Halitosis

What is halitosis?

Halitosis, commonly known as chronic bad breath, is a condition marked by a persistent, and unpleasant odour emanating from the mouth. While often associated with dental hygiene, it can also result from underlying conditions requiring medical treatment. These include digestive disorders, systemic illnesses, and structural abnormalities in the upper gastrointestinal or respiratory tracts.

This condition can significantly impact one’s quality of life, causing social discomfort, anxiety, and diminished self-esteem When it is left untreated, halitosis can strain personal relationships, erode confidence, and affect overall well-being. This is because unlike temporary bad breath caused by certain foods or poor oral hygiene, halitosis is often a recurring or persistent issue that necessitates medical intervention to address its root causes.

What causes halitosis?

Halitosis can be caused by a range of factors, many of which extend beyond oral health concerns. These include:

• Gastrointestinal disorders –  conditions such as gastro-oesophageal reflux (GERD) or a Pharyngeal pouch can lead to bad breath. Additionally, acid reflux, which refers to stomach contents travelling upwards, can result in a sour or foul odour.

• Respiratory infections – chronic sinusitis, post-nasal drip, tonsillitis or infections in the throat can similarly produce foul odour. Other than that, the accumulation of bacteria, and mucus can also contribute to unpleasant breath.

• Systemic conditions – medical conditions such as diabetes, kidney failure, liver dysfunction or disease, and diabetes can result in foul breath. This is because these diseases release distinctive odorous compounds into the bloodstream, which can then be exhaled.

• Lifestyle factors –  smoking introduces chemicals that linger in the mouth, and throat. Meanwhile, dehydration or a diet high in protein or sugar can create conditions where odour-producing bacteria thrive.

• Medications – some medications reduce saliva production, leading to dry mouth, which is a known contributor to halitosis.

What are the symptoms of halitosis?

Halitosis may present itself in various ways, often depending on the underlying cause. These include:

• Persistent, and unpleasant breath
• A metallic or bitter taste in the mouth
• Chronic sore throat
• Difficulty swallowing
• Dry mouth or excessive thirst
• Mucus buildup
• Thick saliva

Who is at risk of halitosis?

Although halitosis can affect anyone, there are certain groups of people who are more susceptible to developing halitosis. This is particularly due to lifestyle, health, and environmental factors, such as:

• Age – as people age, the production of saliva naturally decreases. This leads to dry mouth, which is a common trigger for halitosis. As a matter of fact, older adults are also more likely to have systemic health conditions that contribute to bad breath.

• Chronic illness – people who are diagnosed with conditions such as diabetes, chronic kidney disease or liver dysfunction, often experience halitosis. However, this group of people often experiences halitosis as a symptom of an underlying medical condition, resulting from the accumulation of specific odour-causing compounds in the body.

• Frequent antibiotic users – the overuse of antibiotics can disrupt the natural balance of bacteria in the mouth, and gut. This will inherently promote the growth of odour-producing microorganisms.

• People with GERD – acid reflux causes regurgitation of stomach contents, which can lead to chronic bad breath.

• Smoking – smoking not only leaves a strong odour in the mouth, but also reduces saliva production. As a result, it increases the risk of gum diseases, which exacerbate halitosis.

How is halitosis diagnosed?

Diagnosing halitosis involves a comprehensive assessment to identify its root cause, and guide appropriate treatment. Here at Alpine Surgical Practice, a consultation generally involves the following:

During the initial consultation, the following assessments are typically conducted:

• Medical history review – the general surgeon will assess any existing underlying conditions or medications that could contribute to halitosis.

• Examination of the upper digestive, and respiratory tracts – a thorough evaluation of the throat, sinuses, and oesophagus helps the general surgeon to identify potential structural abnormalities or infections.

Additionally, the general surgeon may recommend further diagnostic tests, such as:

• Blood tests – blood tests are conducted to rule out systemic conditions such as diabetes or liver, and kidney disorders that might cause halitosis.

• Imaging studies – X-rays, Computerised Tomography (CT) scans or Live fluoroscopy studies can help detect abnormalities in the upper gastrointestinal or respiratory tracts.

• Microbial testing – swabs or cultures from the throat, tonsils or nasal passages may be taken to identify infections or bacterial imbalances.

What are the treatment options for halitosis in Singapore?

When it comes to treating halitosis, the treatment option depends on the underlying causes. In fact, it may involve a combination of lifestyle changes, medical therapies, and in some cases, surgical intervention. At Alpine Surgical Practice, Dr Aaron Poh adopts a holistic approach to managing this condition. This includes:

Conservative Treatments

Mild to moderate cases of halitosis can often be managed with non-invasive methods, including:

• Dietary changes – reducing the consumption of odour-causing food, such as garlic, and staying hydrated can further promote saliva production.
• Medications – our general surgeon may prescribe antibiotics or antifungal medications to fight infections in the throat or sinuses, which may contribute to halitosis.
• Proper oral hygiene – incorporating tongue cleaning, regular tooth brushing, and using antiseptic mouthwash can help treat halitosis.

Targeted Medical Treatments

When halitosis is caused by systemic or structural issues, more specific treatments may be necessary:

• Management of gastrointestinal issues – conditions such as GERD may require medications to reduce acid reflux. Our general surgeon may also recommend lifestyle, and dietary changes to minimise the symptoms.
• Therapeutic interventions – for dry mouth-induced halitosis, saliva substitutes or medications can help stimulate saliva production.
• Treatment for infections – addressing chronic sinusitis or tonsilitis with antibiotics, decongestants can help alleviate halitosis.

Surgical Treatments

For more complex cases, surgical intervention may be required. Typically, this treatment route is recommended to address structural abnormalities or persistent infections, including:

• Endoscopic sinus surgery – an endoscopic sinus surgery is often required to clear blocked sinuses, and promote drainage, simultaneously reducing odour-causing infections.
• Correction of structural abnormalities – certain procedures such as anti-reflux surgery/ fundoplication may be performed to treat severe GERD, which contributes to halitosis.

Conclusion

If halitosis has been affecting your confidence or quality of life, then it is time to seek professional help. Chronic bad breath is not always a dental issue as it can be a sign of underlying health conditions that require medical attention. As such, consulting a general surgeon ensures a thorough evaluation, and tailored treatment to address the root cause effectively.

So, do not let halitosis hold you back. Schedule an appointment with our esteemed doctors at Alpine Surgical Practice today. Doing so ensures you are taking the first step towards fresher breath, and better health.

Frequently asked questions

Is halitosis painful?
Halitosis itself does not cause pain, but it can sometimes indicate underlying conditions like throat infections or ulcers, which may be uncomfortable or painful. For that reason, addressing the root cause often resolves these associated symptoms.

How common is halitosis?
Halitosis is surprisingly common, affecting up to 30% of the population at some point. If you are experiencing chronic bad breath, know that you are not alone, and help is available.

Can halitosis be prevented?
Yes, many cases of halitosis can be prevented with simple, proactive steps. Staying hydrated, eating a balanced diet, avoiding smoking, and addressing health concerns promptly can go a long way in maintaining fresh breath.

Can halitosis go away on its own?
Sometimes, halitosis is caused by temporary factors, like eating certain foods or dehydration, which resolves on its own. However, persistent halitosis typically requires medical attention to address the underlying cause.

Can halitosis be a sign of a more serious medical condition?
Yes, chronic bad breath can sometimes indicate more serious issues, such as diabetes, liver disease, or gastrointestinal cancers. If halitosis persists despite good oral hygiene, seeking professional advice is essential.

How can I tell if I have foul breath?
A simple way to check is by cupping your hands over your mouth and nose, exhaling, and smelling your breath. Alternatively, licking the back of your hand, letting it dry, and sniffing can also give an indication. A trusted friend or colleague or family member often offers the most accurate feedback.

Can I still have halitosis despite practising good oral hygiene?
Yes, even with excellent oral hygiene, halitosis can occur due to non-dental causes like sinus infections, digestive issues, or systemic conditions. As such, consulting a specialist can help identify, and manage these underlying problems.

What does follow-up care for halitosis treatment entail?
Follow-up care is personalised to ensure long-term success. It may involve regular check-ups, symptom monitoring, and adjusting treatment plans to address any recurring or new concerns. This collaborative approach helps maintain fresh breath, and overall health.