What is Halitosis?

Those who suffer from halitosis or have a fear of the condition (halitophobia) can be affected significantly both on a personal level, as a result of low self esteem or self confidence, or on a social level due to fear of interacting with others. Halitosis is actually the 3rd most common reason people seek dental aid or treatment, behind tooth decay and periodontal or gum disease.

In almost all cases, halitosis originates in the mouth. Bad breath varies during the day due to changes in the level of moisture in the mouth. Other factors that affect mouth dryness include stress, fasting, eating strong foods like garlic and onions and even fish, meat and cheese. Many people don’t realize, but smoking and drinking caffeine and alcohol can also lead to bad breath.

Typically we all wake up with “morning breath” because the mouth is dry and inactive overnight. Breathing through the mouth also worsens halitosis. Almost one fourth of the general population has chronic or persistent halitosis. These individuals are often the ones who are significantly negatively impacted in their business, personal and social relationships on a daily basis. The most common reason for chronic or persistent halitosis is a high level of metabolic activity of certain bacteria in the mouth and gums.

As mentioned, most halitosis originates in the mouth when proteins, processed by oral bacteria, create these unpleasant odors. Of the more than 600 bacteria in the average mouth, several dozen are capable of producing very strong odors when grown in a lab setting.

Within the mouth, the tongue is the most common source for mouth halitosis. High concentrations of naturally occurring bacteria are found at the back of the tongue. This area in the mouth is undisturbed during everyday normal activity. It also is not as moist and often poorly cleaned or brushed, which allows bacteria to thrive on microscopic food remnants, dead skin cells and postnasal drip. This is an ideal habitat for anaerobic bacteria, which does not require oxygen to grow. Anaerobic respiration (fermentation) can result in some very strong and unpleasant smelling odors.

Odors are produced most often by the breakdown of proteins into individual amino acids followed by further breakdown of certain amino acids into foul gases. Other parts of the mouth such as “niches” in the gums, food impacted between teeth, abscesses, poor dental work and dentures also contribute to overall halitosis, but not as much as the back area of the tongue.

Halitosis may originate in from other areas of the body other than the mouth. It’s unclear about the role of gum disease in causing halitosis, but bacteria growing below the gum line often have a strong odor upon removal. The nose is the second major source for halitosis. Odor exiting from the nostrils differs from odors originating orally. Nasal odor is typically caused by sinus infections or foreign bodies.

Decomposition of the tonsils can also be a source of halitosis, although it is generally considered a minor source. An estimated small percentage does experience small bits of calcified material that often accumulates in the pockets of their tonsils. These small bits smell extremely foul when removed but they do not necessarily cause bad breath.

Some believe that bad breath originates in the stomach and not the mouth. However, most researchers consider the stomach as a very unlikely source for bad breath; however, belching is a different story. Typically the esophagus is a closed flat tube and a simple release of gas or foul smelling air, as is the case in a burp is typically no concern nor is it considered bad breath. A prolonged release of odor of fluid from the stomach however could be an indication of reflux or other serious conditions and should be checked.

There are also systemic or non-oral conditions that may cause halitosis but they are typically infrequent. Such conditions include carcinomas, kidney infections, respiratory infections, Diabetes and liver failure.