Brushing techniques ! How to brush your teeth properly. Recommended by dentist

 Halitosis is an oral health problem where the main symptom is bad smelling breath. In most cases, finding the cause of the bad breath is the first step toward treating this preventable condition

Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. Halitosis is not infectious. About 2.4% of the adult population suffers from bad breath.

Causes of halitosis

Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:

• Dental factors – such as periodontitis (infection around the teeth) or poor oral hygiene
• Dry mouth – caused by medicines, alcohol, stress or a medical condition
• Smoking – which starves the mouth of oxygen.
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The features of halitosis can include:

• A white coating on the tongue especially at the back of the tongue
• Dry mouth
• Build up around teeth
• Post-nasal drip, or mucous
• Morning bad breath and a burning tongue
• Thick saliva and a constant need to clear your throat
• Constant sour, bitter metallic taste.

Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.

Diagnosis

Your dentist likely will smell the breath from your mouth and the breath from your nose and rate the odor on a scale. Because the back of the tongue most often causes the smell, your dentist also may scrape it and rate its odor.

Some devices also can detect certain chemicals that cause bad breath. But these tools aren't always available.

Treatment

To reduce bad breath, help avoid cavities and lower your risk of gum disease, regularly keep your mouth and teeth clean. Further treatment for bad breath can vary. If your dentist thinks another health condition is causing your bad breath, you likely will need to see your primary healthcare professional or a specialist.

Your dentist will work with you to help you better control bad breath caused by mouth issues. Dental measures may include:

• Mouth rinses and toothpastes. If your bad breath is due to a buildup of bacteria called plaque on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Your dentist also may recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup.
• Treatment of dental disease. If you have gum disease, your dentist may suggest that you see a gum specialist, known as a periodontist. Gum disease can cause gums to pull away from your teeth, leaving deep pockets that fill with odor-causing bacteria. Sometimes only professional cleaning removes these bacteria. Your dentist also might recommend replacing faulty fillings, a breeding ground for bacteria.

Lifestyle and home remedies

To reduce or prevent bad breath:

• Brush your teeth after you eat. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath.
• Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath.
• Brush your tongue. Your tongue collects bacteria, so carefully brushing it may reduce odors. A tongue scraper may help people who have a coated tongue from a major overgrowth of bacteria, such as from smoking or dry mouth. Or use a toothbrush that has a built-in tongue cleaner.
• Clean bridges, dentures, retainers and mouth guards. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product.
• Keep your mouth moist. Stay away from tobacco and drink plenty of water. Don't take in too much caffeine, spicy food or alcohol. All can dry out your mouth. Chew gum or suck on candy, preferably sugarless, to make more saliva. For constant dry mouth, your healthcare professional may prescribe an artificial saliva preparation or a medicine that you take by mouth that raises the flow of saliva.
• Change your diet. Stay away from foods such as onions and garlic that can cause bad breath. Eating a lot of sugary foods also is linked with bad breath.
• Replace your toothbrush. Change your toothbrush when it becomes frayed, about every 3 to 4 months or sooner as needed. Also, choose a soft-bristled toothbrush.
• Schedule regular dental checkups. See your dentist regularly — generally twice a year. During these checkups, your dentist can look at your teeth or dentures and clean them.
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Pathology

Etiology

It is thought to be caused by the presence of volatile sulfur compounds that are produced by bacteria. The underlying cause is most commonly poor dental hygiene, however a range of non-dental etiologies are less commonly responsible, including respiratory tract infection, liver failure, and renal disease, as well as the presence of a pharyngeal pouch.

A rare form of fetor oris is fecal oris, the odor of feces on the breath, most commonly seen with a gastrocolic fistula 2.

Practical points

Halitosis does not require imaging on its own but imaging may be undertaken if there are other symptoms which raise the suspicion of an underlying cause other than bacterial overgrowth. This is usually in the form of a barium swallow or other fluoroscopic investigation.