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What Causes Bad Breath? A particular type of germ resides within the soft tissue at the back of the tongue, just below the surface. These germs, known clinically as “anaerobic bacteria,” flourish in environments with little or no oxygen. A thin layer of mucous coats the top surface of the tongue, and traps and accumulates dead tissue and food debris. The anaerobic germs that reside below the tongue’s surface metabolically break down this debris. The germs thrive and multiply in the oxygen-depleted environment under the mucous, and produce volatile sulfur compounds (VSCs). It is these noxious, gaseous sulfur compounds that are exhaled as bad breath.
I. Primary Cause of Bad Breath: Foods What you eat affects the air you exhale. The metabolisms of foods dense in sulfur compounds are the main cause of bad breath. Two such foods, garlic and onions, are packed with sulfur compounds, and well known to cause bad breath. The action of the bad breath germs in breaking down the sulfur proteins in garlic and onions release volatile sulfur compounds that cause bad breath. Other foods high in sulfur compounds include milk, cheese and other dairy products, fish, meats, and coffee. Acidic foods and citrus juices also have high sulfur content, which is converted by the bad breath germs into noxious gaseous volatile sulfur compounds, and exhaled as bad breath.
II. Second Cause of Bad Breath: Dry Mouth After foods, the second most prevalent cause of halitosis or bad breath is dry mouth. Dry mouth, clinically known as xerostomia, occurs when the flow of saliva decreases. Among its other metabolic functions, saliva, “nature’s mouthwash,” is critical in maintaining the health of the mouth by cleaning the tongue of food particles and other debris. Various medications, dieting, hormone imbalances, continuously breathing through the mouth, or various drying agents, reduce the amount of saliva in the mouth, causing dry mouth, which in turn indirectly causes bad breath. Drying agents include smoking, sugar, caffeinated beverages such as coffee, alcohol or sugar-based beverages, and alcohol-based mouthwashes.
III. Third Cause of Bad Breath: Medical Disorders Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract (nose throat, windpipe, lungs), chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, or gastrointestinal illness. Post-nasal drip also causes bad breath. Post-nasal drip is a thick mucus discharge resulting from allergies and colds. This mucous discharge collects on the back of the tongue, creating a protective blanket under which bacteria hide.
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Bad Breath: Clinical Causation Oral malodor, also known as halitosis or bad breath, results from the presence the presence of anaerobic bacteria, especially gram-negative anaerobic bacteria, in the mouth. These bacteria will generate volatile sulfur compounds (VSC), which are known to cause breath malodor.
Oral malodor not only comes from the posterior dorsal surface of the tongue but also from periodontal pockets. A person suffering from gingivitis or periodontal disease may have increased oral malodor from disintegrated epithelial cells. Epithelial cells regenerate faster if periodontal inflammation is present. Therefore, a larger number of these dead epithelial cells remain in the oral cavity and will degrade into malodorous volatile sulfur compounds. VSCs alter the epithelial barrier, permitting penetration of the barrier by antigenic substances. Thereafter, bacterial toxins, bacteria and virus can invade the underlying gingival tissue, thereafter invading the underlying connective tissue. A decrease in VSC will decrease the tissue permeability to oral toxins and bacteria. Systemic conditions and illness can contribute to oral malodor as well. These conditions include oral carcinomas, diabetes, liver and kidney abnormalities, medications that change the oral environment, ENT problems such as chronic sinusitis, and tonsillitis. Evaluation and diagnosis of oral malodor can be achieved with the Halimeter. The Halimeter is a gas-analysis sensor that measures the volatile sulfur compounds in breath.
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It is recognized three chemical compounds cause breath malodor. Specifically, these compounds are hydrogen sulfide (H--S--H), methyl mercaptan (CH.sub.3 --S--H) and dimethyl sulfide (CH.sub.2 --S--CH.sub.3). These compounds result from the degradation of epithelial cells and bacteria in the oral cavity. Specifically, the polypeptide chains of the epithelial cell walls are composed of a series of amino acids including cysteine and methionine, which contain sulfur side chains. The death of microorganisms or epithelial cells results in degradation of the polypeptide chains into their amino acid components, especially cysteine and methionine. Cysteine and methionine are precursors to the formation of volatile sulfur compounds (VSC).