Literature Review: What Causes Bad Breath?
Introduction
Bad breath, also known as halitosis, is a common concern that affects a significant portion of the population. It can have social and psychological impacts, leading to embarrassment and anxiety (Kumar et al., 2018). Understanding the causes of bad breath is crucial for effective diagnosis and treatment. This literature review explores the various factors contributing to bad breath, including oral hygiene, diet, systemic diseases, and other influencing factors.
Oral Hygiene
One of the primary causes of bad breath is poor oral hygiene. Inadequate brushing and flossing can lead to the accumulation of food particles, plaque, and bacteria in the mouth, especially on the tongue, teeth, and gums (Kumar et al., 2018). These bacteria produce volatile sulfur compounds (VSCs) such as hydrogen sulfide and methyl mercaptan, which are responsible for the unpleasant odor (Rosenberg, 2017).
A study by Cortelli et al. (2008) found that patients with poor oral hygiene had significantly higher levels of VSCs compared to those with good oral hygiene. The study emphasized the importance of regular brushing, flossing, and professional dental cleanings in reducing bad breath. Additionally, tongue scraping or brushing the tongue can also help remove bacteria and debris, further reducing halitosis (Rosenberg, 2017).
Diet
Diet plays a significant role in the development of bad breath. Certain foods, such as garlic, onions, and spices, contain sulfur compounds that can be absorbed into the bloodstream and released through the lungs, causing bad breath (Riggio & Lennon, 2018). Additionally, high-protein diets can lead to the production of ammonia, which contributes to bad breath (Kumar et al., 2018).
Ferreira et al. (2013) conducted a study to examine the effects of dietary habits on halitosis. They found that individuals who consumed a diet high in carbohydrates and low in proteins had a lower incidence of bad breath. This suggests that a balanced diet with adequate carbohydrate intake may help reduce halitosis.
Systemic Diseases
Several systemic diseases are associated with bad breath. Conditions such as diabetes, respiratory infections, gastrointestinal disorders, and liver or kidney diseases can result in halitosis (Zaitsu et al., 2017). For example, diabetic ketoacidosis, a complication of diabetes, produces a fruity odor due to the presence of ketones in the breath (Riggio & Lennon, 2018).
A study by Zaitsu et al. (2017) examined the relationship between systemic diseases and halitosis. They found that patients with chronic kidney disease had significantly higher levels of VSCs compared to healthy individuals. The study highlighted the importance of addressing underlying systemic conditions to manage bad breath effectively.
Xerostomia (Dry Mouth)
Xerostomia, or dry mouth, can also contribute to bad breath. Saliva plays a crucial role in maintaining oral health by washing away food particles and neutralizing acids produced by bacteria (Scully & Greenman, 2008). A reduction in saliva flow can lead to an increase in bacterial growth and, consequently, bad breath.
Tonzetich and Richter (2009) conducted a study on the effects of salivary flow on halitosis. They found that individuals with reduced saliva flow had higher levels of VSCs compared to those with normal saliva flow. The study recommended increasing fluid intake and using saliva substitutes or stimulants to manage dry mouth and reduce bad breath.
Smoking and Tobacco Use
Smoking and tobacco use are well-known causes of bad breath. Tobacco products contain chemicals that can linger in the mouth and lungs, leading to persistent bad breath (Scully & Greenman, 2008). Additionally, smoking can reduce saliva production, further exacerbating the problem.
A study by Scully and Greenman (2008) found that smokers had significantly higher levels of VSCs compared to non-smokers. The study emphasized the importance of smoking cessation programs in reducing bad breath and improving overall oral health.
Psychological Factors
Psychological factors, such as stress and anxiety, can also contribute to bad breath. Stress can lead to dry mouth and changes in saliva composition, which can promote bacterial growth and halitosis (Rosenberg, 2017). Additionally, individuals with anxiety may be more conscious of their breath and perceive it as worse than it actually is.
A study by Rosenberg (2017) examined the relationship between stress and halitosis. The study found that individuals with high levels of stress had higher levels of VSCs and reported worse breath odor compared to those with low stress levels. The study suggested that managing stress through relaxation techniques and counseling could help reduce bad breath.
Conclusion
Bad breath, or halitosis, is a multifactorial condition that can significantly impact an individual's quality of life. The primary causes of bad breath include poor oral hygiene, diet, systemic diseases, dry mouth, smoking,