Prevalence and cause ’ s of bad breath in patients attended Shiraz dentistry school . A cross sectional study

Introduction Halitosis or bad breath is a taboo subject that is a widespread problem in the general population. Causes of bad breath can be multifactorial and long time sufferers can be marred from deep psychological stress. Because nine out of ten cases have an oral cause, the initial inquiry should be with a dentist. Bad breath occurs when noticeably unpleasant odors are exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease (1) I n most cases (85–90%), bad breath originates in the mouth itself. The simplest way to distinguish oral from non oral etiologies is to compare the smell coming from the patient mouth with that exiting the nose. If the odor is primarily from the mouth ,an oral origin may be inferred. (2 ). The intensity of bad breath differs during the day, due to eating certain foods (such as garlic, onions, meat, fish, and cheese), obesity, smoking, and alcohol consumption.(3,4) .Since the mouth is exposed to less oxygen and is inactive during the night, the odor is usually worse upon awakening ("morning breath"). Bad breath may be transient, often disappearing following eating, brushing one's teeth, flossing, or rinsing with specialized mouthwash. Bad breath may also be persistent (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees (5) Halitosis did not become a clinical entity until1874, when it was described by Howe.( 6 ) Recognition of this condition is simple, but diseases which cause halitosis may produce distinctly different smells. The distinct smell which each disease produces may offer some help in differentiating the etiology of halitosis if various factors causing this condition are understood. Halitosis can be divided into the following categories:(1) halitosis due to local factors of the pathological origin, (2) halitosis due to local factors of no pathological origin, (3) halitosis due to systemic factors of pathologic origin, (4) halitosis due to systemic factors of non pathologic origin, (5) halitosis due to systemic administration of drugs, and (6) halitosis due to xerostomia. Halitosis may be caused by local conditions such as poor oral hygiene, extensive caries, gingivitis, periodontitis, open contacts allowing food impaction, Vincent’s disease, hairy or coated tongue, fissured tongue, excessive smoking, healing extraction wounds, and necrotic tissues from ulceration. (6-8) In adults, chronic periodontal disease is a major cause of halitosis. Periodontal pockets produce hydrogen sulfides which give off an offensive odor; these pockets encourage trapping of food(8 ,9, 10) Halitosis may also be related to an increase of gram-negative filamentous organisms, an increase in pH to 7.2, and the formation of indoles and amines in the oral cavity (11) Other conditions which may produce halitosis include chronic sinusitis with postnasal drip, rhinitis, lethal granuloma pharyngitis, tonsillitis, syphilitic ulcers, cancrum oris, tumors of the nose, abscess ulcerogangrenous processes, cancerous tumors of the trachea and bronchi, chronic fetid bronchitis, and infectious