Home » Bad breath, causes and remedies for “heavy breath”: what you need to know and advice from the experts

Bad breath, causes and remedies for “heavy breath”: what you need to know and advice from the experts

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Bad breath, causes and remedies for “heavy breath”: what you need to know and advice from the experts

Elena Meli

In 90% of cases the bad smell is caused by the proliferation of germs, a consequence of poor oral hygiene. But sinusitis, respiratory disorders and pathologies such as type 1 diabetes and gastroesophageal reflux also contribute

It’s one of those problems that people don’t like to talk about. Also because, when you open your mouth, you immediately “give yourself away”: bad breath is an embarrassing disorder, despite being very widespread. For some it becomes a constant nuisance: there are people whose bad breath is chronic and persistent, regardless of what they eat or how they brush their teeth. A group of Dutch researchers discovered that this characteristic is hereditary and depends on mutations in a gene, Selenbp1, which produces a protein capable of binding the mineral selenium and above all capable of metabolizing methanethiol, a gas that is normally formed during digestion but which has an unpleasant smell of rotten cabbage because it contains sulphur.

In rare cases, a gene is to blame

At the University of Radboud, in the Netherlands, it was observed that in the blood of the members of all families with chronic halitosis large, anomalous quantities of methanethiol and other sulfur compounds, such as dimethylsulphide, which are equally smelly, are found; when the blood reaches the lungs, these gases are exchanged with air and so the breath that patients exhale is full of unpleasant-smelling gases. The fault lies with the mutations on the Selenbp1 gene, found in all people with chronic halitosis: the mutated protein is unable to metabolize methanethiol and the like, which can thus accumulate first in the blood and then in the breath.
The authors specify that at the moment the cause of this type of halitosis is understood but there is no cure; However, these are rare cases and in reality the majority of people with bad breath can easily solve the problem, once the reason has been identified.

In most cases it can be resolved

There are no excuses: unless you fall into the small category of people with “genetic” bad breath, bad odor in the mouth can practically always be resolved by recognizing the cause and acting accordingly.
An American survey has included bad breath among the hundred most stressful health problems but it shouldn’t be something to be ashamed of, given that estimates speak of a very democratic disorder: up to one in two people has bad breath.
The fault is almost always something wrong in the mouth, as explained by Giano Ricci, dentist and member of the Italian Society of Periodontology and Implantology (SIdP): «Halitosis depends in about 8 percent of cases on extraoral problems such as sinusitis or other respiratory disorders, in another 2 percent from pathologies such as type 1 diabetes, renal failure, hiatal hernia, gastroesophageal reflux or other disorders of the gastrointestinal tract; in 90 percent of patients it is a problem of the oral cavity, which can be a consequence of poor hygiene or conditions that facilitate the proliferation of bacteria, such as the presence of gum “pockets” or detachment of the gums from the teeth.”
The creators of the smell, in fact, are mostly the germs that remain in the mouth: these are generally gram-negative or anaerobic bacteria which through their metabolism produce volatile sulphurous substances, such as hydrogen sulphide, dimethylsulphide and methylmercaptan, from The particularly unpleasant smell of rotten cabbage.

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The responsibles

In addition, the metabolism of some amino acids can also lead to the formation of compounds such as putrescine and cadaverine, smelly from their name. «Many germs that colonize the mouth and gums, such as Porphyromonas gingivalis or Bacteroides forsythus, degrade proteins, producing the compounds responsible for bad breath», confirms Ricci. «Inflammation of the gums is therefore one of the most frequent causes of bad breath, as is the presence of dental plaque, which is formed precisely by bacteria, or dental cavities, also due to germs. For this reason, in case of bad breath it is important to contact the dentist.” With one exception: if when you wake up in the morning your breath doesn’t smell like flowers, there’s no need to worry because there is so-called “physiological halitosis”, due to the putrefaction of food residues or epithelial cells in the mouth. desquamated by the bacteria that normally colonize the oral cavity. There are in fact “bad” ones, responsible for tooth decay and periodontitis, but also less aggressive ones that we normally live with: they too can cause not exactly pleasant breath in the morning, especially in women, which however disappears after brushing your teeth. Generally these are gram-negative bacteria that live in the papillae of the tongue, the extrusions that make it rough and also serve us to perceive flavours: it is difficult for saliva to be able to “clean” them enough, so the bacteria grow, creating a biofilm (sometimes it even becomes visible, like a whitish or yellowish film covering all or part of the tongue) and they feast on what ends up remaining on the tongue, from pieces of food to dead cells.

How often to brush your teeth, why to floss

Also for this reason, as the dentist specifies, «to prevent and combat bad breath, careful oral hygiene is needed in which the tongue is not forgotten, which perhaps needs to be “scraped” with specific instruments. Brushing your teeth and mouth correctly is the first step to having “light” breath: your teeth should be brushed at least twice a day, in the morning and in the evening, better if you can do it even after lunch.
The spaces between teeth should not be neglected and should be cleaned in the evening with dental floss or micro-brushes, and it may be a good idea to use mouthwashes to reduce the colonization of bacteria. When you can’t brush your teeth, sugar-free gum can be a little helpful (the mechanical action and the stimulus to produce more saliva can help eliminate bacteria, ed.), but rinsing with a mouthwash or a gel product to apply to the teeth with the fingertip. «To ensure good oral hygiene and therefore also combat bad breath, professional hygiene sessions, which you undergo regularly, are of great help – continues Ricci -. It is the dentist who indicates the necessary frequency: for those who are young or do not have gum problems, once a year may be enough, but if the risk of periodontitis is high, 2 or 3 sessions a year may also be needed to eliminate the bacteria well , entering the gingival sulcus. The sessions also serve to identify another cause of halitosis, oral dryness: saliva is in fact a powerful detergent and antibacterial of the oral cavity, if little is produced, bad breath is more likely. In these cases, specific mouthwashes can help keep the mouth moist, and it is good to drink plenty throughout the day.”

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Prosthetics and appliances

It is equally important to carefully clean dentures or dental appliances, which otherwise promote bad breath due to the proliferation of germs.
Keeping breath fresh therefore also means avoiding more serious problems such as cavities and especially gingivitis: according to SIdP data, adults with more or less serious inflammation of the gums are 30 million but only 13 percent receive the diagnosis , so serious periodontitis is on the rise, which today affects around 3.5 million Italians and can lead to tooth loss.
In short, bad breath is not only a problem that can compromise social relationships, but it can be the precursor to worse oral pathologies or even the indicator of different problems, which should not be underestimated: if oral hygiene is correct and the dentist cannot find causes for bad odor in the mouth, should be investigated elsewhere. Sometimes, for example, it may depend on a concomitant respiratory infection, for example a sinusitis or a cold: the secretions can literally “leak” into the oral cavity and give off a bad smell, but in these cases it is a disorder that is easily resolved recovering from the infection.

Other causes

Other reasons for bad breath can be more serious: liver problems, such as chronic hepatitis, can reduce its ability to metabolize various compounds and cause bad breath; the same goes for other digestive tract disorders, such as gastroesophageal reflux or gastric ulcers.
Behind halitosis that does not depend on oral problems there may also be metabolic diseases: in type 1 diabetes, for example, the characteristic fruity “acetone” odor is one of the signs of the disease and depends on the fact that in the impossibility of use glucose as “fuel” for the body, due to the insulin deficiency, the body exploits fatty acids by producing ketone bodies, responsible for bad breath. Which can sometimes also be present in the case of type 2 diabetes or in patients with renal failure, where the odor is typically fishy and depends on alterations in urea metabolism.
Even diseases in which there are enzymatic alterations can lead to bad breath, often with peculiar characteristics: in phenylketonuria, for example, the breath can have an odor similar to that of mice, in methionine adenosyl transferase deficiency it resembles cooked cabbage, in Homocystinuria tastes like sweet mold. However, these are rare cases after all: almost always, if the breath is bad, you just need to brush your teeth and tongue better and more often.

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How the diagnosis is made

It may be enough to smell the patient’s breath, but there are also methods to be more precise than that and to establish how much and how the breath smells. There is also a measurement “tool”: the Rosenberg and McCulloch scale, which, based on the results of various tests, indicates how smelly your breath is on a scale from zero (no detectable odor) to five (very strong odor). ; the tests must be done after having gone at least one day without eating “smelling” foods and without smoking, at least 12 hours after brushing your teeth the last time and avoiding using perfumes of any kind in the previous six hours. Then, the analysis consists of smelling the mouth, the saliva, the biofilm of the tongue collected with a speculum, the debris between tooth and tooth taken with dental floss, the breath exhaled from the nose; This organoleptic test can also be combined with gas analysis with special instruments, which generally measure the quantity of sulfur compounds in the breath in a fairly precise and reproducible manner.

Stop smoking and protein diets

Brushing your teeth is the first defense strategy and fight against bad breath, but quitting smoking is also essential: cigarette smoking, as well as chewing tobacco, has a very negative effect on mouth odor. The same applies to the use of some drugs, which can temporarily promote bad breath: this is the case of some antidepressants, antifungals, antihistamines, anticholinergics, chemotherapy. Equally at risk are high-protein diets conducted for long periods, because they generally reduce carbohydrates to a minimum, forcing the body to exploit fatty acids for energy: in doing so, large quantities of ketone bodies are produced which, if abundant, can be toxic.

March 16, 2024 (changed March 16, 2024 | 7:00 pm)

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