Bad breath

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Classification according to ICD-10
R19.6 Bad breath
ICD-10 online (WHO version 2019)

Bad breath or foetor ex ore (also called halitosis , from Latin halitus : breath, breath; also ozostomy , and cacostomy ) is an unpleasant odor of the breath or the exhaled air.

terminology

The synonymous use of the technical terms halitosis and foetor ex ore is - strictly speaking - incorrect. Foetor ex ore is an unpleasant, atypical odor ( stench ) when you exhale through the mouth. One assumes an intraoral cause here. The term halitosis also describes unpleasant exhaled air, which can also be perceived when the mouth is closed, i.e. when exhaling through the nose. This may indicate an extraoral cause (tonsils, sinuses, upper respiratory tract, stomach).

Pathophysiology

Linus Pauling (1901–1994) found at least 200 different volatile , mostly organic compounds in human halitosis by gas chromatography , which mix with the exhaled breath. About 3000 different volatile compounds have now been identified using this method.

The normal exhaled air of humans contains about 78% nitrogen , 17% oxygen , 4% carbon dioxide and only about 1% other gases. However, this one percent can contain highly odor-active volatile compounds, so that despite the low volume fraction, the odor of the exhaled air is perceived as unpleasant or even unbearable. These include sulfur compounds such as hydrogen sulfide (H 2 S), methane thiol ( methyl mercaptan ) and dimethyl sulfide, as well as amines , diamines and other nitrogen compounds such as 1,5-diaminopentane , indole and skatole , ketones such as acetone (propanone) and short-chain carboxylic acids ( propionic acid , butyric acid ). These substances arise z. B. by bacterial decomposition (mostly anaerobic gram-negative bacteria) of organic substances from food residues, saliva or dead tissue material (flaked epithelial cells ).

causes

Oral, extraoral or systemic causes can be considered as triggers for bad breath.

Oral causes

Local causes in the oral cavity are present in 85–90% of cases . Most bacteria are present on the back of the tongue , in combination with tongue coating, and thus by far the most common cause of halitosis, particularly pronounced in the lingua plicata and the black hairy tongue . Other causes are, in descending order: marginal periodontitis , open caries , poor oral hygiene , local infections ( candidiasis , dentitio difficilis , gingivitis , peri-implantitis ) and unkempt removable dentures .

Rare intraoral causes can be necrotizing ulcerative gingivitis (NUG), acute herpetic gingivostomatitis , pemphigus vulgaris or pemphigoid , Behçet's disease , erythema exudativum multiforme , abscesses , glossitis rhombica mediana and ulcerating and disintegrating tumors.

Other causes are:

Extraoral causes

  • The most common extraoral causes of halitosis are found in the ENT area. They make up about 5–8% of all causes. Of those are tonsillitis (about 2/3) and sinusitis (about 1/5) the most common causes.
  • Diphtheria , an infection of the upper respiratory tract, often causes a putrid, sweet odor in the air.
  • Bronchiectasis , pulmonary gangrene

Systemic causes

The gastrointestinal tract is irrelevant as a possible cause of bad breath - viewed as a percentage (<0.1%).

diagnosis

Bad breath patients often cannot perceive the smell of their own breath, as the sense of smell only responds to changes in the concentration of a fragrance. Small breathing measuring devices, with which supposedly the sulfur content of the exhaled air can be determined, promise remedy.

Biomarkers

Volatile substances in the breath can act as biomarkers to indicate the presence of diseases, e.g. B. keto bodies for diabetes mellitus . Some odorous substances give specific indications of tumor diseases . Since the medical nose is often not sensitive enough to perceive it, specially trained dogs or chemosensors can be used to detect them. However, the use of such sniffing methods is limited, because volatile substances also occur in the environment, often even in higher concentrations, the production of volatile substances varies greatly from person to person, and they usually only arise as secondary metabolites and are therefore less specific. Other methods are often more precise and economical. The following are currently considered useful diagnostic areas of application for breath testing:

Halitophobia

A significant proportion of patients who fear they have bad breath think so wrongly. This fear of bad breath (one's own) is known as halitophobia .

therapy

  • The focus is on dental rehabilitation, which may consist of the therapy of carious defects, gum treatment, professional teeth cleaning and professional tongue cleaning .
  • Afterwards, if the halitosis persists, a daily tongue cleaning is announced despite conscientious oral hygiene (teeth cleaning). Place the tongue cleaner with the outer ring at the rear end of the tongue and pull it forward with light pressure. The dorsal (rear) limitation is the highest point when the tongue is stuck out ("top of the hill"). Do not clean further dorsally as the risk of injury increases considerably. The tongue coating is then rinsed off under running water. Repeat this about 3–4 times. Use after brushing your teeth. The first time you clean your tongue, you should start carefully so as not to trigger a gag reflex. But even this measure only has a success rate of about 60%, as the odor-forming substances are often located in the furrows and pits of the tongue, which cannot be removed even with a tongue cleaner. In addition, special tongue cleaning pastes should be used, supported by mouth rinses.
  • Mouthwashes
    • with sage , thyme, marigold flower tea, mallow, special oral care solutions or antibiotic solution (eg. as metronidazole).
    • with xylitol powder; starves harmful Streptococcus mutans bacteria and establishes a healthy oral flora that prevents bad breath.
    • with chlorophyll or sucking chlorophyll dragees.
    • Deodorant and antibacterial mouthwash solutions ( cetylpyridinium chloride (CPC), chlorhexidine , (reliably kills bacteria in the mouth)).
    • A combination of zinc and chlorhexidine in low concentrations appears to be the most efficient way to remove volatile sulfur compounds (VSC ), which are largely responsible for bad breath.
  • If necessary, therapy for the underlying disease
  • Drink often, especially black tea , the polyphenols it contains , especially the flavonoid theaflavin, impede the growth of plaque bacteria .

Often those affected tend to cover up the smell through constant consumption of peppermints , chewing gum , mouth sprays or menthol pastilles or the use of cosmetic mouthwashes. Such blind or blanket therapies are usually unsuccessful.

Probiotic germs are increasingly used. The bacteria used are either Streptococcus salivarius K12 or Lactobacillus salivarius WB21, which are administered using lozenges that the patient lets melt on the tongue. Overall, it could be shown that compared to placebo lozenges the sum of the volatile sulfur compounds could be reduced significantly more frequently, that the bacterial composition in the oral cavity actually changed and that the applied bacteria suppressed the growth of halitosis-associated bacteria.

Delusions of self-odor are summarized under the term olfactory reference syndrome or as self-odor hallucinosis . A patient with real bad breath usually does not perceive the actual odor present; the halitophobic, however, clearly smells the non-existent odor according to his own statements. In the everyday life of the halitophobic, everything revolves around the delusion of smelling unbearable from the mouth. Such patients have often gone through a doctor-hopping session because they are convinced that their problem is organic, not psychological. In the case of halitophobia, however, psychotherapeutic intervention is called for, and these patients are very difficult to motivate.

Cultural history

Bad breath has serious consequences in Greek mythology , known as the Lemnian outrage : Because Aphrodite saw her sanctuaries on Lemnos neglected, she punished all women on the island with foul-smelling breath. As a result, their husbands stayed away and instead enjoyed themselves with Thracian slaves. The jealous wives then killed all the male residents of the island in one night. Thoas alone was hidden by his daughter Hypsipyle and survived.

Each year in the United States on August 6, National Fresh Breath Day ( English National Day of fresh breath celebrated).

literature

  • Louis ZG Touyz: Oral malador - a review. In: J Can Dent Assoc. Volume 59, 1993, pp. 607-610.
  • Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition ibid 1986, ISBN 3-13-352410-0 , p. 42 f. ( Smell of breath ).

Web links

Wiktionary: Bad breath  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ L. Pauling , AB Robinson, R. Teranishi, P. Cary: Quantitative analysis of urine vapor and breath by gas-liquid partition chromatography. In: Proc Natl Acad Sci US A. Vol. 68, 1971, pp. 2374-2376. doi: 10.1073 / pnas.68.10.2374 .
  2. ↑ Wolfgang Legrum: Fragrances, between stink and fragrance , Vieweg + Teubner Verlag (2011) pp. 61–63, ISBN 978-3-8348-1245-2 .
  3. ^ A b S. Goldberg, A. Kozlovsky, M. Rosenberg: Association of diamines with oral malodor . In: Bad breath. A multidisciplinary approach . Ed .: D. Van Steenberghe, M. Rosenberg; Ramot Leuven, 1996.
  4. ^ S. Goldberg, A. Kozlovsky, D. Gordon, I. Gelernter, A. Sinov, M. Rosenberg: Cadaverine as a putative component of oral malodor. In: J. Dent. Res. Vol. 73, 1168 (1994).
  5. ↑ I. Kleinberg, M. Codpilly: The biological basis of oral malodour formation . In: Bad breath. Research perspectives . Ed .: M. Rosenberg; Ramot Tel Aviv, 1995, pp. 13-39.
  6. ↑ G. Delanghe, J. Ghyselen, L. Feenstra, D. van Steenberghe: Experiences of a Belgian Multidisciplinary Breath Odor Clinic . In: Bad breath. A multidisciplinary approach . Ed .: D. Van Steenberghe, M. Rosenberg; Ramot Leuven, 1996, pp. 199-209.
  7. ↑ Andreas Filippi, Zungenreinigung , Quintessenz, 2011; 62 (9): 1195–1199. Retrieved October 5, 2019.
  8. ↑ a b c Beate Augustyn, Martina Kern: Nursing measures in symptom treatment. In: Eberhard Aulbert, Friedemann Nauck, Lukas Radbruch (eds.): Textbook of palliative medicine. Schattauer, Stuttgart (1997) 3rd, updated edition 2012, ISBN 978-3-7945-2666-6 , pp. 948-958; here: p. 950.
  9. ^ Franz Rost: Pathological physiology of the surgeon (experimental surgery). Springer-Verlag, 1925 and 2013, ISBN 978-3-642-99097-7 , p. 244 ( limited preview in the Google book search).
  10. ↑ Jae Kwak, George Preti: Volatile disease biomarkers in breath: a critique. In: Current Pharmaceutical Biotechnology , Vol. 12, No. 7, 2011, pp. 1067-1074. doi: 10.2174 / 138920111795909050 .
  11. ↑ a b Andreas Filippi, Halitosis , Quintessenz Verlag, limited preview. Retrieved October 6, 2019.
  12. ^ Sugar against caries ( Memento from November 27, 2011 in the Internet Archive ) Radio Bremen TV Buten and Binnen Magazin.
  13. ↑ PS Thrane, A. Young et al. a .: A new mouthrinse combining zinc and chlorhexidine in low concentrations provides superior efficacy against halitosis compared to existing formulations: a double-blind clinical study. In: The Journal of clinical dentistry. Volume 18, Number 3, 2007, pp. 82-86, PMID 17913002 .
  14. ↑ Tea against bad breath. In: Wissenschaft.de. May 21, 2003, accessed September 8, 2019 .
  15. ↑ Delia Nagel, Christina Lutz, Andreas Filippi, Halitophobie - the underestimated clinical picture , Schweiz Monatsschr Zahnmed, Vol 116: 1/2006, pp. 57–60. Retrieved October 8, 2019.