Learn about possible causes of bad breath. How do you control bad breath or even eliminate it completely.

Bad breath, also commonly known as halitosis, is breath containing an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. Halitosis is a term used to describe a severe form of bad breath. It is important to note that it is normal human nature to have bad breath in certain situations.

Studies have shown that about 85% patients suffering from halitosis have an oral condition as the source. The oral condition could be anything from a tooth infection to gum infections. Poor oral hygiene is another common cause of bad breath. Infections of the sinuses or respiratory tract may occasionally cause a similar problem. If a person has healthy teeth and gums (i.e. no cavities, periodontitis, or abscesses), the next most common source of oral malodor is the tongue. Smoking is also a common cause of bad breath.

The production of bad breath (oral malodor) can be caused by various conditions and may involve both oral and non-oral sources. Non-oral sources of breath odor are generally related to systemic problems and/or medications. Conditions such as diabetes, liver and kidney disorders, and pulmonary disease may contribute to offensive breath odor. This is also true of some medications, especially those that reduce salivary flow such as antidepressants, antipsychotics, narcotics, decongestants, antihistamines, and antihypertensives. These non-oral sources of breath odor have been well reviewed in the literature. However, while systemic conditions and medications can contribute to breath problems, most authorities seem to agree the majority of bad breath originates in the oral cavity.

While the tongue is considered the primary source of odor producing bacteria, other dental problems can generate these offensive gases. Dental conditions such as gingivitis, periodontal disease(gum disease), cavities, active oral infections and poor oral hygiene have been shown to contribute to bad breath. If dental disease is the source of oral malodor, treatment of the condition will often eliminate the problem. Likewise, transient breath problems from dehydration, eating spicy foods, eating foods that give off an unpleasant odor, smoking or chewing tobacco, and drinking certain beverages will most often disappear shortly after their use is discontinued. While eliminating these sources can successfully treat the majority of patients who suffer from bad breath, some individuals continue to have chronic breath problems.

It has been estimated that up to 25% of the population suffer from bad breath on a regular basis in spite of having good physical and oral health and after the elimination of offensive foods and beverages.

Oral Causes of Bad Breath

  • Poor Dental Hygiene:
    • Infrequent or improper brushing and flossing can leave food particles to decay inside the mouth
    • teeth are covered with a white film called plaque, which harbors odor causing bacteria
    • food stuck between the teeth
    • Pale or swollen gums
  • Infections in the mouth:
    • Periodontal (gum) disease
    • Gums may be red, swollen and bleed easily, especially after brushing or flossing
    • Pus may drain from between teeth
    • A pocket of pus (abscess) at the base of a tooth
    • Loose teeth or a change in “fit” of a denture
    • Painful, open sores on the tongue or gums
  • Respiratory-tract infections:
    • Throat infections, sinus infections, lung infections
    • Sore throat
    • Swollen lymph nodes (“swollen glands”) in the neck.
    • Fever
    • Stuffy nose, or a greenish or yellowish nasal discharge
    • A mucus-producing cough
    • Salivary gland problems.  Lack of salivary flow can also cause difficulty swallowing dry foods, difficulty speaking for a prolonged period, a burning sensation in the mouth, an unusually high number of dental caries (cavities)
  • External agents:
    • Garlic
    • onions
    • coffee
    • cigarette smoking
    • chewing tobacco
  • Simple remedies for elimination of dry mouth (Xerostomia) and bad breath:
    • Chewing stimulates saliva and aids in cleaning out noxious bacteria
    • Purchase sugar-free candy or sugarless gum
  • Systemic illnesses associated with dry mouth:
    • Diabetes, kidney disease, lung disease, liver disease, sinus disease, reflux disease and others
    • Xerostomia  associated with dry eyes can be a sign of Sjogren’s syndrome
  • Psychiatric illness and bad breath:
    • Some people may perceive that they have bad breath, but it is not noticed by oral-health-care professionals or others. This is referred to as “pseudo-halitosis”

How to Treat Bad Breath

  • Bad breath caused by poor oral hygiene or dental problems can be easily treated and prevented. Daily brushing of your teeth, tongue and gums, brushing after meals, flossing daily, and rinsing with mouthwash, are a few simple steps you can take to eliminate bad odor. Bacteria thrive on food particles on our teeth to create Volatile Sulfur Compounds (VLCs), which cause bad breath. At least 2 minutes of brushing is necessary to properly clean all tooth surfaces. In addition 30% of the surfaces of our teeth are not cleanable with a brush
  • Regular visits to the dentist (twice a year) should be made for dental examinations and for a professional teeth cleaning. Systemic management of halitosis includes antibiotics, nasal mucous control methods, avoidance of certain foods and medications, salivary substitutes, and management of systemic diseases
  • Bad breath caused by a systemic condition or medications can be dealt with by treating the underlying condition or changing medications
  • Bad breath caused by smoking or consumption of certain foods can be prevented by eliminating these offending agents

Controlling Bad Breath

  • Improve oral hygiene through regular brushing and flossing
  • Drink plenty of water every day to encourage saliva production. An occasional swish of the mouth with water can loosen food particles.
  • Other products that keep your breath fresh throughout the day and prevent plaque from forming include:
    • sugar-free gum
    • sugarless lozenges
    • raw carrots and celery
  • Call your dentist or physician if your bad breath persists despite a good diet and proper dental hygiene.

Morning Breath is Normal

  • Some types of bad breath, such as “morning mouth,” are considered to be fairly normal, and they are usually not health concerns. The “morning mouth” type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor
  • It may be difficult if not impossible for an individual to know they have bad breath because of a constant flow of bad smells from the mouth

Cryptic Tonsils

Another less common cause of bad breath can be cryptic tonsils or chronic cryptic tonsillitis. The tonsils function as part of the immune system defense against invading organisms. Because of the wrinkly surface the tonsils are able to “sample” things that are being swallowed. This process is uneventful with normal tonsils. If however, the tonsils get slightly inflamed they start catching food particles that pass by while being swallowed. These food particles are difficult to remove. The rotting food and byproducts of bacteria cause the bad odor. Doctors will usually prescribe an antibiotic to reduce the size of the tonsils, however this is usually a temporary solution as the cryptic tonsils comes back. For any person that suffers from this condition regularly, surgical removal of tonsils is recommended.

Self-Consciousness: A Barrier to Communication

Regardless of the source of oral malodor, chronic breath problems can be detrimental to one’s self-image and confidence causing social, emotional, and psychological anxiety. The problem of assessing and treating oral malodor is exacerbated by the personally sensitive nature of the topic. Even in close relationships, people are often reluctant to inform others their breath is offensive. Asking a trusted confidant or experienced health professional is considered the most reliable method of confirming a chronic breath odor problem. This however, can be awkward and embarrassing for both the patient and the dental professional, who historically has been hesitant to bring up the subject. Since the dental office is the most logical place to assess and treat oral malodor, it is important to develop a relationship with your oral health provider who can provide you with information that specifically pertains to you.