The net effect is that the overall concentration of volatile sulfur compounds found in a person's breath is reduced, and as a result their breath will be more pleasant.
Research has suggested that mouthwash products that contain zinc ions can reduce the concentration of volatile sulfur compounds found in a person's breath. This action is presumed to be related to the fact that the zinc ions bind to the precursor compounds that anaerobic bacteria require to produce volatile sulfur compounds.
"Antiseptic" mouthwash (i.e., Listerine and its generic equivalents) has been suggested as suitable product for the treatment of bad breath. The effectiveness of this type of rinse is related to its ability to kill the anaerobic oral bacteria that produce volatile sulfur compounds. Antiseptic mouthwash has not been shown to have a neutralizing effect directly on the volatile sulfur compounds themselves. Some dentists feel that antiseptic type mouthwashes are not the best choice for treating bad breath. This criticism stems from the fact that these products often contain significant amounts of alcohol (on the order of 25%). Alcohol is a desiccant (a drying agent) and therefore can have the effect of drying out the tissues of the mouth. Our discussion about xerostomia explains how mouth dryness can aggravate a person's breath problems.
The compound cetylpyridinium chloride is often included in the formulation of mouthwashes. It has antibacterial properties and therefore can help to control the number of anaerobic bacteria that are found in a person's mouth.
Are breath mints, lozenges, drops, sprays, and chewing gum an effective treatment for bad breath?
Just like with mouthwashes, breath mints, lozenges, drops, sprays and chewing gum, on their own, are usually not an effective means by which to cure bad breath. However, when these products are used in conjunction with diligent tongue cleaning and tooth brushing and flossing they can be valuable adjuncts. Especially if they contain agents that have the ability to neutralize volatile sulfur compounds (such as chlorine dioxide, sodium chlorite, and zinc). As an added benefit, the use of mints, lozenges, and chewing gum stimulates the flow of saliva. As discussed previously, saliva has a cleansing and diluting effect on the bacteria and bacterial waste products that are found in a person's mouth, thus helping to minimize breath odor problems.
How to use mouthwash so to get the most benefit from its antibacterial properties.
The bacteria that cause bad breath live both on the surface and also deep within the dental plaque that accumulates on and around a person's teeth, gums and tongue. An antibacterial mouthwash will not have the ability to significantly penetrate into and through the plaque on its own. This means that the most effective use of a mouthwash will be after your brushing, flossing and tongue cleaning efforts have removed, or at least disrupted, the dental plaque. Rinsing after your cleaning routine allows the mouthwash to get at any of the free floating bacteria you have dislodged. It also allows the mouthwash to have an effect on those bacteria that, while not dislodged, have become exposed due to the disruption of their dental plaque colony. When you rinse with a mouthwash it is best that you gargle it. As you gargle, make an "aaahhh" sound. This will extend your tongue outward and allow the mouthwash to
contact a greater portion of the posterior portion of your tongue. This area is the precise region where the largest accumulation of bad breath producing bacteria typically reside. All mouth rinses should be spit out after gargling. Children should not be given mouthwash because of the possibility that they may swallow it.
4) Clean your mouth well, especially after eating foods that are high in protein content.
The bacterial waste products that cause of bad breath are created when oral anaerobic bacteria digest proteins. After you eat a meal or snack, especially one that is high in protein content, make sure that you clean your mouth promptly and thoroughly. Doing so will minimize both the time duration and amount of food that is available for the offending bacteria.
If our noses can't reliably help us judge the quality of our own breath, how can we determine if we do have bad breath? One solution is to ask the opinion of a spouse or significant other. If you don't feel you can ask them, ask your dentist or hygienist at your next dental appointment, after all, evaluating oral conditions is part of their job. If you find this type of question too personal to ask an adult, don't overlook asking a child. As we all know, sometimes the least inhibited and most honest responses come from children.
Symptoms: How can a person can test the quality of their own breath?
There are ways you can objectively smell your own breath. However, you have to take a slightly indirect route. Try this technique. Lick your wrist, wait about five seconds while the saliva dries somewhat, and then smell it. What do you think? That's the way you smell. Or, more precisely, that's the way the end of your tongue smells (your tongue's "anterior" portion). How was it? Did you pass this first check? Now try this second experiment. It will check the odor associated with the back portion of your tongue (your tongue's "posterior" aspect). Take a spoon, turn it upside down, and use it to scrape the very back portion of your tongue. (Don't be surprised if you find you have an active gag reflex.) Take a look at the material that has been scrapped off, usually it's a thick whitish material. Now, take a whiff of it. Not so bad? Pretty nasty? This smell, as opposed to the sampling from the anterior portion of your tongue, is probably the way your breath smells to others.
Just as your experimentation has suggested, for most people the fundamental cause of bad breath is the whitish coating that covers the surface of the posterior portion of their tongue. More accurately, bad breath is caused by the bacteria that live in this coating. (The second most common fundamental cause of bad breath is bacteria that accumulate elsewhere in a person's mouth.)
The remainder of the text on this page describes the various methods by which dental researchers attempt to quantify bad breath. If you're interested in this topic of course please read on, otherwise you may want to skip to our next page which continues on with our discussion about causes of halitosis.
Before a dental researcher can evaluate the effectiveness of a cure for bad breath they must first have a way to quantify the person's level of malodor, both initially and after the cure they are studying has been administered. Some of the different methods researchers use to measure bad breath are discussed below.
As for quantifying the organoleptic measurement itself, what exactly does constitute a weak, strong, or average level of bad breath? Will each judge participating in the research be able to make equivalent comparisons? Complicating things even more, as we all know, when we are repeatedly exposed to a bad odor our sense of smell acclimates to the odor and therefore loses much of its sensitivity. Breath malodor that seems exceedingly objectionable at the beginning of testing may seem quite less so as the evaluation continues.
Some of the bacteria that cause periodontal disease (gum disease) produce waste products that are quite odiferous and as a result contribute to a person's breath problems. The presence of some of these types of bacteria can be tested for by way of performing a BANA test. The bacteria in question have the characteristic of being able to produce an enzyme that degrades the compound benzoyl-D, L-arginine-naphthylamide (abbreviated BANA). When a sample of a patient's saliva that contains these bacteria is placed in with the BANA testing compound they cause it to break down, thus creating a color change in the testing medium.
next dental appointment, after all, evaluating oral conditions is part of their job. If you find this type of question too personal to ask an adult, don't overlook asking a child. As we all know, sometimes the least inhibited and most honest responses come from children.
Symptoms: How can a person can test the quality of their own breath?
There are ways you can objectively smell your own breath. However, you have to take a slightly indirect route. Try this technique. Lick your wrist, wait about five seconds while the saliva dries somewhat, and then smell it. What do you think? That's the way you smell. Or, more precisely, that's the way the end of your tongue smells (your tongue's "anterior" portion). How was it? Did you pass this first check? Now try this second experiment. It will check the odor associated with the back portion of your tongue (your tongue's "posterior" aspect). Take a spoon, turn it upside down, and use it to scrape the very back portion of your tongue. (Don't be surprised if you find you have an active gag reflex.) Take a look at the material that has been scrapped off, usually it's a thick whitish material. Now, take a whiff of it. Not so bad? Pretty nasty? This smell, as opposed to the sampling from the anterior portion of your tongue, is probably the way your breath smells to others.
Just as your experimentation has suggested, for most people the fundamental cause of bad breath is the whitish coating that covers the surface of the posterior portion of their tongue. More accurately, bad breath is caused by the bacteria that live in this coating. (The second most common fundamental cause of bad breath is bacteria that accumulate elsewhere in a person's mouth.)
The remainder of the text on this page describes the various methods by which dental researchers attempt to quantify bad breath. If you're interested in this topic of course please read on, otherwise you may want to skip to our next page which continues on with our discussion about causes of halitosis.
Before a dental researcher can evaluate the effectiveness of a cure for bad breath they must first have a way to quantify the person's level of malodor, both initially and after the cure they are studying has been administered. Some of the different methods researchers use to measure bad breath are discussed below.
As for quantifying the organoleptic measurement itself, what exactly does constitute a weak, strong, or average level of bad breath? Will each judge participating in the research be able to make equivalent comparisons? Complicating things even more, as we all know, when we are repeatedly exposed to a bad odor our sense of smell acclimates to the odor and therefore loses much of its sensitivity. Breath malodor that seems exceedingly objectionable at the beginning of testing may seem quite less so as the evaluation continues.
Some of the bacteria that cause periodontal disease (gum disease) produce waste products that are quite odiferous and as a result contribute to a person's breath problems. The presence of some of these types of bacteria can be tested for by way of performing a BANA test. The bacteria in question have the characteristic of being able to produce an enzyme that degrades the compound benzoyl-D, L-arginine-naphthylamide (abbreviated BANA). When a sample of a patient's saliva that contains these bacteria is placed in with the BANA testing compound they cause it to break down, thus creating a color change in the testing medium.