The subject is not even included in the standard textbook of pediatrics. Only few studies have been published in pediatric literatures.
But bad breath is a common concern not only in adults but also in children especially among adolescents resulting to embarrassing situations often with social consequences.
Children are honest. They will tell you straight that you have bad breath.
Others will give you signals like avoidance, letting you feel isolated.
Some will even cover their nose when you speak or open the windows in your presence.
Halitosis is the medical term for bad breath. Other names include: oral malodour, fetor oris or fetor ex ore.
It is defined as an offensive smell or odor of breath coming from the mouth, nose or airway.
Bromhidrosis is a generalized body odor or foul smelling sweat.
Halitophobia is an exaggerated fear by a person who believes that he has bad breath which in reality he doesn't have.
Often the fear is accompanied by psychologic problems that need psychologic evaluation and management.
Nature usually cleanses the mouth with the regular flow of saliva washing bacteria away from the surfaces of the oral cavity.
Decrease in the flow or stagnation of saliva several hours after meals and during the night result in bacterial multiplication leading to change in the odor of breath.
Conditions that result in xerostomia (dry mouth) such as low fluid intake, mouth breathing and talking for prolonged periods can result in bad breath.
Degradation of the mucous, food, oral debris (organic waste from dead or damaged tissues) and dental plaques (mixture of saliva, bacteria and carbohydrate on the surface of teeth) by bacteria present in the oral cavity result in the production of odorous volatile (readily evaporates at low temperature) gases, the cause of bad breath.
Halitosis is not a disease but a symptom of a variety of causes.
The common sources of bad breath involve the mouth, nose and throat.
Other sources include: liver, lungs, kidney problems; diabetes; medications; menstruation; H. Pylori infection of stomach and intestinal parasites.
In the mouth the common sites are the back of the tongue, the gums, between the teeth, dental decay such as abscessed teeth or dental caries.
Faulty dental restoration or poor fitting crowns where foods get impacted may result in bacterial multiplication resulting in degradation and putrefaction (decomposition of organic matter) leading to bad breath.
Gingivitis (inflammation of the gums with swelling sometimes with bleeding) and periodontal disease (disease of the structures supporting the teeth) are considered sources of bad breath.
The coating at the back of the tongue is another source of bad breath.
In children this is due to accumulation of mucous degraded by bacteria resulting in bad breath.
As the child grows the coating at the back of the tongue thickens increasing the incidence of bad breath.
Inflammation of the tonsils may be a source of bad breath in children.
The tonsillar crypts (deep depression or invagination of the tonsil) may be filled with food and oral debris.
Accumulation of these materials together with bacteria may become calcified froming small concretions that are foul smelling called tonsilloliths.
Tonsilloliths maybe coughed out like small yellow stones and when squeezed or broken will produce a very foul smelling yellow substance.
The nose is a common source of foul odor. Nasal obstruction such as nasal polyp, foreign body, tumor, adenoids and nasal infection such as sinusitis or rhinitis are the frequent causes of malodour coming from the nose.
Nasal obstruction that causes mouth breathing may cause bad breath.
Foreign body in the nose is quite common in young children and may be the source of bad odor coming from the nose.
Foreign body can be anything (beads, beans, seeds, small toy, part of toy, screws, eraser, paper, food, crayons, etc.) that the young child often introduces into his/her nose.
Foreign body stuck in the nasal passages will produce inflammation with exudation, infection and putrefaction eventually causing foul odor.
Sometimes children may complain of putting an object into the nose. Most often however the complaint is a unilateral (sometimes bilateral) foul-smelling purulent (sometimes with blood) discharge from the nose.
This presentation is so common that any child with foul-smelling nasal discharge should be considered to have a foreign body stuck in the nose causing nasal obstruction, retained secretions and infection.
Careful history taking will show that the child was playing with a small object before the onset of the symptoms. Further questioning will reveal that the object is now missing. X-rays are of limited value because most of the foreign bodies are not seen by X-ray (paper, cloth, sponge, food) unless the foreign body is opaque.
Foreign body in the nose maybe visible in the front portion of the nasal cavity.
In attempts to remove the foreign body, one should exercise extreme caution that the object should never be pushed backwards because of the danger that the foreign body may fall to the throat and becomes aspirated.
Small children should never be left alone playing with small objects, for they have the tendency to insert these objects into their orifices (mouth, nose, ears, rectum, vagina).
We have seen children with several foreign body encounters. In one child we have removed a watermelon seed in his left ear. After several weeks he swallowed a ten centavo coin.
Later on a fish bone was removed from his throat and after a year we extracted a calamansi seed from his right nose. We used to call him the "walking foreign body." Now, he is an architect practicing in the United States. (To be continued)
