Bad breath (halitosis), is a symptom in which a noticeably unpleasant odor is present on the exhaled breath. Concern about bad breath is estimated to be the third most frequent reason for people to seek dental care, following tooth decay and periodontal disease (gum disease), and about 20% of the general population are reported to suffer from bad breath to some degree.
Bad breath is a common problem that can affect anyone at any age. About one in four people are thought to have bad breath (halitosis) on a regular basis.
Certainly bad breath can ruin relationships and sometimes, a person’s bad breath can blow you away, and he or she may not realize there’s a problem. There are nice ways of letting someone know about bad breath. You could offer mints or sugarless gum without having to say anything.
What Causes Bad Breath?
There are no statistics on what percentage of the population has bad breath. That’s because studies usually rely on someone reporting whether or not they think they have bad breath and may not be accurate.
But studies show that about 80% of bad breath comes from an oral source. For instance, cavities or gum disease can lead to bad breath, as can tonsils that have trapped food particles; cracked fillings, and less-than-clean dentures.
Several internal medical conditions also can cause your breath to go downhill fast. They include diabetes, liver disease, respiratory tract infections, and chronic bronchitis. You’ll want to see your doctor to rule out things like acid reflux, postnasal drip, and other causes of chronic dry mouth (xerostomia).
Woodall recalls a 30-year-old patient who had chronic bad breath, though her teeth were “immaculate” and her tongue was very clean. Her doctor tested her for acid reflux and other stomach conditions, “gave her some medicine, and her bad breath went away,” Woodall says.
Other common causes are listed below:
- Food: Food is a primary source of bad odors that come from the mouth. Some foods, such as garlic, onions, and spicy foods, exotic spices (such as curry), some cheeses, fish, and acidic beverages such as coffee can leave a lingering smell. Most of the time this is short term. Other foods may get stuck in the teeth, promoting the growth of bacteria, which causes bad breath odor. Low carbohydrate diets may also cause “ketone breath.” These diets cause the body to burn fat as its energy source. The end-product of making this energy is ketones, which cause a fruity acetone-like odor on the breath when exhaled.
- Tobacco products: Smoking and chewing tobacco can leave chemicals that remain in the mouth. Smoking can also precipitate other bad-breath causes such as gum disease or oral cancers.
- Poor dental hygiene: When a person does not brush or floss regularly, food particles remaining in the mouth can rot and cause bad odors. Poor dental care can lead to a buildup of plaque in the mouth, which causes an odor of its own. Plaque buildup can also lead to periodontal (gum) disease. The mild form of gum disease is called gingivitis; if gingivitis is not treated, it can advance to periodontitis.
- Health problems: Sinus infections, pneumonia, sore throat (pharyngitis) and other throat infections, thrush, bronchitis, postnasal drip, diabetes, acid reflux, lactose intolerance, other stomach problems, and some liver or kidney diseases may be associated with bad breath.
- Dry mouth: Also called xerostomia, dry mouth can also cause bad breath. Saliva helps moisten and cleanse the mouth, and when the body does not product enough saliva, bad breath may result. Dry mouth may be caused by salivary gland problems, connective tissue disorders (Sjögren’s syndrome), medications, or breathing through the mouth.
- Mouth infections: Cavities, gum disease, or impacted teeth may cause bad breath.
- Dentures or braces: Food particles not properly cleaned from appliances can rot or cause bacteria and odor. Loose-fitting dentures may cause sores or infections in the mouth, which can cause bad breath.
- Medications: Many medications, including antihistamines and diuretics, can cause dry mouth (see above), which can cause bad breath. Other medications that may lead to bad breath may include insulin shots, triamterene (Dyrenium), and paraldehyde.
- Morning breath: Bad breath in the morning is very common. Saliva production nearly stops during sleep, which allows bacteria to grow, causing bad breath.
- Other causes of bad breath: Objects stuck in the nose (usually in children), alcoholism, and large doses of vitamin supplements may also cause bad breath.
Symptoms
Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don’t know it. Because it’s difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions.
Do I have bad breath?
It’s not always easy to tell if you have bad breath. Other people may notice it first, but could feel uncomfortable telling you.
A simple tests to find out whether you have bad breath is:
- Lick the inside of your wrist with the back of your tongue and wait for a few seconds until the saliva dries. If your wrist smells unpleasant, it’s likely your breath does too.
- Use a teaspoon, turn it up-side-down and scrape the back of your tongue to collect some of the “white stuff” that is there. Smelling this will tell you what others smell on your breath. You can also use your fingernail to scrape the back of your tongue and collect some “white stuff” to smell.
- Some people can smell their own breath by cupping a hand over your mouth and breathe out through your mouth and then breath in through your nose. This method is not as reliable as the spoon method.
When to seek medical help?
If you have bad breath, review your oral hygiene habits. Try making lifestyle changes, such as brushing your teeth and tongue after eating, using dental floss, and drinking plenty of water.
If your bad breath persists after making such changes, see your dentist. If your dentist suspects a more serious condition is causing your bad breath, he or she may refer you to a physician to find the cause of the odor.
Bad Breath Treatment
Specific medical treatment to cure bad breath depends upon the cause.
In patients who suffer from dry mouth (xerostomia), artificial saliva may be prescribed by a dentist.
Dentists can also prescribe special toothpaste and mouthwash that can improve the symptoms of bad breath.
Follow-Up
Follow all instructions provided by the dental or medical professional, and use any prescribed mouthwash or toothpaste as directed.
If the patient’s dentist determines that the bad breath odor is not of oral origin, the patient may be referred to a physician.
If the odor is due to gum disease, the dentist may refer the patient to a periodontist, who specializes in treating gum conditions.
Treating and preventing bad breath
Improving oral hygiene is usually enough to cure bad breath and prevent it happening again.
Your dentist can advise you about ways to improve your oral health and will recommend:
- regularly brushing your teeth and gums
- flossing between your teeth
- keeping your tongue clean
Bad Breath Prevention
Good oral care, regular dental visits, stopping tobacco use/smoking, and avoiding certain foods can prevent most cases of bad breath.
