Bad Breath

BAD BREATH

Bad breath usually originates in the mouth itself due to putrification. It rarely comes form the GI tract; so don’t send patients with bad breath to a GI doctor. A study in Belgium showed that 86% of bad breath was due to the oral cavity, 5% ENT, 3% tonsils, unknown 5%, so a very small proportion is due to all the diseases that can happen in your body.

Bacteria are the cause of most bad smells, like that dirty dishrag, fecal matter, bad breath, and body odor. The bacteria break down meat and tissue in the mouth and some of the gases that are released are the same as in shit. Potential sites for bad breath bacteria are the back of the tongue, dental plaque, under bridges, around crowns, and abscesses.

The back of the tongue is a good site because there is a high level of microorganisms, it is poorly cleaned by saliva, and , there is post-nasal drip that lands there which is yummy for bacteria to eat. Tongue brushing reduces bad breath by 68-77%.

The odor is worse when the mouth is dry and bad breath decreases right after eating something. Mouth breathing, fasting, medications, prolonged talking, insufficient fluids, and stress all cause mouth dryness, therefore they all cause bad breath.

When someone comes in with bad breath make sure they bring along someone because a lot of people have an irrational fear of having bad breath that just isn’t true. Tell them to come back in 2-3 hours and not to put anything in their mouths during this time. Take a history from them and compare nasal and oral odors. Do a spoon test – take a spoon and scoop at the back of the tongue and see if any green or yellow stuff comes on the spoon, this is post-nasal drip.

People come into the doctor complaining that they have little stones that drop onto their mouths and they smell really bad when squeezed. Most doctors don’t know what it is. All it is plaque falling from the tonsils, it is nothing to worry about and it does not cause bad breath. Now you will know what it is and you won’t scare your patients.

How do you alleviate bad breath? Dental care and oral hygiene, including flossing at night, drinking lots of water, chewing gum if the mouth is dry, deep gentle tongue cleaning with a plastic cleaner, stay away from coffee, gargle with mouthwash before bedtime, eat breakfast.

Category: Microbiology Notes