Halitosis or bad breath is an unpleasant odour that emanates from the mouth. It is a common concern among patients with gum disease 

In 80 percent of cases of bad breath, the origin of the bad breath is in the mouth. The most common cause in the mouth is tongue coating  (43% of cases), followed by gum disease (11 % of cases), and a combination of the two (18% of cases). 

The compounds that are causing the bad odour are the end products of bacterial breakdown. The compounds that cause the most bad odour contain sulphur and are called volatile sulphur compounds (VSC’s). Hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide [(CH3)2S], are the main contributors to bad mouth breath. 

Non-sulphur containing volatile (airborne) compounds such as indole, skatole, amines and ammonia, contribute to halitosis but to a lesser extent.

A lot of patients with gum disease complain about bad breath.  Anaerobic (non-oxygen consuming) gram-negative bacteria, such as Porphyromonas gingivalis, Tanerella forsythia and Treponema denticola are usually found in patients with gum disease and are also associated with higher production of volatile compounds that cause bad breath. 

A recent study by Music et al in 2021 looked at data from 10 patients with gum disease and bad breath. They measured bad breath the old fashioned way by smelling the breath and they also used a portable sulphur monitor 

Bad breath was given a score as follows:  0: no appreciable odour; 1: barely noticeable odour; 2: slight, but clearly noticeable odour; 3: moderate odour; 4: strong odour; and 5: extremely foul odour

Tongue coating was given one of three possible scores. No coating was scored as 0, light coating as 1 and heavy coating as 2.

The extent of gum disease was evaluated by calculated the total inflamed and bleeding surface areas in the gums.

They found a significant relationship between bad mouth smell and bleeding gums. Bleeding gums are a sign of active gum disease with significant bacterial activity. 

They also a significant relationship between bad mouth smell and tongue coating. 

There was also a significant relationship between bad mouth smell and volatile sulphur compounds. 

So to reduce bad odour coming from the mouth it is important to reduce inflamed bleeding gums with home hygiene and regular cleaning. 

It is also important to reduce the coating on the tongue, since the tongue has a big surface are and can collect a coating of living and dead cells that release odour causing compounds. 

More details here: 

Musić L, Par M, Peručić J, Badovinac A, Plančak D, Puhar I. Relationship Between Halitosis and Periodontitis: a Pilot Study. Acta Stomatol Croat. 2021 Jun;55(2):198-206. doi: 10.15644/asc55/2/9. PMID: 34248153; PMCID: PMC8255038.

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