Understanding and controlling halitosis in the 21st century – Arifa Sultana

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  Posted by: Dental Design      16th May 2019

Halitosis, fetor oris, oral malodour and bad breath are all terms used to describe an unpleasant odour emanating from a person’s mouth. It is a problem that has plagued humanity for thousands of years and is referred to in some of the earliest Egyptian, Greek and Chinese medical writings.[1]Throughout history remedies have been suggested to address halitosis including herbal recipes comprising of myrrh and honey or juniper seeds, root of cypress and rosemary leaves. The Romans attempted to hide halitosis with perfumed

tablets or by chewing leaves and the stalks of plants. The Greek physician, Hippocrates, advocated a concoction of red wine, dill seeds and spices. Ancient Chinese emperors insisted that their visitors chewed cloves before gatherings and in early Islamic literature, the use of “siwak” (a wood containingsodium bicarbonate and tannic acid)was advised to address morning breath.[2]

Although a socially sensitive subject, it appears that halitosis has been a noteworthy source of concern for centuries, and yet it remains an extremely common condition. Indeed, oral malodour affects approximately fifty per cent of the general population to some degree[3]and it is believed that around one in four people have halitosis on a regular basis.

The stigma and embarrassment associated with unpleasant breath casts a negative influence on quality of life. Sufferers can experience distress and anxiety to such an extent that they may change their behaviour, perhaps covering their mouth when they speak and avoiding certain activities including interacting with other people. Patients that have unpleasant breath may be isolated in social or professional situations and for some individuals, the psychological effect causes such a decline in self-confidence and self-worth that there is potential for more severe psychological problems to develop as a result.[4]Equally, patients that worry or suspect that they may have offensive smelling breath can have concerns that may affect social and personal interaction. Nevertheless, with education from dental professionals it is possible to improve patient understanding and enable them to develop a sense of control over this troublesome problem.

Most patients understand that unpleasant smelling breath can occur for a multitude of reasons including poor dental habits, eating strongly flavoured foods, crash diets, smoking and heavy alcohol consumption. However, various systemic conditions and certain medications as well as disorders of the nasal cavity, upper respiratory or gastrointestinal tracts can also cause malodorous breath.[5]That said, in ninety per cent of cases, halitosis originates in the oral cavity and is often the result of poor oral hygiene, food impaction, unclean dentures, faulty restorations, periodontal disease, certain types of oral canceror throatinfections.[6]Nevertheless, a healthy mouth can still create odorous gases as despite a plausible scientific explanation, some individuals appear to produce more anaerobic bacteria than others.

Essentially, halitosis occurs when anaerobic bacteria breakdown protein rich substrates. These may be food debris, exfoliated cells, blood or saliva components that are left between teeth and gums or on the surface or dorsum region of the tongue.As microbial putrefaction takes placeamino acids are converted into foul smelling volatile sulphur compounds (VSCs) such as methyl mercaptan (CH3SH), hydrogen sulphide (H2S) and dimethyl sulphide ((CH3)2S), which are then expelled in the breath.[7]

Consequently, patients that have or suspect that they may have malodorous breath should consistently practice a good oral hygiene routine to prevent bacterial accumulation. Research reveals that tooth brushing alone cannot improve oral malodour but by adding effective interdental cleaning, tongue cleaning and the use of a mouthwash to the oral hygiene routine, VSC levels can be reduced.[8]However, it is important to recommend a clinically proven mouthwash such as CB12 as many other rinses may simply contain masking agents to disguise oral malodour and only have a temporary effect. CB12 oral health products contain low concentrations of zinc acetate and chlorhexidine diacetate, a combination that has shown extraordinary efficacy in converting the offensive sulphur content of VSCs to odourless, insoluble sulphides and offering long lasting effects.[9]  Furthermore, CB12 mouthwash enhances the oral hygiene routine with anti-plaque agents and fluoride to prevent cavities and strengthen the teeth.

Naturally, some patients may try sucking on mints, chewing parsley, fennel or cinnamon sticks in an attempt to disguise or improve the odour of their breath. Yet, one cannot help thinking that these so-called ‘remedies’ echo of the peculiar ideas that our ancestors had in the past. After all, following centuries of research, progress in scientific knowledge and education, dental professionals can now offer reliable oral health instructions and confidently recommend products that enable patients to control and prevent oral malodour much more effectively.


For more information about CB12 and how it could benefit your patients, please visit www.cb12.co.uk


[1]Eggert, F. M. Bad breath is an ancient concern, University of Alberta Bad Breath Research Clinic, 2004  http://www.ualberta.ca/~feggert/BREATH_2.HTM.[Accessed 19th March 2019]

[2]Elias MS, Ferriani MGC. Historical and social aspects of halitosis. Rev Latino-am Enfermagem 2006 setembrooutubro; 14(5):821-3. http://www.scielo.br/pdf/rlae/v14n5/v14n5a26.pdf[20th March 2019]

[3]Bahadir Uğur Aylikci, Hakan Çolak. Halitosis: From diagnosis to management. J Nat Sci Biol Med. 2013 Jan-Jun; 4 (1): 14-23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633265/[Accessed 20thMarch 2019]

[4]Eli, I., Baht, R., Koriat, H. and Rosenberg, M. (2001)‘Self-perception of breath odor’, Journal of the American Dental Association, 132(5), pp621-626.http://www.ncbi.nlm.nih.gov/pubmed/11367966[Accessed 20thMarch 2019]

[5]Attia E.L, Marshall K.G. Halitosis. Review Article. CMA Journal. June 1982 Vol. 126 1281-1285. https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC1863329&blobtype=pdf[Accessed 20thMarch 2019]

[6]Spielman A.l, Bivona P, Rifkin B.R. Halitosis. A common problem. NY State Dent J 1996 Dec;62(10):36-42. http://www.ncbi.nlm.nih.gov/pubmed/9002736[Accessed 20thMarch 2019]

[7]Porter, S.R. and Scully, C.  ‘Oral malodour (halitosis)’, British Medical Journal, Sept 2006 333(7569), 632-635. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570844/[Accessed 20thMarch 2019]

[8]Aung E.E, Ueno M, Zaitsu T. Furukawa S. and Kawaguchi Y. Effectiveness of three oral hygiene regimens on oral malodour reduction. Trials: 2015; 16:31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324034/[Accessed 20thMarch 2019]

[9]Thrane P.S, Young A, Jonski G, Rölla G. A new mouthrinse combining zinc and chlorhexidine in low concentrations provides superior efficacy against halitosis compared to existing formulations: a double-blind clinical study. J Clin Dent. 2007;18(3):82-6. https://www.ncbi.nlm.nih.gov/pubmed/17913002[Accessed 20thMarch 2019]





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