Halitosis (Bad Breath)

Every mouth contains the components that produce volatile sulfur compounds (VSCs) bacterial, saliva, and proteins.

VSCs are a major component in the development of periodontal diseases. There are three compounds that produce oral malodor.

1. hydrogen sulphide
2. methyl mercaptan
3. dimethyl sulphide.

These compounds are the degradation end products from polypeptides. The walls of bacteria and human cells are polypeptide chains. The flagella, pili and fimbriae of bacteria are polypeptides. Thus, the dead and desquamating bacteria and epithelial cells are a major source of VSCs.

The sulcular and junctional epithelia have a rapid turnover and are a major source of VSCs. Studies suggest that these epithelial cells are replaced in 2 to 4 days. With gingival inflammation, the sulcular and junctional epithelial rate are increased eight-fold. Thus, this epitheliam may be totally replaced in as little as 6 hours sloughing off millions of dead cell. The potential VSCs from polypeptides becomes clinically and socially significant.

It is generally believed that by-products of bacterial metabolism are the primary factors in the etiology of periodontal disease. They induce a change in the crevicular epithelial barrier to permit an increase in accessibility of microbial substances to the underlying connective tissue layer, where they initiate a sequence of destructive inflammatory reactions.

The maintenance of the tissue barrier is important, since toxic substances such as endotoxin and bacterial dextrans have been shown to be incapable of causing inflammation in healthy sulcular gingiva (Gaffar et al., 1981; Rizzo, 1968). Both the sulcular and junctional epithelia appear to be crucial sites with regard to the development of periodontal disease. VSCs may also interfere with normal maturation of collagen.

VSCs have been shown to have a direct effect on protein synthesis by human gingival fibroblasts (Johnson and Tonzetich et al, 1980). VSCs play a major role in preparing tissues for the invasion of bacterial toxins.

VSCs are controlled by regular oral hygiene, such as brushing and flossing to reduce bacteria and inflammation, thus reducing available polypeptides which ultimately become VSCs. Oral rinses that contain oxidizing agents help to control VSCs. Chlorine dioxide is the most effective oxidizing agent currently available.

Ordinary toothpastes and mouthwashes temporarily mask odors with a more pleasant smell. Products containing chlorine dioxide eliminate bad breath at its source. These products can be obtained through your dentist and should be used in conjunction with good oral hygiene maintenance and regular dental visits.

Management of Periodontitis with Oral Care Products Reduction of Bleeding on Probing by Oral Care Products; Chapek, C., Reed, O., Ratcliff, P. Compendium XV, 740, June 1994 and Compendium XVI, Feb 1995.

Pi Dental Center, Fort Washington, PA