Halitosis (Bad breath)

Japanese: 口臭 - こうしゅう（英語表記）Halitosis (Bad breath)

What is the disease?

Bad breath is the smell that comes out of the mouth, and it mostly comes from the oral cavity. Other causes may include the ENT area, digestive tract, and respiratory system. Even though it is an odor that comes from the mouth, people often do not notice that they have bad breath.

What is the cause?

Physiological bad breath is caused by dry mouth when waking up, when hungry, when nervous, etc. It can also be caused by poor oral hygiene, periodontal disease, cavities, or poor oral hygiene. Prosthetics ( Hot spots ) (dentures and crowns), Tongue coating ( Absolutely ) , Lingual tonsils ( Zetsu entanglement ) There are bacterial and inflammatory odors that come from the mouth, and dietary odors that leave behind the smell of food.

If you have a disease in the ENT, respiratory or digestive system, the smell from the affected area may appear as bad breath. Systemic diseases such as diabetes can also cause bad breath.

There are people who brush their teeth excessively but are convinced that they have bad breath. Even if the test shows that they don't have bad breath, they still worry about the people around them. This is because worrying about it is an illness in itself, Self-smell disorder ( Self-reporting ) It is called.

Testing and diagnosis

Bad breath is diagnosed objectively by using gas chromatography (a gas analyzer) to measure the presence of odor-causing substances such as hydrogen sulfide, methyl mercaptan, and dimethyl sulfide.

To determine the actual cause of bad breath, an oral examination will be performed to check for periodontal disease, cavities, dental treatment status, etc. If the cause is not found within the oral cavity, examinations of the ENT, digestive tract, respiratory system, etc. may be performed.

Treatment methods

The treatment is to remove the cause. As most cases start in the oral region, the first priority is to treat periodontal disease and cavities, and to maintain oral hygiene through proper brushing. In addition, tongue coating (which turns white as if the tongue has coating on it) is a breeding ground for bad breath, and bacteria and Candida grow on it, producing hydrogen sulfide and methyl mercaptan, which cause bad breath, so it is necessary to remove these causes. Other diseases in the nasal cavity, paranasal sinuses, and pharynx (malignant tumors, Sinusitis ( Lottery ) Sinusitis, Tonsillitis ( Tongue surgery ) We will check to see if you have any other conditions (such as tonsillar tonsillitis or lingual tonsillitis) and proceed with appropriate treatment if necessary.

Osmia is considered a mental problem and a psychiatric consultation is recommended, but if you explain the problem to your patient and they are able to gradually accept it, psychiatric treatment may not necessarily be necessary.

What to do if you notice bad breath

If you notice that you have bad breath, either by yourself or someone else points it out to you, you should take care of your mouth by brushing your teeth carefully and removing any tongue coating you have, while also visiting a dentist to have your mouth examined and receive instructions on how to take care of your mouth. There are also dental clinics that specialize in treating bad breath.

Shigeru Ono

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな病気か

　口臭とは口から吐く息とともに出るにおいで、ほとんどは口腔領域からのものです。その他、耳鼻科領域、消化管、呼吸器などに原因がある場合があります。口から出るにおいなのに、口臭は本人が気づかないことが多いものです。

原因は何か

　生理的な口臭は、起床時、空腹時、緊張時など口腔内の乾燥によって起こります。また、口腔内の清掃不良、歯周病やむし歯、不良補綴物(ほてつぶつ)（入れ歯や冠）、舌苔(ぜったい)、舌扁桃(ぜつへんとう)から発生する細菌性・炎症性のにおい、食べた物のにおいが残る食事性のものがあります。

　耳鼻科領域、呼吸器領域、消化器領域に病気があると、病変部から発生するにおいが、口臭となって出てくることもあります。全身性の病気では、糖尿病でも口臭が起こります。

　なお、ブラッシングはやりすぎるほどやっているのに口臭があると確信している人がいます。検査で口臭はないと言われても、まわりの人を気にしてしまいます。これは気になること自体が病気で、自臭症(じしゅうしょう)といいます。

検査と診断

　口臭は、ガスクロマトグラフィー（ガス分析装置）を用いて、硫化水素、メチルメルカプタン、ジメチルサルファイドなど、臭いの原因となるものがあるかどうかを測定し、口臭が発生しているかどうかを客観的に診断します。

　実際に口臭を発生させている原因については、歯周病、むし歯、歯の治療状況など口腔内検査をします。口腔内に原因がない時は、耳鼻科領域や消化管、呼吸器などの検査を行うこともあります。

治療の方法

　治療法は原因を除去することです。その多くが口腔領域からの発症であることから、歯周病やむし歯の治療と、正しいブラッシングによる口腔内の清潔の保持が第一です。また口臭の温床とされる舌苔（舌に苔が付着したように白くなります）には細菌類・カンジダなどが増殖し、口臭の原因となる硫化水素、メチルメルカプタンなどが産生されますので、これらの原因を除去することが必要です。そのほか鼻腔・副鼻腔、咽頭などに病気（悪性腫瘍、副鼻腔炎(ふくびくうえん)蓄膿症、扁桃腺窩炎(へんとうせんかえん)、舌扁桃炎）があるかを調べて、必要に応じてそれぞれの治療を進めます。

　自臭症は精神的な問題とされて精神科受診がすすめられますが、口臭に関しての説明を行い少しずつでも受け入れることができるようであれば、必ずしも精神科治療の必要はないでしょう。