Dear Editor,
Halitosis (foul odour from mouth) is psychologically depressing and social embarrassment for the individual. To gel rid of halitosis, patients often brush their teeth forcefully and frequently and rinse their mouth with different mouthwashes currently available in the market but the underlying cause remains untackled. This letter attempts to explain the cause of halitosis and highlight the adverse effects of mouthwashes.
Gastrointestinal problems like amoebiasis and giardiasis lead to coating of the tongue. The intake of tea, coffee, milk or food on a coated tongue often leads to a foul taste in the mouth. In acute maxillary sinusitis, patient complains of a foul odour along with the presence of postnasal drip and mucopurulent sputum. Diseases of the respiratory tract like lung abscess and bronchiectasis must be ruled out. Persons suffering from uncontrolled diabetes mellitus may have a typical acetone breath. In chronic renal failure, nitrogenous waste products like urea and non protein nitrogen (NPN) are retained in blood. One of the ways by which the body eliminates these is through the buccal and intestinal mucous membrane. The mouth has a foul ammoniacal odour and white coating accumulates over the tongue. Uraemia results in swollen and haemorrrhagic gums [1]. In acute fever, salivary secretion is inhibited and the mouth becomes dry. Food debris are not washed away and hence bacteria multiply leading to halitosis.
Intra-orally, halitosis may occur due to gingivitis, periodontitis, periodontal pockets, pericoronitis, deeply carious teeth with resultant stagnation of food debris and unhygienic dentures. Following tooth extraction or oral surgical procedures, patient is on a soft diet. Lack of normal chewing, slight bleeding and bacterial decomposition of blood gives rise to malodourous breath. Acute necrotizing ulcerative gingivitis (ANUG) has a characteristic metallic odour [2].
Mouthwashes generally contain an antiseptic such as benzakonium chloride, antibiotic agents, essential oils used as flavours, alcohol, sodium perborate, zinc chloride, menthol, thymol, eucalyptol, glycerine and boric acid [3]. These susbstances can cause allergic reaction. Prolonged use of a mouthwash in which the alcohol concentration is high can induce white lesions in oral mucous membrane.
Chemicals irritate the oral mucosa. Studies by Kowitz et al [4] have demonstrated the occurrence of epithelial peeling, mucosal ulceration and inflammation, gingivitis and petechiae in patients using 20 ml of a full strength mouthwash for 5 seconds, twice daily for 2 weeks. To prevent dental carries, 0.2% chlorhexidine mouthwashes are generally prescribed. Chlorhexidine can cause altered taste sensation and superficial desquamation of oral mucosa.
Chewing of carrot and coconut after food cleanses the pits and fissures present on the occlusal surface of posterior teeth. To get rid of smoker's breath, it is advisable to rinse one's mouth with water after a cigarrette and chew a clove. Essential oils present in clove, mint, aniseed and ajwain masks halitosis for a while. Chewing a betel leaf is an ancient Indian tradition. The ingredients of a prepared'paan’ and the juice of the betel leaf help in camouflaging halitosis. But prolonged use of betel nut(supari) and paan masala’ causes oral submucous fibrosis.
A healthy body with regular bowel movements and proper oral hygiene can prevent halitosis.
REFERENCES
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