Halitosis

About the Disorder

Halitosis, bromopnea and foetor ex ore are all synonyms indicating a problem generally commonly referred to as “bad breath”. While it is surely overstating the case to say this is a “pathology”, in its most marked and persistent forms the problem is certainly felt to the point that it can strongly influence the life of the patient affected, particularly in a society such as ours in which personal image plays such an important role in interpersonal relationships.

Proof of the economic and social relevance of the problem is, on the one hand, the growing demand for medical examinations, medical treatment and dental care for the diagnosis and resolution of halitosis; on the other hand, the enormous consumption of products to fight halitosis, ranging from toothpaste to mouthwashes, to mints and chewing-gum.

Causes and factors originating halitosis

Bad breath can originate for a number of reasons and be connected to different physiological conditions. Even if it is undoubtedly the mouth the organ directly involved in the symptom of halitosis, the origin of the affection is not always limited to the mouth only. A distinction therefore needs to be made between:

  • factors that are permanently present, responsible for causing bad breath and which are to be found directly in the oral cavity;
  • different “upstream” causes, that may be connected to several factors and/or affections involving various organs and apparatuses.

PERMANENT FACTORS

In all cases of halitosis, recent studies have identified common symptomatic factors, i.e. an excessive bacterial profileration,coupled with the presence of sulphur compounds in the oral cavity.

Excessive bacterial proliferation in the oral cavity

The organism’s mucosae are always equipped with  protective, physiological bacterial flora, and as such the mucosa in the oral cavity is no exception. However, balances regulating life and functionality of such biofilms are very labile and can be easily disrupted by external or internal events that can increase bacterial proliferation.

In the specific case of oral mucosa, many different factors interfere with bacterial growth: lowering of pH levels in the oral cavity following food intake, for instance, is one of the main causes of bacterial proliferation; in fact, anaerobic bacteria in particular find their ideal habitat when pH is acid, a condition encouraging rapid proliferation. Food residues stagnating in the oral cavity after meals also become a source of nourishment for bacterial species inhabiting the area, thereby promoting their proliferation.

For that matter, the anatomy of the mouth itself, typically irregular in its structure both because of natural features (due to the presence of furrows, papillary and tongue evagination for instance), and owing to pathological conditions (gingival pockets, caries,…), makes it impossible for certain internal areas to be accessed by even the most accurate oral hygiene. This encourages bacterial proliferation more than in other anatomical districts. But the real reasons for an increased microbial proliferation aren’t to be found in the oral cavity itself.

Very often, pathological situations or insufficient functioning of certain organs or apparatuses can result in increased bacterial proliferation not only in the organ directly involved, but also at the level of the oral cavity. For instance, it has been highlighted that the presence of Helycobacter pylori at gastric level causes an overgrowth of oral bacteria and that intestinal Candida is closely related to the insurgence of the typical white coating on the tongue, the clear visible sign of increased microbial proliferation.

But why does this correlation exist between the increased bacterial proliferation and halitosis? The answer is simple: as already mentioned, food residues remaining in the oral cavity after meals, or in any case any proteic residue located in the mouth (for instance: saliva, blood coming from caries or gingival bleeding, cells flaking off…) turn into nourishment for the buccal bacterial colonies, acting as a substrate for metabolic, fermentative transformations that cause the release of sulphur compounds in the oral cavity.

Presence of sulphur compounds

Sulphur is an odourless non-metal in nature which, however, is characterised by the typical smell of foul eggs whenever it takes the form of salts. Compounds containing sulphur are therefore recognizable by their bad smell and can be found in the oral cavity for several reasons and through different metabolic routes. As already mentioned, a first cause explaining the presence of sulphur compounds in the mouth is bacterial proliferation which, through fermentation of proteic substrates, produces compounds such as methylmercaptan (smell resembling decomposed cauliflower),  hydrogen sulphide (smell of foul eggs), isovaleric acid (smell similar to sweaty feet), etc.

Another factor originating the formation of sulphur compounds in the oral cavity – perhaps the most ordinary one – , is the consumption of halitosis related foods, rich in ill-smelling essential oils and sulphurate active principles; other factors commonly involved are the consumption of alcohol or smoke, which not only release sulphurate compounds directly at oral cavity level, but they also determine  an alteration of metabolic processes in the long run, resulting in the development of halitosis due to organic causes.

 DIFFERENT “UPSTREAM” CAUSES

Different triggering factors can be identified, classifying them into three groups based on the anatomical and/or functional district involved:

  • halitosis related to problems of the upper and lower airways
  • halitosis related to gastric problems
  • halitosis related to depuration problems and fermentation processes

HALITOSIS RELATED TO UPPER AND LOWER AIRWAYS  

HALITOSIS RELATED TO GASTRIC PROBLEMS HALITOSIS RELATED TO DEPURATION PROBLEMS AND FERMENTATION PROCESSES

• Smoking
• Tonsillitis, acute or chronic Sinusitis
• Poor oral hygiene

• Caries, Gengivitis, Stomatitis, Parodontitis
• Dental implants and prosthesis
• Microbic coating on the tongue
• Insufficient salivation
after night rest (morning halitosis), mouth breathing, prolonged phonation

• Bad digestion
• Functional Dyspesia• Helicobacter pylori
• Gastro-esophageal reflux
• Diet rich in animal proteins (meat, eggs, dairy products)
• Intestinal parasitic infections
• Intestinal Candida
(white coating on the tongue)
• Food intolerances
• Enteric problems of various kinds  (ulcerative colitis, Crohn’s disease, etc.)
• Hepatopathy, renal insufficiency• Menstrual cycle
• Alcohol, pharmacological therapies
• Diabetes, Ketonaemia
• Prolonged fasting
• Halitosis related foods (onion,garlic, etc.)

Based on the above description regarding on the one hand factors permanently present and, on the other, different “upstream” causes, it is clear how an effective approach on the topic of halitosis needs to provide for a method applicable … in both directions.

Instead, taking action only to fight the symptom, by using mint capsule and sweets as breath fresheners, or trying to improve one’s oral hygiene, as is often the case,  only “cushions” the symptom without actually solving the problem definitely.

Nature can once again be of great help, offering specific elements with proven efficacy, skillfully combined to act not only against the symptom but on the actual “upstream”, root causes.

Nature can help you in case of halitosis

Our Approach

A natural and effective approach

Solving the problem of halitosis is often very difficult. Once again, nature can be of great help, thanks to the use of Grapefruit Seed Extract (GSE), the antimicrobial efficacy of which has been confirmed by numerous studies and applications.

GSE and halitosis

Grapefruit Seed Extract has exceptional broad spectrum antimicrobial properties: in fact, it is active over 800 bacterial strains (both Gram+ and Gram-), as well as over 100 strains of yeasts and moulds (including Candida), besides  numerous viruses and parasites. What’s moreoever most surprising and that finds no equal in the natural world, is GSE’s selectivity, as has been proven by a study published in the “Journal of Orthomolecular Medicine” Vol.5 n° 3 of 1990. In fact, while GSE is active against pathogens, it remains almost harmless towards physiological bacteria and therefore does not significantly alter physiological bacteria defending the mucosae. These properties make it the ideal ingredient for hygienising the oral cavity in order to effectively counter microbial proliferations and fermentations causing bad breath. Hence, the usefulness of GSE against halitosis primarily regards its activity at oral cavity level, when included in appropriate formulations conveyed in tablets to be dissolved in the mouth.

At any rate, GSE carries out a systemic action: in particular, whenever there are factors causing halitosis that are connected to intestinal fermentation, its activity as a “selective cleanser” turns out to be particularly useful in correcting the intestinal dysbiosis originating the disorder. The use of GSE is particularly recommended even when halitosis is connected to gastric problems. In fact, Grapefruit Seed Extract has shown to be effective in providing gastric protection and in accelerating healing processes of damaged gastro-intestinal mucosae, besides being active against Helicobacter Pylori. Hence, GSE once again represents a valid aid for all gastric problems, potentially involved in originating halitosis (reflux, functional dyspepsia, H. Pylori etc.).

For the above reasons, GSE therefore represents the cornerstone of an extraordinarily effective approach against halitosis, combined with specific vegetable extracts; in particular, Xylitol turns out to be particularly useful owing to its direct action against the specific symptom.

Xylitol and halitosis

Xylitol, an extract from Betula Pendula, is a polyalcohol with 5 atoms of carbon to be found in vegetable fibres and in fruit. With the same sweetening power of sucrose, yet with a definitely lower calorie intake, Xylitol has the great virtue of inhibiting the proliferation of microorganisms in the oral cavity: it therefore not only carries out an anti-caries action while protecting the gums but also offers a marked anti-halitosis effect.

Its properties are mainly attributable to its activity of rebalancing the level of pH in the oral cavity (and consequently inhibiting microbial fermentation) on the one hand; on the other, it stimulates salivation, ensuring  increased “cleansing” of the oral cavity and consequent elimination of microorganisms producing ill-smelling sulphur compounds.

For the above considerations, GSE and Xylitol are of fundamental importance in hygienising the oral cavity, since they effectively contrast microbial proliferation and fermentation, rebalancing pH levels and simulating salivation: this prevents the formation of foul-smelling sulphur compounds, responsible for bad breath.

This good alliance of GSE with Xylitol therefore represents the essential combination enabling the resolution of the “symptom” called halitosis. To this couple of elements, which is always present, specific vegetable extracts have been added, in order to formulate three different products with the aim of contrasting the differente causes of halitosis. Inclusion of specific aromas completes the anti-halitosis action. The following table identifies specific actions and related vegetable extracts necessary to act against the different causes effectively.

HALITOSIS RELATED TO UPPER AND LOWER AIRWAYS   HALITOSIS RELATED TO GASTRIC PROBLEMS    HALITOSIS RELATED TO DEPURATION PROBLEMS AND FERMENTATION PROCESSES   
To promote functionality of the airways through specific ingredients:

• Myrrh resin
• Mauve root
• Hedge mustard flowered plant

To promote digestive processes and gastric functionality through use of specific ingredients:   • Rhubarb root
• Liquorice root
• Cardamom fruits
To promote purification of the organism and elimination of intestinal gases through specific functional components:

• Milk thistle fruit
• Achillea aerial parts

By matching specific ingredients (considering their activity on the causes) to the essential combination of GSE and Xylitol (for their activity on the symptom), three different approaches are obtained, each one suitable for a specific requirement:

IN CASE OF HALITOSIS RELATED TO THE UPPER AND LOWER AIRWAYS    

In order to take action against the symptom (countering the formation of foul-smelling sulphur compounds and refreshing the breath)  and on upstream causes (promoting physiological functionality of the airways)…

Nature can help you with…

Action against the symptom

Grapefruit Seed Extract: thanks to its marked, selective antimicrobial action, GSE effectively contrasts microbial proliferations and fermentations, which are responsible for bad breath.

Xylitol: it rebalances  pH levels and stimulates salivation, inhibiting microbial fermentations and contrasting formation of foul-smelling sulphur compounds.

Mint and Lemon (natural fragrances and essential oils): added to the formulation in appropriate concentrations, these ingredients effectively add fragrance and deodorize the breath, giving the product a fresh taste and contrasting bad breath in a direct way.

Action against “upstream” causes related to the upper and lower airways 

Myrrh: gum resin extracted from Commiphora myrrha, it contains terpenic active principles (dipentene, limonene, delta-epinene, eugenol, cadinene, cresol and cinnamic aldehyde) with beneficial properties against inflammation of the mucosae. Myrrh is a particularly useful remedy in case of irritations and inflammations of the airway mucosa, whether due to smoking or to affections such as sinusitis and tonsillitis, or originating from gingival or dental problems of different origin and nature.

 Altea: rich in mucilages and pectins, it exerts an emollient and decongestant action on the mucosae in both acute and chronic catarrhal forms, as well as in irritative affections of the airways. Altea root is therefore indicated in the treatment of all problems related to the airways that are connected to the insurgence of halitosis for different reasons.

Hedge Mustard: known as the “Singer’s plant”, hedge mustard has antispasmodic, anti-inflammatory, mucolytic and expectorant properties and is therefore indicated in all affections of the airways, both acute and chronic.

These vegetable ingredients are best conveyed in pratical, pleasant-tasting chewable tablets (both for their action on the symptom and on its causes).

 IN CASE OF HALITOSIS RELATED TO GASTRIC PROBLEMS   

In order to act against the symptom (countering the formation of foul-smelling sulphur compounds and refreshing the breath)  and on upstream causes (promoting physiological functionality of the airways)…

Nature can help you with…

Action against the symptom 

Grapefruit Seed Extract: thanks to its marked, selective antimicrobial action, GSE effectively contrasts microbial proliferations and fermentations, which are responsible for bad breath.

Xylitol: it rebalances pH levels and stimulates salivation, inhibiting microbial fermentations and contrasting the formation of foul-smelling sulphur compounds.

Liquorice (natural aroma) and Cardamom (natural essential oil): added at adequate concentrations, they effectively freshen and deodorize the breath, giving the product a strong and pleasant taste at the same time, contrasting the problem of bad breath directly.

 Action on causes related to gastric problems  

Rhubarb: with an extremely rich phytocompound, rhubarb is an excellent stomachic and eupeptic ingredient; in fact, it stimulates gastric secretion and motility, enhancing both digestion and gastric emptying, functions that are considerably slowed down in case of dyspepsia or gastritis.

Cardamom: the high content of terpenic molecules gives the product marked beneficial properties on the gastro-intestinal tract; its principal actions are: eupeptic, as it stimulates the digestion;  carminative, so much that cardamom extract is among the most important ingredients in phytotherapy in case of non inflammatory, chronic dyspepsia. Not least, due to its essential oil, cardamom exerts a significant antiseptic action, particularly effective against bacterial species colonising the digestive tract.

Liquorice: with its emollient and anti-inflammatory activity, liquorice has well-known beneficial properties for the gastric mucosa (particularly with its anti-ulcer action), mainly due to the presence of glycyrrhizin and flavonoids.

These vegetable ingredients are best conveyed in practical, pleasant-tasting chewable tablets (both for their action on the symptom and on its causes).

IN CASE OF HALITOSIS RELATED TO DEPURATION PROBLEMS AND FERMENTATION PROCESSES   

In order to act against the symptom (countering the formation of foul-smelling sulphur compounds and refreshing the breath) and on upstream causes (promoting the organism’s depuration processes and elimination of intestinal gases).

Nature can help you with…

Action against the symptom

Grapefruit Seed Extract: thanks to its marked, selective antimicrobial action, GSE effectively contrasts microbial proliferations and fermentations, which are responsible for bad breath.

Xylitol: it rebalances pH levels and stimulates salivation, inhibiting microbial fermenations and contrasting the formation of foul-smelling sulphur compounds.

Cinnamon (natural flavour and essential oil): cinnamon flavour and essential oil, included in the formulation in appropriate concentrations, refresh and deodorize the breath effectively, giving the product a firm, pleasant taste and contrasting the problem of bad breath in a direct way.

Action on causes related to depuration problems and fermentation processes   

Milk Thistle:   rich in flavolignan substances (silimarin, silybin, silicristin) it has marked properties for hepatic protection and depuration. Moreover, it has a marked antioxidant activity, capable of improving the organism’s general efficiency also in case of chronic problems.

Achillea: the beneficial properties that Achillea exerts at systemic level, thanks to the synergy of all the functional elements present in the phytocomplex, are mainly: spasmolytic, carminative, choleretic and anti-hepatotoxic. These properties are proven by studies that have confirmed in vivo Achillea’s ability to stimulate biliary excretion and to lower the level of transaminase in the blood stream due to liver failure. Due the combination of these properties, Achillea is used in gastrointestinal disorders presenting flatulence and cramps, as well as a depurative of the organism.

These vegetable ingredients are best conveyed in practical, pleasant-tasting chewable tablets (both for their action on the symptom and on its causes).