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Bad breath, or halitosis, is usually considered little more than a social faux pas, but it could in fact be a warning sign of a serious health problem.

“Bad breath needs to be addressed,” Nyoman Selvi, a dentist, said on Tuesday. “It not only affects the people around us and our interactions with them, but having bad breath can also point to a serious matter.”

She said halitosis could be caused by any number of illnesses, from pneumonia, bronchitis and chronic sinus infections, to liver and kidney problems and diabetes.

“Even people with gastritis can have bad breath because of high acid levels in their stomach,” said Nyoman, who practices at Puri Medika Clinic and Tugu Medika in Depok.

“Consistent bad breath cannot be regarded as a trifling matter,” she said during a weekly health discussion hosted by the KBR68H radio network.

“People tend to ignore bad breath because they believe it is not a serious issue. They think that they only need some mouthwash or a peppermint to make the smell disappear,” Nyoman said.

She added that halitosis could also be caused by constipation or chronic acid reflux.

“Basically, they have to fix their systemic problems to make the halitosis disappear,” she said.

“If bad breath persists even after brushing one’s teeth properly, flossing, using mouthwash and avoiding foods with strong odors such as onions and petai [stinky green beans], then it must be regarded as a sign of serious problems,” Nyoman said.

Dania Sari, not her real name, said she experienced regular halitosis despite brushing her teeth regularly, flossing and using mouthwash.

“I have tried everything, including chewing gum, but it just doesn’t go away. It only disappears for a while,” she said.

“I am ashamed and I think my boyfriend is annoyed by it,” she added.

Dania said her bad breath made her self-conscious, especially when meeting new people at social functions.

“I’m afraid that I will make the situation worse and they will smell something bad coming from my mouth.”

Nyoman said that 80 percent of halitosis cases were caused by mouth-related illnesses, but that few people here made regular visits to the dentist to look after their oral health.

Commonly, Nyoman said, halitosis is a warning sign of gum disease, caused by the buildup of plaque on teeth. If the gum disease goes untreated, it can lead to further damage to the gums and the jawbone.

She said bad breath could also indicate serious tooth decay, cavities, gingivitis and also dry mouth (xerostomia), which is caused by a lack of saliva.

Nyoman said halitosis could also be a symptom of oral cancer, which some studies have shown may be linked to the prolonged use of mouthwashes containing alcohol.

“Alcohol is dangerous and basically we have good bacteria in our mouth to keep it odorless,” she said. “All we have to do is brush our teeth properly and make sure all areas of our teeth are brushed, including the inner side.” She added that it was also important to brush the tongue.

“Please keep in mind that many of these mouthwashes only provide a temporary way to mask the unpleasant mouth odor.”