Oral hygiene and fresh breath are associated to be healthy. Over time poor dental care will cause mouth odour. The foods we eat may contribute to bad breath. However, bad breath may be a symptom of a health condition also or a side effect of some medications. Most people aren't aware of the fact that over 50% of the bacteria found in the human mouth contributes to bad breath. Every year on August 6, the world celebrates Fresh Breath Day. This day is observed to educate and spread awareness on factors that cause bad breath. We will also know about the other factors that ensure good oral dental hygiene along with the fresh breath. We at Medicircle are conducting a series on the National Fresh Breath Day, where we are trying to create awareness about oral hygiene amongst the general public. 

Dr Rathika Rai was a former principal and HoD of a dental college in Chennai. She was a clinical head and consultant with Apolo. She has done her MDS in Prosthodontics from AB Shetty Memorial Institute of Dental Sciences, Mangalore. A goal she achieved during her tenure in dental college was that it remained the only college in the city to have full admission in BDS and MDS along with a ranking of 27th in the National Institution Ranking framework in the country.

Explaining Halitosis or bad breath

Dr Rai says, “Halitosis is a multifactorial and common disease which makes it an apt thing to be discussed on Fresh Breath Day. This is a very common condition that is present in the majority of our population. It seems a very simple oral condition, but it causes a lot of embarrassment and distress and also creates low self-esteem amongst patients. This odour that emanates from the body may be due to oral or external causes.

There are different types of halitosis or bad breath. We can classify them as genuine halitosis or pseudo halitosis. As the name suggests pseudo means false, here the patient does not have halitosis but he/she thinks that they have bad breath. So he has a phobia about his bad breath. In this condition, they do not require any major dental procedures. The only requirement is reaffirming the oral hygiene procedures which the patient has already been following while giving reassurance and confidence to the patient that everything is fine with him.

On the other hand, we have genuine halitosis. This again can be of two varieties. One is physiologic halitosis, wherein the body itself emanates a bad odour, which again is a normal process. The other one is pathological halitosis wherein there is some kind of problem within which is generating the bad odour. Sometimes, when you get up early in the morning you would have bad breath. That is mainly because during the nighttime there is salivary secretion which reduces and kind of activates the bad bacteria in the oral cavity. The bad bacteria is what generates bad breath.

Sometimes even the food we eat can emanate a pungent odour, especially when you eat onions and garlic. Even smoking and alcohol at times tend to give rise to bad breath. These are very transient kinds of halitosis, which can be handled with simple measures like regular brushing and a proper mouthwash. Maybe if required, you can visit a dentist, but halitosis will disappear after a period of time.”

She explains pathological halitosis by saying, “This halitosis occurs because of some inherent condition in the oral cavity. The primary cause of this is poor oral hygiene. Poor oral hygiene is improper brushing, improper maintenance of your teeth. What happens when you eat food is that the food forms a very thin layer around the teeth. This is called a plaque. It is a kind of biofilm.

This biofilm actually harbours a lot of microorganisms. So when you're brushing, you're basically eliminating the biofilm thus eliminating microorganisms. Failure to do proper brushing will cause accumulation of this plaque, which over a period of time will form a calcified layer called calculus or the tartar. This calculus will then start affecting the gums.

If unattended it will start infecting your underlying supporting structures. This infection we call periodontitis. The collection of microorganisms start developing into a bad odour. Eliminating this will require aggressive treatments.”

Adding to it, “Another cause could be an untreated open deep dental cavity or tooth cavity. When you have an open cavity, which starts attracting food. Stuck food cannot be eliminated during your brushing or your rinsing procedure resulting in halitosis. Another cause is the biofilm present on the tongue. This thick layer on the tongue becomes the reason for halitosis. There is another condition called pericoronitis.  It is a condition where when your wisdom tooth erupts into the oral cavity. 

When there is a lack of space, it tries to pushes through the tissues. So in this process, a small pouch is formed between the tooth and the tissue. This acts again as a pocket. Unknowing to the patient, the food starts collecting inside. This attracts the microorganisms which start developing into bad odour.

Another common cause is xerostomia or hyposalivation (decreased saliva). Saliva is very important as it acts as a buffering agent, a cleansing agent and as a lubricant. So, when the saliva content is reduced, these microorganisms increase. These microorganisms react with organic components present in the saliva and other fluids in the mouth. And they generate volatile compounds like sulphur. This sulphur is responsible for your bad odour. Sulphur is also present in onions and garlic. Xerostomia can also be caused by certain medications.

Medicines taken for anti-diabeties, antihypertension, antipsychotics, chemotherapy and radiotherapy decrease the level of saliva. Apart from this, halitosis also occurs when we are undergoing certain dental treatments. For instance, when a child goes for braces. When you have braces in the mouth and if you don’t follow good oral hygiene, then food will tend to get accumulated. This will start the cycle of emanating bad odour.

These are the basic oral reasons causing bad breath, apart from this there are systemic reasons, For instance, if one has a bad tonsil or sinusitis, you will have a bad breath. Other problems like upper respiratory tract infections, lung infections, diabetes or gastrointestinal problems, will surface as bad breath.”

Right Age for Oral Hygiene

She says, “Oral hygiene starts right from birth. Even as infants we advise parents to take a soft muslin cloth and wipe the gum pads to see that there is no food. With the eruption of the first tooth in the mouth, your visits to the dentist start. Till the child develops his own psychomotor skills to handle the brush by himself, he will require assistance from the parent. We always recommend brushing twice daily. Along with healthy food and a proper diet. This could be tricky as children love sweets and sticky food.

But parents should ensure that after they consume this food they at least rinse their mouth. This is where your cavities and gum problems resulting in bad odour start. Nowadays there are many attractive brushes that are present in the market. right from cartoon brushes to those that vibrate when you are brushing wrong. The right age should be when the first tooth erupts and one should visit the dentist.”

Right Age for Children to Floss 

She recommends, “Once the child has a full set of teeth flossing can be done. Again flossing has to be done with a lot of care ensuring you do not injure your gums. So once that care needs to be taken to see that you do not cause more injury to the gum in the process of taking care of the teeth. So flossing also can be started once you have the full complement of teeth you can start

Tips for Good Oral Hygiene

She suggests, “Brush regularly, twice at least, if not after every meal. Brushing should be done with proper force, a proper brush and with proper technique. We are generally under the impression that more force results in better cleaning. This is not true. The with more force you are likely to cause more damage.

One needs to change their brush regularly. As I had said there are different types of brushes now. So you can select whichever you prefer.  The mandatory thing is brushing twice if not after every meal. The tongue also needs to be cleaned effectively every day. These days the brushes come with spikes at the back. So you do not need to have a separate tongue cleaner. Sometimes the metallic tongue cleaner can be a little hard and sharp for the tongue. So this brushing and cleaning of the tongue should be done together along with flossing.

Indians in general are not used to the thought of flossing every day. So I always recommend my patients, if not every day, at least alternate days or once in three days or at least once a week. Flossing for some is difficult but again it has been made easier. You have floss holders. One should take care that during flossing they do not injure their gums.

Apart from this, you should use mouthwash. In the market, you have medicated and non medicated mouthwashes. Unless prescribed by your dentist, a non-medicated and regular oral mouthwash should be used. But otherwise, we have the medicated one which is very potent. That is called the Hexidine mouthwash. So these are the basic things. But apart from this, you need to visit your dentist. Many think that the visit to the dentist should happen only during the problem and not otherwise.”

How often should you visit the dentist?

She lends, “I always tell my patients don't come when you have pain because pain is an indicator that the problem has reached its maximum wherein it requires very aggressive treatment like maybe a root canal, or extraction of your tooth, or even gum surgeries. I always tell them to come even if they do not have a problem so there will be no major treatments."

How often should you change your toothbrush?

She advises, “It depends on your force. You can see in the toothbrush, the tip gets flared or it loses its shape. That's a time when your toothbrush needs to be discarded. At the same time, this unkempt shape is an indication that you are using too much force.

But again as I said, the brushes these days, the bristles are very textured. So they are not like the earlier brushes or bristles which were harder. So you do not find much fraying off your brushes. But definitely after two months, I think I would ask my patients to change the brush.”

Parting advise 

She mentions, “We advise patients to visit their dentist every six months or once a year. But patients with artificial teeth need to visit the dentist more frequently. because you know the again as I told food tends to get accumulated between these dentures and bridges. The eyes are the window to your soul and the oral cavity is a mirror to your health. As they say, a healthy mouth always equals a healthy body.”

(Edited by Priyal Shah)