Halitosis (halitosis)

• If more than one person feels odor in the mouth of the other person at any time of the day without the need for close contact,
• If this situation has been going on for several months, it means that the person has a halitosis problem.
• The cause of bad breath is that anaerobic bacteria break down saliva and food proteins to produce amino acids suitable for them, as a result of which they release volatile sulfur compounds (volatile acid) containing hydrogen sulfide and methanetinol.

The main volatile sulfur compounds causing halitosis are;

• Hydrogen sulfide (H2S),
• Methyl mercaptan (CH3S4)
• It is dimethyl sulfide (C2H6S)
• These compounds; They are released into the environment as a result of the breakdown of amino acids such as cysteine ​​and methionine.
• Diamines (indole and skatole) or polyamines (cadaverine and putrescine) are of secondary importance in halitosis.
• When hydrogen sulfide and methyl mercaptan penetrate the mucosa, it makes the mucosa more permeable to some ions and molecules.
• It damages cell structure, collagen integrity, cell metabolism and DNA synthesis.
• Studies have shown 70% lower collagen in tissues exposed to HS.
• In other words, the patient with halitosis may have periodontal disease or skin deterioration in the long term.

Physiological Bad Breath

• Physiological bad breath occurs as soon as you wake up in the morning and goes away when you eat.
• It is not pathological and does not require treatment.
• Hunger breath contains less than 10 ppm of hydrogen and methane.
• Levels greater than 20 ppm indicate excessive bacterial growth.
• Bad odor occurs as a result of putrefaction in the oral cavity.
• Saliva flow decreases during sleep,
• As a result of the drying of the tongue and mouth, which is washed less with saliva during the night, the proliferation of bacteria in the mouth increases with the growth of bacteria on the back of the tongue and in the mouth with heat.
• Gases formed by the activities of intestinal bacteria formed during the night also accumulate in the mouth.
• High levels of Ca+ and Mg+ in the serum in the morning cause bad breath.
• 2-3 days after the release of the luteinizing hormone in the menstrual cycle, there may be an increase in breath odor due to the increase in acetone level in the breath and urine.

Bad breath originating from the oral cavity

• It is caused by deposits on the tongue.
• Bacteria that settle in the deep pits of the crypts break down proteins from saliva and food into volatile sulfur compounds.
• These gases are called volatile sulfur compounds.
• Infective foci in the mouth, necrotic channels, ulcerated gums, under-bridge deposits provide bacteria to the back of the tongue.
• Bacteria themselves do not smell,
• Therefore, the treatment of bad breath is not only periodontal or endodontic treatment.
• Dry mouth is the cause of bad breath.
• Since some of the VSB (volatile sulfur compounds) is soluble in water, it is retained in the saliva, very little of it is added to the mouth air.
• However, in a dry mouth, most of the VSB enters the air of the mouth and causes bad breath.

Bad breath originating from the back of the tongue

• It mostly comes from the back of the tongue, but the source of the bacteria is not inside the mouth.
• In this type, VSB gases take their source from the digestive tract.
• When the digestive enzymes or organs cannot digest the nutrients properly, it means that the food is left to the bacteria to rot.
• It is because the foods that cannot be digested by the enzymes in the stomach and intestines cause putrefaction by the bacteria.
• Here, it is not the bacteria that comes into the mouth, but only the smell.
• Gases released in the digestive tract rise to the mouth without burping without the will and knowledge of the individual.
• Fats are broken down by the lipase enzyme and proteins are converted into polypeptides and peptides by the protease enzyme.
• If there is no healthy flora, the efficiency of enzymes is impaired and metabolic disorder leaves food residues that cannot be digested.
• Bacteria decarboxylate proteins in an anaerobic environment.
• This degradation process is called putrification.
• Released are VSB and malodorous fatty acids.
• These people experience gas complaints or reflux called meteorismus.
• Gastric and intestinal gases leak into the mouth continuously throughout the day, causing bad breath.

breath odor

• It comes from the lungs, not bad breath.
• It occurs in two ways:

1- If there is an infection in the lung parenchyma or the lower respiratory tract (sinusitis, chronic nasal airway obstructions, chronic tonsillitis, throat infections, tumors related to the upper respiratory tract, respiratory tract tumors, bronchiectasis), the unpleasant smelling gases released from here are directly mixed with the expiratory air.

2-It is the conversion of blood gases whose chemistry changes into aromatic compounds in expiratory air.

Ketone odor in diabetics, changes in blood gas profile and concentration, odors caused by lower respiratory tract pathologies.

• It is essential to take a good anamnesis in order to distinguish breath odor from bad breath.
• The swamp odor emitted by the breath indicates a major problem in the synthesis of prostaglandins in the body and a serious inflammation.

Psychological Bad Breath

• They think your mouth stinks.
• In fact, there is no measurable pathological odor in the mouth.

EFFECT OF NUTRITION ON HALITOSIS

• The pH of saliva is the most important factor affecting the formation of halitosis.
• While acidic pH reduces the occurrence of halitosis, neutral or alkaline environment increases it.
• Fermentable carbohydrates allow the environment to undergo an acidic change.
• The sugar associated with starch, salivary glycoproteins, and mucins make the environment acidic.
• Acidic foods reduce bad breath. Basic foods increase odor.
• The second major factor affecting pH is nitrogenous components.
• Nitrogenous components cause the environment to become alkaline.
• Amino acids originating from proteins and peptides, free amino acids and urea are the most important nitrogenous components.
• All foods containing sulphurous amino acids, alcohols and short-chain proteins cause bad breath more easily than others.
• For example: A boiled egg is a rich source of sulfur amino acids.
• At the same time, protein and amino acid pills cause bad breath.
• It is written in the package insert of drugs such as Carnitene, Carnipure, AminoBurst3000, L-Carnitine that the breath can smell like fish.
• While the ideal pH should be 6.5 to prevent bad breath, odor may occur at this pH.
• The glucose and carbohydrates that are free in saliva are in contact with glycoproteins, increasing these protein components and causing an increase in odor in the ideal pH environment.
• In other words, while glucose and carbohydrates, which make saliva acidic, should prevent odor formation in theory, in practice they increase alkalosis and bad breath caused by protein and peptides.
• A person who eats a lot of meat has more halitosis than a vegetarian.
• Meat usually contains fat, and volatile fatty acids formed in the gastrointestinal tract are absorbed into the blood and exhaled (cadaverine).
• Carbohydrate malabsorption smells sweet, protein malabsorption smells like rotten eggs.
• Those who do not take any carbohydrates have a fruity smell due to ketosis, and those who eat too much meat have a smell of ammonia.
• Vitamin A and B12 deficiency and Zn deficiency can also cause halitosis.

Other Factors Causing Halitosis

• Candidiasis: In Candida infections, they cause odors similar to the smell of spoiled sweet and rotten fruit.
• Parasites: Some parasites and their larvae pass through the lungs and cause infection. Parasitoses increase the amount of gas in the intestine. In a study conducted in the USA, the rate of parasitic infestation in children with halitosis was found to be 19%.
• Malignant: In tumoral lesions in any part of the body, bad breath occurs as a result of the expulsion of volatile gases due to the necrotic process with breath air.
• Constipation: It is one of the most common causes of bad breath.
• Sweeteners in chewing gums and mouthwashes: When aspartame is broken down by bacteria, it turns into methanol, a foul-smelling gas. Methanol also turns into formic acid, which is also foul-smelling, over formic acid.
• Digestive disorder: If there is a problem in protein digestion, one of the toxins that comes out is cadaverine. This indicates that the clostridia population is increasing.