h and gum. This will provide shelter for the food debris and bacteria causing bad breath.
8) Ulcerative lesions& coatings:
Almost all ulcerative lesions of the mouth are associated with bad breath. These lesions may be caused by bacteria,viruses,food allergies or due to autoimmune disorders. Apthous ulcer is the commonest amoung ulcerative lesions. Others are herpes,fungal infections,vincents angina,infectious mononucleosis,scarlet fever,diphtheria,drug reactions and ect. Cancerous ulcers produce severe bad breath. All fungal infections produce white coating(candidiasis). Leucoplakia is a white thick patch on the mucus membrane of the mouth & tongue. It is considered as a precancerous condition. Offenssive breath is associated with these conditions.
9) Diseases of the salivary glands:
Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin film of coating called biofilm can provide an anaerobic condition in the mouth. Saliva can wet these layers and make an aerobic condition which is unfavourable for the bacteria .Any condition which reduces the production of saliva can increase bacterial activity. Some times the salivary duct is obstructed by stones or tumors.Cancer of the salivary gland is associated with offenssive odor. In suppurative parotitis purulant dischrge in to the mouth causes bad breath.
Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.
11) Tonsillar plaques & tonsillar fluid:
If bad breath persists even after maintaining proper oral hygeine there is possibility of this condition. Serous fluid secreated from the folds of tonsil is very offenssive. Some patients complain that they hawk some cheesy materials from the throat;which are very offenssive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteriae. In such conditions tonsillectomy gives noticiable relief from bad breath.
12) Pharyngitis& pharyngial abscess:
Pharynx is a fibromuscular tube which forms the upper part of the digestive & respiratory tract. Inflmmation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis along with other signs like cough and throat irritation. Abscesses in the wall of pharynx can also produce offenssive discharge of pus in to the throat.
Denture users may complain about bad smell due to lodgement of small food debris in between. Proper brushing may not be possible in denture users especially fixed dentures.
Tobacco chewing is associated with bad breath. The smell of tobacco itself is unpleasent for others. Tobacco can irritate the mucus membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. All these causes offenssive smell.
Smokers always have bad smell. It can also produce lesions in the mouth & lungs causing bad breath.Smoking increases carbon dioxide in the oral cavity & reduces oxygen level,causing a favourable condition for bacteria. Smoking reduses appetite & thirst hence acid peptic disease is common in chain smokers.
16) Lesions in the nose & ear:
Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with discharge of pus in to the throat through the eustachian tube(passage from middle ear to the throat)can also cause offenssive odor. Chronic rhinitis(infection of mucus membrane of nose) and forign bodies in the nose can also produce bad smell in the expired air.
17) Diabetes mellitus:
Mostly all diabetic patients suffer from bad breath. Coated tongue,ulcers &coatings in the mouth ,increased sugar level in tissues ect are responsible for bad breath.Bac