Dr. Manisha Agarwal

One thing that can put away talking to someone very interesting is bad breath. And it is not an uncommon problem. While most just try to use mouth wash and chewing gums to keep it away, it is important to note that bad breath can be a sign of underlying causes, both in the mouth and the body as a whole.  

Identifying the reason can help in early diagnosis and prompt treatment of the actual disease condition.

There could be oral and general causes for bad breath or halitosis as it is medically called.  Food habits and other lifestyle habits including smoking can also lead to bad breath.

Oral causes:

• Presence of food debris in a moist environment (saliva) is ideal for the oral bacteria to act on the food particles and break them down. This causes a bad breath, when it leads to plaque formation and it then calcifies into a hardened substance called calculus.  Plaque and calculus are the main ingredients for tooth decay and periodontal disease.
• Severe tooth decay leads to bad breath as does periodontal infections. In severe cases, there could even be abscess formation in the root area of the tooth with pus formation 
• Unclean dentures are another source of halitosis. There could be food lodged in between teeth or the undersurface of the denture, leading to bad breath.
• Dry mouth or xerostomia - Certain diseases and drugs can lead to dry mouth with reduced amounts of saliva.  Saliva has a natural flushing effect on the bacteria, and in its absence, the bacteria thrive, leading to a bad odour.

General health:  Chronic diseases like gastroesophageal reflux disease, digestive disorders, liver disorders, cancer, and diabetes can lead to bad breath. 

Others:

• Long-term smoking and/or chewing tobacco and alcohol are also reasons for bad breath.
• Crash diets:  People on low-carb diets can have a bad breath, owing to burning of the fat and producing ketones, which have a strong smell.
• Medications: Nitrates to reduce angina, chemotherapy agents for cancer, phenothiazines for anxiety can all lead to bad breath. They reduce saliva and/or release chemicals causing bad breath.

Management:  The first step in managing halitosis is to nail the cause down, which makes it easier to treat.

• Start with oral hygiene check, and if there is decay or gum disease, consider restorations and cleaning.
• Mouth rinses can be used in the maintenance phase.
• Cessation of tobacco use should be considered.
• General health conditions like GERD should be managed
• Artificial saliva in cases of xerostomia
• Alternative medications if they are causing the bad breath

Oral breath is definitely embarrassing but can be managed very easily.

Those who have experienced it would vouch for the fact that toothache is one of the worst pains. There could be times when the attack happens out of nowhere and you are crying for relief.

The tooth has 2 parts - the visible part called the crown and the invisible part called the root which is embedded in the jaw bone and covered by the gums.  

Both the crown and the root have 3 layers from inside out. The crown has enamel, dentin, and pulp. The enamel is the mineralized part of the tooth, dentin has fine sensory dentinal tubules, and the pulp receives nerve and blood supply to the tooth through a small orifice at the end of the tooth called the apex.  On the root surface, instead of enamel, there is a softer substance called cementum.  The dentin and the pulp continue through the tooth, but are thinner in the root portion of the tooth.

The mouth has the largest amount of bacteria in the body. These act on the food deposits on the tooth and produce acid which leads to breakdown of the enamel. The only symptom when enamel breakdown happens is food lodgment, and it continues till treatment ensues. Once the breakdown reaches the dentin, sensitivity sets in, and most people go for treatment then. If not, the next layer is the pulp, when there is severe pain.  This acute pulpitis causes pain in spurts and can be unbearable.

On the root surface, if there is periodontal disease and the gum line goes down, then cementum gets worn off (far more easily than enamel) and decay reaches the dentin and pulp (again faster than in the crown).

Whatever the case, the treatment would be the same:

• Dental examination, clinical testing, and x-rays would be diagnostic. Tapping the tooth would reproduce the same pain and that is indicative of acute pulpitis
• Antibiotics and pain killers would be given to control the pain
• Once the infection subsides, root canal therapy is initiated.  Using the decayed portion to gain access to the root, thin instruments called reamers and files are used to clean out the pulp space completely. They are then shaped to accommodate an inert substance called gutta percha which ensures infection does not seep into the tooth again.
• With RCT, the tooth is weakened, and therefore a crown needs to be placed. This could either be a ceramic crown or a full metal crown based on economic and esthetic reasons.

The best way to avoid this is regular visits to a dentist so that decay is identified in the early stages and treated with the minimal cost and maximum natural tooth preservation.

You may often find that no matter how much you brush your teeth or whichever teeth whitener you might use, your teeth still appear stained and your smile still appears dull. There are certain foods, such as coffee, alcohol like red wine, soya sauce etc. which can be considered obvious culprits. However, it is not only the foods that cause staining, several other factors contribute to this as well. Following is a list of 5 things which can stain your teeth sooner than you think.

1. High intake of tea
Research has suggested that tea, be it brewed tea, green tea or iced tea, causes a high level of staining in your teeth; often in levels much higher than coffee. This is because tea contains a high level of tannins and also high amounts of acid, which aid the staining process, and eventually lead to much yellower teeth and long-lasting stains.

2. Drinking high amounts of lemonade
Lemonade is rich in sugars and acids, which effectively lead to wearing down of the enamel and exposing the next layer called the dentin, which itself is yellow in color. This makes the teeth appear yellowish. In cases where the enamel coating on your teeth is thin, the acid erosion takes place quicker; often leading to stained teeth. This condition may often become permanent or semi-permanent, with modes of reversal becoming increasingly difficult.

3. Extended periods of medication-intake
Injuries or illnesses, which lead to taking medications for sustained periods, can negatively affect the flow of blood to the teeth. This may lead to discoloration and staining. Certain medications, such as cough syrups which are rich in sugars can, also result in yellowing of teeth.

4. Swimming for long durations
Swimming for prolonged periods [usually around 6 hours a week in chemically-treated pools, can also lead to the browning of your teeth. This is because, often when you open your mouth and let water in, you allow certain chemicals to enter your mouth which can have adverse reaction on the tooth enamel. This ultimately leads to teeth corrosion and eventual staining.

5. Having excessive sugary drinks
Certain drinks which contain large amounts of synthetic food coloring increase sugar levels and aid the growth of bacteria in your mouth, thus causing tooth decay and discoloration of teeth.