Bad breath, or halitosis, is a very real problem for millions of people around the globe. As a dental professional, you may be aware that a varying degree of halitosis is present at any one time in about half of the population, and up to 25 per cent regularly suffer from unpleasant smelling breath.
The lifestyle effects of halitosis are self-evident and can have a huge affect on the sufferer’s quality of life: disrupted or failed personal relationships and compromised professional prospects are common consequences. As a result, persistent halitosis at any level can have a devastating impact on the sufferer’s confidence and feeling of self worth.
Sensitivity to such a potentially embarrassing condition can also lead sufferers to change their everyday behaviour, withdrawing from potential social situations and living a more solitary lifestyle. In more extreme cases negative feelings of self worth can spark depression and bring about the need for psychiatric support.
This is where your dental skills come in - clinical statistics show that 90 per cent of halitosis is generated from within the oral cavity. Its diagnosis and tailored advice on prevention form a solution within the remit, and indeed the responsibility, of every dental professional.
The gases which are believed to cause ‘bad breath’ in 90 per cent of cases are known as ‘volatile sulphur compounds,’ or VSCs. These are predominantly created by the breakdown of food particles by the oral bacteria, specifically the gram negative, anaerobic bacteria which exist in the crypts at the back of the tongue or in periodontal pockets. In a healthy mouth the volume and concentration of VSCs are usually too low to cause a noticeable odour, but strong flavoured foods, smoking, poor oral hygiene, untreated tooth decay or abscesses, or an infection such as tonsillitis, can all increase bacterial activity and result in halitosis. If you have an interest in periodontics, you should also be aware that there is some evidence that VSCs may be a factor in the development of periodontal disease.
The three halitosis-causing VSCs are hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide ((CH3)2SH). Whilst all three must be eliminated for fresh breath, methyl mercaptan is the most potent, introducing a strong, noxious odour even when exhaled in very small quantities.
Traditional mouth rinse usually contains antibacterial and masking agents to reduce the numbers of bacteria and disguise the oral malodour, but the effects often don’t last too long. Tests have now shown that a combination of zinc acetate and chlorhexidine diacetate effectively convert the offensive sulphur content of the VSCs to odourless, insoluble sulphides in an action with much longer-lasting effects.
The ability of zinc, and some other metals, to inhibit the formation of VSCs has now long been known, as have the properties of chlorhexidine. Products such as CB12, which use this combination of compounds to neutralise VSCs, can even be used immediately after brushing – the SLS in toothpaste doesn’t affect the chlorhexidine’s effectiveness against oral malodour.
Bad breath is an emotive subject, and there will be occasions when a patient will not be aware they have the condition as friends, or even family members, may be reluctant to mention it. A simple personal check to suggest to the patient is to lick their wrist, and then test the smell of the saliva when it dries. Once halitosis is identified, it is important to assess how the patient really feels about it, and to what degree the condition has affected their life. It is then of course your responsibility as their dental care provider to offer suitable solutions to help combat the problem, enabling your patients to get their lives back on track.