Bad breath may indicate an underlying illness

Halitosis, according to Dr Collin Wandera, a dentist at Harry Medicare in Kampala, is a reasonably common condition affecting about 20 percent of the population. Dr Wandera says in every 10 patients, at list one or two are diagnosed with halitosis.  The good news is, halitosis is curable.   

The main symptom of halitosis is foul-smelling breath that does not go away. Other symptoms include a thick white coating on the tongue, especially at the back of the tongue, plaque buildup on the teeth, pungent morning breath, thick saliva, a constant need to clear your throat and a constant sour metallic taste on the tongue.  

Causes 
Halitosis is usually caused by poor oral hygiene. However, according to Dr Wandera, in many cases, it is a symptom of an underlying problem. Finding the root cause of halitosis is the first step in treating the problem. 

The causes of bad breath can be categorised into two groups; oral cavity related causes and underlying health condition causes. The most common cause of bad breath is poor oral hygiene.         
“When you do not take the time to brush and clean your teeth, the whitish-yellowish sticky film called plaque (food residue) builds up on your tongue, teeth and as it ferments and decays, it starts to smell, causing bad breath,” Dr Wandera says. 

Over time, if not removed by brushing, plaque will eventually calcify (stick and harden onto your teeth). This is as result of a chemical reaction between plaque and saliva.     

“When the plaque calcifies, it becomes stone hard that not even a toothbrush cannot remove it.  To remove it, you might have to go to a dentist, for scaling and polishing. If you have seen people with seemingly yellow teeth, it is hardened plaque on the teeth in most cases, which has piled up over the years. The plaque usually builds up, around the front lower teeth, which is the incisors and the first molars around the cheeks.”    

Dry mouth 
“The mouth has normal good bacteria but saliva washes some of it away throughout the day. So, if you are not producing enough saliva to keep the mouth moist, your mouth will get a bad odour, the reason most people wake up with bad breath in the morning, ” Dr Wandera says. 

Some medications such as antiretroviral drugs can also cause dry mouth. People with several tooth cavities are also predisposed to halitosis, since the food particles pile up in the cavities and decay, causing a bad adour. 

People with dentures are also more susceptible to having bad breath if, according to Dr Wandera, they do not keep the dentures clean. It is also not good to go to bed wearing dentures.   

Gum disease can also predispose a person to bad breath. According to clevelandclinic.org, gingivitis is a common gum disease which causes inflammation of the gums, redness, swelling and bleeding of the gums.

Untreated gingivitis can lead to periodontitis, which damages gum tissue and can lead to tooth and bone loss around your teeth. Gingivitis is caused by plaque on the teeth, and can be prevented through effective brushing and flossing.  

Underlying health conditions
People with ulcers, are also predisposed to having bad breathe. This, according Doctor Franklin Wasswa, a general doctor at Entebbe Hospital, is because of the ulcer causing bacteria in the stomach called Helicobacter pylori. (H pylori). 

Another health condition that leads to halitosis according to Dr Wasswa, is gastroesophageal reflux disease (GERD), a digestive disorder in which stomach acid or fluid leaks back into your esophagus, the tube that takes food from your mouth to your stomach. Diabetes can also cause halitosis.  According to my.clevelandclinic.org, other causes of halitosis include infections in the nose, throat or lungs and pneumonia, which will sometimes cause one to cough up liquid that smells bad.   

Treatment

Treatment for halitosis is dependent on the cause. For example, if the cause is poor oral hygiene, a cleaning at the dentists and improved oral hygiene at home will help. Good oral hygiene, according to Dr Wandera, involves brushing your teeth at list twice a day; after breakfast and before you go to bed. Flossing using dental floss and going for dental checkups every once in a while, is also recommended. 

Dr Wandera also puts emphasis on brushing the tongue since it collects food particles that will cause bad adour when they decay. To clean in between teeth, use interdental brushes and floss. Dr Wandera also recommends using mouth wash, but cautions against using it often, since it kills good bacteria in the mouth.   
If the halitosis, is a symptom of a systemic health condition in the mouth or elsewhere in the body, then your doctor can help you with proper diagnosis and treatment. 

Brushing properly

Use a soft-bristled toothbrush. Be sure its size and shape allow you to reach all areas of your mouth. When brushing, make sure you get to the outside, inside and top of each tooth. Do not press down hard on your brush since aggressive brushing or using a hard-bristle brush could cause gum recession. You are also advised to replace your toothbrush at least every three or four months.