It may sound like today’s piece is about the Ghana Ports and Harbors Authority (GAPOHA) but that is not the case. “Say Gapoha” used to be a way that police officers used to test for excessive alcohol intake in road drivers’ breaths when breath analyzers had not been fully introduced on the market. This subjective method is still being used by individuals to detect bad breath by cupping their hands and saying “GAPOHA” and sniffing their breath. Bad breath, which is scientifically termed as halitosis, is a noticeably unpleasant odor from the breath regardless of whether it comes from the mouth(oral) or non-oral sources. It is derived from the Latin word “halitus” which means breath and Greek suffix “osis” which means abnormal. Bad breath in our local languages translates as “anumkankan”(Akan), “dan shala”(Ga) and “bakinka wari”(Hausa). I guess we are on the same page now?
Halitosis has been a problem in the past and it was first documented in manuscripts dating as far back as 1550 BC. It is a very common problem affecting 1 in 4 individuals at a point in time and it is estimated to be the 3rd most common complaint that clients bring to the dental clinic, with tooth decay and periodontal disease(severe gum disease) being the 1st and 2nd respectively. A study in Brazil reported that 15% of people reported bad breath and it was 3 times higher in males than females and 3 times higher in people over 20 years of age compared to those below 20 years. In Ghana, a study carried out at the University of Ghana Medical & Dental School revealed the prevalence of self-reported halitosis to be 18%.
Halitosis has several effects on individuals including social, personal development, and economic problems. Individuals who report halitosis do not like to speak in public, they avoid friends and family, they shy away from work colleagues, and also spend huge amounts of money on herbal concoctions and various mouthwashes in order to alleviate the condition. This is a major concern, hence the need to address it today as we approach World Oral Health Day 2020.
Our grandmothers in the village would always attribute bad breath to a scent coming from the head but this is totally false. According to a classification by Miyazaki et al in 1999, halitosis can be grouped into genuine, pseudohalitosis, and halitophobia. This classification helps us as dentists to know how to treat it since each of the groups has different treatment options. And this can only be done when you visit the dental clinic where the dentist would take a thorough history, detailed examination, and perform certain investigations in order to tell which group an individual falls in.
Genuine halitosis can be further grouped into physiologic and pathologic. Physiologic halitosis means that there is no apparent disease in the mouth causing bad breath. It is usually temporary or transient. Examples include the morning bad breath after waking up, eating certain foods such as onions and garlic, certain spices, cheese, not hydrating often causing dry mouth, stress, excessive alcohol intake, and smoking. Pathologic halitosis is bad breath as a consequence of an infection in the mouth or systemic disease. This is further grouped into intraoral(coming from the mouth) and extraoral(coming from other places apart from the mouth). Intraoral causes are more common(90%) than extraoral causes(10%). Intraoral causes include tongue coatings, periodontal disease(severe gum disease), poor oral hygiene, tooth decay, oral cancers, poor care of dentures, etc. Extraoral causes include infection in the tonsils(tonsillitis), nasal obstructions, chronic sinusitis, pneumonia, intestinal gas production, diabetes, liver failure, kidney failure as well as the use of certain long-term medications(amphetamine, disulfiram, etc.)
Pseudohalitosis is the 2nd group of halitosis that occurs in apparently healthy individuals when an obvious malodor cannot be perceived but the individual is convinced that he or she suffers from it.
Halitophobia is the 3rd group of halitosis and it is an exaggerated fear of having halitosis when there is no physical or social confirmation to suggest that the individual has it. It usually occurs after treatment of genuine halitosis and may also be associated with obsessive-compulsive disorder and psychosis.
In conclusion, a proper diagnosis by a dentist is key to successful treatment so instead of gargling your mouth with that mouthwash next to your bathroom sink or throwing some mints into your mouth, kindly visit your dentist. Dentistry is not expensive; negligence is.
AUTHOR: DR MICHAEL AWUA-MENSAH
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