Bad breath, is it all caused by Helicobacter pylori?

In the eyes of some people, Helicobacter pylori infection is the initiator of bad breath, and some people even directly call bad breath HP (the abbreviation of Helicobacter pylori) breath. However, is Helicobacter pylori really the "number one suspect" of bad breath? In addition to it, what other possible causes are there for bad breath? What are the manifestations of bad breath caused by different reasons? What is the scientific attitude to prevent and treat bad breath?

There are many reasons for bad breath

First of all, bad breath can be real or fake. What we usually call real bad breath is bad breath, which means that the bad breath in the mouth does exist objectively. False bad breath is caused by psychological and mental factors, which means that the patient thinks he has bad breath but actually does not.

True halitosis is a common manifestation of many health problems. In other words, its cause is not unique. It may come from the oral organs or from organs outside the oral cavity. Therefore, true halitosis can be divided into oral halitosis and non-oral halitosis according to different causes.

Among true halitosis, 85% is oral halitosis, which has many causes, but the most important are tongue coating and periodontal diseases (gingivitis and periodontitis). In addition, poor oral hygiene (accumulation of dental plaque and soft deposits), tooth decay, pulp necrosis, crowded teeth, dry mouth (can be caused by drug treatment, mouth breathing, radiotherapy, autoimmune diseases, diabetes, etc.), tooth extraction wounds, oral mucosal diseases (stomatitis and neoplasms, etc.), peri-implantitis, wisdom tooth pericoronitis, etc. may all lead to halitosis.

Another 15% of true halitosis is non-oral halitosis, and its cause is not limited to one system or organ: ① The respiratory system, mainly concentrated in the ear, nose and throat area (about 10%), with tonsillitis being the most common, and may also involve Vincent pharyngitis, rhinitis, sinusitis, etc. In addition, diseases such as bronchiectasis and lung abscess can also cause halitosis; ② The digestive system, including gastrointestinal and liver diseases. Although many doctors and patients believe that halitosis is highly correlated with stomach problems, in fact only 0.5% of halitosis cases are related to stomach problems, and the correlation between stomach problems caused by Helicobacter pylori infection (such as gastric ulcers) and halitosis still needs further research and confirmation. In addition, cirrhosis and liver failure may also cause halitosis; ③ Endocrine system and metabolic disorders. Even drug treatment may be the source of halitosis.

Therefore, it is an exaggeration to regard Helicobacter pylori as the culprit of bad breath.

Bad breath smells different

Different people have different causes of bad breath, and the smell is also different. Bad breath caused by endocrine and metabolic diseases is particularly complex, and it is not just "stinky". Therefore, a more accurate term for bad breath is bad breath. For example, the bad breath of diabetic patients (children or adults) has a fruity smell, the bad breath of patients with intestinal obstruction has a fecal smell, and the bad breath of patients with renal insufficiency has a fishy smell, and so on.

"Prescribing the right medicine for the right condition" is the key

Given that the causes of bad breath are very complex, when treating bad breath it is important to first determine the source of the problem and then seek a solution based on the corresponding problem.

The most effective way to treat oral halitosis is to maintain oral hygiene and control oral microorganisms. The specific measures are as follows:

1 Use mechanical methods to remove food residues and oral microorganisms in the mouth, such as brushing teeth, flossing, and cleaning the tongue coating. The tongue coating is not only a hotbed for oral bacteria (especially anaerobic bacteria), but also may contain residual food residues. It is an important source of oral halitosis. Therefore, it is very important for patients with halitosis to clean the tongue coating. You can use an ordinary toothbrush or a tongue scraper to clean the tongue coating, but the latter is better. Special reminder: ① Because the tongue coating is relatively "dirty", it is recommended to clean it after brushing your teeth; ② In order to prevent vomiting, it is recommended to pull the tongue out as much as possible when brushing the tongue coating. Cleaning the tongue coating can also help improve the sense of taste.

Since periodontitis is an important cause of bad breath, professional periodontal treatment is also one of the ways to solve the problem of bad breath. In addition to requiring patients to take good care of themselves, they should also accept ultrasonic dental cleaning (commonly known as teeth cleaning) and manual scaling as appropriate.

2 Use chemical methods to control oral microorganisms, such as using mouthwash. Common chemical ingredients include chlorhexidine, chlorine dioxide, hydrogen peroxide, triclosan, essential oils, etc. Among them, chlorhexidine is the most effective, but the side effects are also obvious; essential oils are the mildest, but the duration and degree of effectiveness are relatively limited.

3. Convert the bad-smelling compounds in the mouth from volatile components to non-volatile components.

4. Cover up the bad smell, such as using chewing gum, toothpaste, etc.

2. For non-oral halitosis, the primary disease should be treated accordingly, so consultation with an otolaryngologist or internist is required.

One key opens one lock. If you have bad breath, you must first find out the cause.

References

[1] Bollen CM, Beikler T. Halitosis: the multidisciplinary approach[J]. Int J Oral Sci, 2012, 4(2): 55-63.