Bad Breath - Diagnosis & Therapy

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Bad Breath - Diagnosis & Therapy
Bad Breath - Diagnosis & Therapy
Video: Bad Breath - Diagnosis & Therapy
Video: What Causes Bad Breath? 2023, February

Bad breath

Bad breath (halitosis, foetor ex ore) is unpleasant, but mostly harmless. Once the causes of bad breath have been found, it can usually be treated well. Contrary to popular belief, bad breath usually does not arise in the gastrointestinal area, but in about 90 percent of cases in the oral cavity itself. The first point of contact is usually the dentist. Basically, bad breath can be diagnosed by smelling (organoleptically) or instrumentally (e.g. using a Halimeter). Treatment is based on the underlying cause. Most often the goal is to get rid of odor-causing bacteria in the mouth.


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  • What types of bad breath are there?
  • What are the causes of bad breath?
  • How is the diagnosis made?
  • How is bad breath treated?
  • What can I do myself?
  • Whom can I ask?
  • How are the costs going to be covered?

What types of bad breath are there?

The term bad breath is actually an umbrella term. In medicine, two forms of bad breath are distinguished:

  • Foetor ex ore: bad odor when exhaling through the mouth. The cause here is usually within the oral cavity.
  • Halitosis: foul odor when exhaling through the nose (with your mouth closed). The cause is usually in the ENT area (less often in the gastrointestinal tract).

Note In the case of bad breath, we are not talking about temporary bad breath, such as after eating onions, garlic etc., but rather bad breath that can be perceived over a longer period of time.

What are the causes of bad breath?

According to the Halitosis Working Group of the German Society for Dentistry, Oral and Maxillofacial Medicine (DGZMK), the cause of bad breath is in the oral cavity in 85 to 90 percent of all cases. Only in rare cases is it in the nasopharynx - even more rarely, a serious illness (e.g. gastrointestinal disease) is the trigger.

The most common cause of bad breath is bacterial coating on the tongue. The bacteria (approx. 880 to 1000 different species; partly still unknown) that cause the bad breath find ideal living conditions in the niches of the oral cavity and in the recesses of the rough tongue. Here they break down protein from saliva or from leftover food and other organic material. This releases volatile sulfur compounds (VSC) that mix with the air you breathe. This creates the unpleasant smell.

Note Decomposition is a normal process that does not necessarily have to lead to bad breath, because odor-causing bacteria are present in every oral cavity. The decisive factor for whether or not bad breath occurs is the amount alone. As long as there is a bacterial balance in the oropharynx, there will be no bad breath. A weakened immune system also increases the number of odor-causing bacteria.

Causes of a bacterial imbalance in the oral cavity can include

  • Poor oral hygiene,
  • Tongue coating,
  • Inflammation of the gums (gingivitis)
  • Inflammation of the periodontitis (periodontitis),
  • Caries,
  • badly fitting dentures,
  • unkempt prostheses,
  • Interdental spaces where food particles can collect,
  • Abscesses in the mouth.

Other causes

Dry mouth (xerostomia): A dry mouth due to reduced salivation also has a positive effect on the development of bad breath. Sufficient saliva is important for a healthy oral flora and ensures that leftovers are flushed out of the mouth. A reduced flow of saliva promotes bacterial colonization and can lead to bad breath.

Factors that lead to dry mouth include:

  • Snoring,
  • Smoking ("Smokers Breath"),
  • Alcohol,
  • insufficient fluid intake,
  • Mouth breathing,
  • Use of certain drugs (e.g. some antihypertensive drugs, sedatives and sleeping pills, drugs for Parkinson's disease and epilepsy, antidepressants).

The stale breath in the morning is also explained by the fact that less saliva is produced during the night and the mouth dries out more.

Causes in the ENT area or gastrointestinal tract can include:

  • Acute and especially chronic tonsillitis (tonsillitis),
  • Large tonsils (which hold back food particles),
  • Certain infectious diseases,
  • Inflammation of the sinuses (sinusitis)
  • Lung diseases (e.g. pneumonia, purulent bronchitis),
  • Heartburn (reflux)
  • Inflammation of the gullet (esophagitis)
  • Inflammation of the stomach lining (gastritis) caused by Helicobacter pylori
  • Gastric ulcer (ulcus ventriculi),
  • low-carbohydrate and high-calorie diets (ketone or acetone breath),
  • very rare: malignant tumor.

Note Possible general diseases such as diabetes, kidney diseases or liver diseases can also cause bad breath.

How is the diagnosis made?

Since bad breath is oral in most cases, the first point of contact is the dentist. During the dental exam, the oral cavity is examined carefully to find out the cause of the bad breath. The oral hygiene is assessed, the saliva flow rate is measured, the teeth are examined for caries, the tongue plaque and the gums are checked, etc.

During the organoleptic assessment, the breath is examined. The patient breathes on the doctor. In this way, the strength of the odor can be assessed at a defined distance from the odor source. The professional organoleptic measurement is carried out either using a (at least) five-point scale with the same distance between patient and doctor or depending on the distance to the patient.

Degrees of severity

  • Grade 1: odor noticeable only at a distance of ten centimeters
  • Grade 2: odor only perceptible at a distance of 30 cm
  • Grade 3: odor noticeable at a distance of one meter

Note The organoleptic assessment is the simplest method to determine bad breath. The disadvantage of this method is that it is difficult to reproduce because it can be influenced by subjective parameters (e.g. sense of smell).

Precise statements about the strength of the bad breath can be made by measurements, for example with the Halimeter. This measuring device measures the concentration of sulfur compounds in the breath. In this method, the patient blows air into a mouthpiece that is attached to the measuring device. This determines how strongly the breath is permeated with sulfur compounds. If a certain limit is exceeded, one speaks of bad breath.

If the examinations actually confirm the presence of bad breath, the cause of the bad breath must be determined. Since bad breath occurs in the oral cavity in over 90 percent of cases, the dentist will carefully inspect the oral cavity.

Further investigations

If there are indications of a disease in the head and neck area, further clarification by an ENT doctor is required. If the cause of the bad breath cannot be determined either in the mouth or in the ENT area, an internal clarification makes sense. The following further examinations may be necessary. These include, for example:

  • Blood test,
  • imaging tests such as (gastroscopy) or x-rays of the esophagus and stomach.

How is bad breath treated?

Treatment for bad breath depends on the underlying cause.

Cause in the oral cavity

The aim is to remove odor-causing bacteria in the mouth. The patient's cooperation plays a decisive role in the success of the treatment. After the treatment, regular check-ups (every three to six months) should be carried out by the dentist.

Note Professional oral hygiene with appropriate oral hygiene training at home is the most important measure against bad breath.

Cause: reduced salivation

A dry mouth from decreased salivation can cause bad breath. Possible causes include alcohol consumption, smoking, stress, insufficient fluid intake or constant breathing through the mouth (mouth breathing). But medication can also reduce the flow of saliva. Here the patient can counteract bad breath himself.

Cause: tooth defects

Tooth decay, leaky fillings or crown margins are often a cause of bad breath. These can be remedied by the dentist. Poorly cared for removable dentures must also be cleaned and possibly relined again.

Cause: Defective teeth Caries, leaky tooth fillings or crown margins are often a cause of bad breath. These can be remedied by the dentist. Badly cared for removable dentures must also be cleaned and possibly relined.

Cause: coating on the tongue

Professional tongue cleaning helps to remove the "bacterial felt" on the tongue. This is especially the case if gingivitis or periodontal disease has been identified.

Tip Tongue cleaning can and should also be carried out daily at home.

What can I do myself?

There are simple preventive measures to ensure that odor-causing bacteria cannot even develop in the mouth. These include:

  • daily brushing of teeth,
  • fluoridated toothpastes,
  • special odor-binding toothpastes,
  • Tongue cleaner,
  • Dental floss or interdental brushes,
  • AirFloss devices,
  • Mouthwashes with antibacterial and / or active substances that neutralize the sulfur compounds,
  • bioactive natural products (e.g. chlorophyll chewable tablets),
  • regular visits to the dentist,
  • adequate hydration.

Whom can I ask?

The first port of call for bad breath is the dentist.

  • You can find dentists in your area under Dentist search.
  • You can find dental clinics in your area under Search for dental clinics.

Note Some dental practices offer special bad breath consultation hours.

If the causes of the bad breath are not in the oral cavity, you can contact the following doctors:

  • General Practitioner,
  • Specialist in ear, nose and throat medicine,
  • Specialist in internal medicine.

How are the costs going to be covered?

Professional tooth cleaning: Oral hygiene is one of the own services (= services to be borne by the insured person), as it is not the subject of the contractual regulations concluded by the health insurance carriers with the service providers. This is why this benefit has not yet been covered by social security. However, some health insurance providers have been granting different grants for some time. In addition, the health insurance funds for children and adolescents (between the ages of 10 and 18) have been covering the costs of professional oral hygiene once a year since July 2018 (twice a year with fixed orthodontics at the same time). Inquire about this directly with the health insurance provider responsible for you.

The cost of professional oral hygiene depends on the time it takes. Inquire directly with your dentist. Some dental practices also have a so-called Halimeter. This instrument is used for professional examination by the doctor.

Note There are also handy and sufficiently reliable devices for self-use at home or on the go, in order to test the success of daily oral hygiene measures yourself. The costs for this are to be borne by yourself.

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