So fresh, so clean – the truth behind halitosis

halitosis Arifa Sultana uncovers the truth behind halitosis and explains how to control the issue in the 21st century.

Halitosis, fetor oris, oral malodour and bad breath are all terms used to describe an unpleasant odour emanating from a person’s mouth.

It is a problem that has plagued humanity for thousands of years. Some of the earliest Egyptian, Greek and Chinese medical writings refer to it (Eggert, 2004).

Throughout history, remedies have been suggested to address halitosis. These include herbal recipes comprising myrrh and honey or juniper seeds, root of cypress and rosemary leaves. The Romans attempted to hide halitosis with perfumed tablets or by chewing leaves and the stalks of plants.

The Greek physician Hippocrates advocated a concoction of red wine, dill seeds and spices. Ancient Chinese emperors insisted that their visitors chewed cloves before gatherings. In early Islamic literature, the use of ‘siwak’ (a wood containing sodium bicarbonate and tannic acid) was advised to address morning breath (Elias, Ferriani, 2006).

Although a socially sensitive subject, it appears that halitosis has been a noteworthy source of concern for centuries. Yet, it remains an extremely common condition.

Indeed, oral malodour affects approximately 50% of the general population to some degree (Aylıkcı, Colak, 2013). Around one in four people have halitosis on a regular basis.

Social stigma

The stigma and embarrassment associated with unpleasant breath casts a negative influence on quality of life. Sufferers can experience distress and anxiety to such an extent that they may change their behaviour. They may cover their mouth when they speak and avoid certain activities including interacting with other people.

Patients with unpleasant breath may feel isolated in social or professional situations. For some individuals, the psychological effect causes such a decline in self-confidence and self-worth that there is potential for more severe psychological problems to develop as a result (Eli et al, 2001).

Equally, patients that worry or suspect that they may have offensive smelling breath can have concerns that may affect social and personal interaction. Nevertheless, with education from dental professionals, it is possible to improve patient understanding. They can enable them to develop a sense of control over this troublesome problem.

Causes and control

Most patients understand that unpleasant smelling breath can occur for a multitude of reasons. These include poor dental habits, eating strongly flavoured foods, crash diets, smoking and heavy alcohol consumption. However, various systemic conditions and certain medications as well as disorders of the nasal cavity, upper respiratory or gastrointestinal tracts can also cause malodorous breath (Attia, Marshall, 1982).

That said, in 90% of cases, halitosis originates in the oral cavity. It is often the result of poor oral hygiene, food impaction, unclean dentures, faulty restorations and periodontal disease. Also, certain types of oral cancer or throat infections (Spielman, Bivona, Rifkin, 1996).

Nevertheless, a healthy mouth can still create odorous gases. Despite a plausible scientific explanation, some individuals appear to produce more anaerobic bacteria than others.

Essentially, halitosis occurs when anaerobic bacteria breakdown protein rich substrates. For example: food debris, exfoliated cells, blood or saliva components left between teeth and gums or on the surface or dorsum region of the tongue.

As microbial putrefaction takes place, amino acids are converted into foul smelling volatile sulphur compounds (VSCs) such as methyl mercaptan (CH3SH), hydrogen sulphide (H2S) and dimethyl sulphide ((CH3)2S), which are then expelled in the breath (Porter and Scully, 2006).

Consequently, patients that have – or suspect that they may have – malodorous breath should consistently practise a good oral hygiene routine. This will prevent bacterial accumulation.


Research reveals that toothbrushing alone cannot improve oral malodour. However, adding effective interdental cleaning, tongue cleaning and the use of a mouthwash to the oral hygiene routine, reduces VSC levels (Aung et al, 2015).

However, it is important to recommend a clinically-proven mouthwash. Many rinses may simply contain masking agents to disguise oral malodour and only have a temporary effect.

CB12 oral health products contain low concentrations of zinc acetate and chlorhexidine diacetate, a combination that has shown extraordinary efficacy in converting the offensive sulphur content of VSCs to odourless, insoluble sulphides and offering long lasting effects (Thrane et al, 2007). Furthermore, CB12 mouthwash enhances the oral hygiene routine with anti-plaque agents and fluoride to prevent cavities and strengthen the teeth.

Naturally, some patients may try sucking on mints, chewing parsley, fennel or cinnamon sticks in an attempt to disguise or improve the odour of their breath. Yet, one cannot help thinking that these so-called ‘remedies’ echo of the peculiar ideas that our ancestors had in the past.

After all, following centuries of research, and progress in scientific knowledge and education, dental professionals can now offer reliable oral health instructions and confidently recommend products that enable patients to control and prevent oral malodour much more effectively.

For the article references, please email [email protected].

This article first appeared in Oral Health magazine. You can read the latest issue here.

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