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Bad breath and halitosis in children
by Daniel Ravel DDS, FAAPD
Bad breath can be an embarrassing problem for children, as well
as parents. Bad breath, or halitosis, can be a symptom of
various conditions including: postnasal drip, dry mouth, dental problems,
and sinusitis. Halitosis in children is often due to the decomposition
of mucus secretions and debris which accumulate on the tongue,
in the nose, and between the teeth.
Halitosis is an offensive odor which comes from the mouth,
nose, or airway. It is also defined as exhaled air containing more than
75 parts per billion of odor-producing volatile sulfur compounds.
WHAT ARE THE SOURCES OF HALITOSIS IN CHILDREN?
Halitosis can be caused by oral sources, non-oral sources, and
psychological problems.
The source of halitosis is the oral cavity in up to 85% of
affected individuals. The most common odor-causing sites in the
mouth are: the dorsum (back) of the tongue, the area between the teeth,
and under the gum line.
The coating on the tongue usually consists of desquamated (shed)
epithelial cells, blood cells, and bacteria. It is possible for
more than 100 bacteria to attach to just one oral epithelial cell.
The worst oral odor occurs when many desquamating oral epithelial cells
are trapped in the plaque and crevices on the dorsum of the tongue.
Halitosis results from the action of specific bacteria
(gram-negative anaerobes) on oral debris and dental plaque.
Sulfur-containing substrates are eagerly devoured by these bacteria.
The bacterial breakdown of methionine and cysteine molecules
yields hydrogen sulfide and methylmercaptan both of which produce
bad breath. These volatile sulfur compounds (VSCs) have a rotten egg smell.
The oral conditions which predispose to the production of
bad breath are:
a decrease in the flow of saliva, stagnation of saliva, a
predominance of gram-negative anaerobes, an increase in the relative
amount of protein in the diet, a reduction in the relative amount of
carbohydrate in the diet, a rise in the oral pH to a more alkaline environment,
and an increase in the number of dead or necrotic oral
epithelial cells in the mouth.
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