Chronic or persistent bad breath is usually referred to by dentists and the wider medical world as halitosis (from the Latin halitus meaning ‘breath’ and the Greek osis meaning ‘disease’). It’s thought to affect between 22% and 50% of the global population.
There are generally several types of odour that characterise bad breath, unpleasant both for the person who has it and for those around them:
In 80%-90% of cases, halitosis is of oral origin. Like the gut, the mouth contains billions of bacteria (around 770 different species) which form the oral microbiota.
Some of these bacteria naturally feed on proteins, emitting foul-smelling volatile sulphur compounds (VSC) (1-3). When the oral microbiota becomes unbalanced (referred to as dysbiosis), the overabundance of these bacteria produces an excessive amount of these VSC, which are responsible for persistent bad breath.
As a reminder, simple ‘morning breath’ is usually normal and not pathogenic. Reduced saliva flow during the night causes dryness in the mouth (worse in people who sleep with their mouth open) and thus a temporary accumulation of bacteria.
In halitosis, the following factors are largely responsible for the oral microbiota becoming unbalanced:
It should also be noted that smoking and alcohol (as well as an overly rich diet) alter the balance of the oral microbiota, potentially promoting halitosis. Combatting chronic bad breath therefore requires, above all, regular dental care and a healthy lifestyle.
Fortunately, the oral microbiota naturally contains other species of bacteria, referred to as probiotic, as they are beneficial for health, in this case oral/dental health.
Their effect on bad breath appears to be related to their ability to inhibit the growth of pathogenic bacteria, to produce antimicrobial substances which reduce dental plaque, etc.
Though lactobacilli represent just 1% of the bacteria in oral flora, a human study of 130 subjects, in which 3790 isolates of lactic bacteria were noted, suggests that Lactobacillus rhamnosus offers significant capacity as an antagonist of key oral pathogens (4).
Another study assessing probiotic efficacy found Lactobacillus salivarius and Lactobacillus reuteri to confer potentially powerful effects against halitosis within less than 4 weeks. Probiotics such as Bifidobacterium longum may also have a role in preventing dental caries (6).
Synergistic probiotic formulations have thus been developed to provide the oral microbiota with billions of ‘friendly’ bacteria (one such product is the probiotic supplement Oral Health, which comes in the form of orodispersible sticks and combines the 4 ‘friendly’ species mentioned above, together with prebiotic fructooligosaccharides to nourish the probiotics).
Bad breath can also be caused by ENT and respiratory disorders, and in particular, poor digestion, which causes reflux of stomach acid and foul-smelling gases.
More generally, certain fungi such as Agaricus bisporus have also been studied for their ability to reduce malodorous compounds in the body, in particular, to break down ammonia (a by-product of protein metabolism, levels of which can sometimes be excessive). Agaricus bisporus can be found in supplements specifically targeted at bad breath (such as the famous Champex®).
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