Bad Breath

1 What is Bad Breath?

Bad breath is also called halitosis, and commonly results if you do not brush and floss every day.

The bacteria that accumulates between your teeth can give rise to the bad odor in the mouth.

Other oral health problems such as dry mouth, gum disease, and cavities may lead to bad breath.

Sinusitis or other nasal problems may also be the cause. Eating certain foods such as raw onions, garlic or cabbage, and smoking habits can develop bad breath.

Some medicines leave behind a particular odor in the breath. Having a bad breath can be very embarrassing and may be one of the reason for anxiety.

Temporary relief

There are various chewing gums, mints, and mouthwashes available in the market that claim to combat breath odor.

However, most of these products can provide temporary relief as they do not treat the underlying disorder that is causing bad breath.

Maintaining consistent and proper dental hygiene by brushing and flossing regularly can help improve your bad breath.

If self-care techniques do not provide a solution, consult your dentist or physician to check whether a more serious condition is the reason behind your bad breath.

2 Symptoms

Odors are the main symptoms of bad breath.

Bad breath may have different odors, depending on its source or the underlying disease condition.

Some individuals with bad breath may not even be aware of the problem while some people worry about their breath odor even though they have negligible or no breath odor.

Ask your close friend or relative to confirm the presence of odor in your breath, as it is often difficult to assess your own breath.

Try making lifestyle changes, such as drinking plenty of water, brushing your teeth and tongue after eating, and use an interdental floss.

Consult your dentist if your bad breath persists even after making such changes.

If your dentist suspects that a more serious disease condition is the reason for your bad breath, you may be referred to a physician for further investigation.

3 Causes

Most of the time, bad breath is a result of some kind of problem in your mouth, and there are many possible causes that include the following:

  • Food: The breakdown of food particles stuck in between your teeth may increase bacterial counts that cause a foul smelling odor. Eating certain types of foods such as raw onions, cabbage, garlic, and other spices may cause bad breath. Once these foods are digested, they gain entry into your bloodstream, which are then carried to your lungs resulting in a bad breath.
  • Tobacco products: Smoking may cause its own unpleasant odor in the mouth. Chronic smokers and users of oral tobacco products may also develop gum disease, which is another source of bad breath.
  • Poor oral hygiene: If you do not brush and floss every day, food remains in your mouth for long time causing a bad odor in your breath. A colorless, sticky layer of bacteria called plaque forms on the surface of your teeth and if it is not cleansed away regularly, plaque deposits can irritate your gums (gingivitis) and lead to the formation of plaque-filled pockets in the space between your teeth and gums (periodontitis). The uneven tongue surface may also trap odor releasing bacteria. Dentures that are not cleaned regularly or that do not fit accurately trap odor-causing bacteria and food particles.
  • Dry mouth: Saliva cleanses your mouth by removal of food particles that give rise to bad odor. A condition called xerostomia or dry mouth causes decreased production of saliva, which can contribute to bad breath. Dry mouth normally occurs during sleep, and is the cause of "morning breath," which is even bad if you sleep with your mouth open. Some medications may cause a chronic dry mouth, as well as problems with salivary glands.
  • Infections in your mouth: Bad breath may also be caused by surgical wounds after oral surgical procedures such as tooth extraction, or as a result of a decayed tooth, gum problems or oral ulcers/sores.
  • Other mouth, nose and throat conditions: Occasionally, bad breath may result from small stones formed in the tonsils that get covered by bacteria and release odor. Chronic inflammation in the nose, throat, or sinuses that cause postnasal drip can give rise to bad breath.
  • Medications: Certain medications can indirectly cause bad breath by contributing to dry mouth. Some medications metabolize in your body to release chemicals that impart a peculiar odor to your breath.

Other causes

Cancers and metabolic disorders can cause a distinct breath odor because of the chemicals they produce.

Chronic reflux of acids from the stomach (gastroesophageal reflux disease) is associated with bad breath.

In young children, bad breath may be a sign of entrapment of a foreign object such as a small toy or a food particle in a nostril.

4 Making a Diagnosis

Your dentist can help diagnose bad breath and can help identify the cause.

Dentists usually prefer to schedule morning appointments for the evaluation of bad breath.

This can decrease the chance of foods that you consume during the day from hindering the examination.

Eating, drinking, chewing gum or smoking is restricted for at least three hours before your appointment.

Do not apply perfume, scented lotions, or scented lipstick or lip gloss while going to your appointment, as these products can mask odors.

If you have taken antibiotics within the last month, check with your dentist to find out if your appointment needs to be rescheduled.

Your dentist will begin with an evaluation of your medical history by asking questions such as:

  • When did you first begin to experience bad breath?
  • Does your bad breath appear occasionally or is it continuous?
  • How many times do you brush your teeth or clean your dentures?  
  • How often do you use an interdental floss?
  • What kind of foods do you eat?
  • Do you take any medications or supplements?
  • Do you have any other health conditions?
  • Do you have a habit of breathing through your mouth?
  • Do you snore?
  • Do you have allergies or sinus problems?
  • Do you suspect anything as the cause for your bad breath?
  • Do other people notice or comment on your bad breath?

Your dentist will evaluate both the breath released from your mouth and from your nose to rate its odor on a scale.

As the back portion of the tongue is most likely source of the smell, your dentist may also scrape it and rate the odor.

Alternatively, sophisticated detectors are available to identify the chemicals causing the bad breath.

5 Treatment

The most important treatment of bad breath is consistent practice of good oral hygiene, which helps avoid dental cavities and decreases your risk of gum disease.

Further, the treatment for bad breath may be decided based on its underlying cause.

If your bad breath is believed to be caused from an underlying disease condition, your dentist will refer you to a primary care physician.

For causes related to your oral health, your dentist can help you manage the problem.

Dental measures include the following:

  • Mouthwashes and toothpastes: If your bad breath is from buildup of bacteria (plaque) on the surfaces of your teeth, your dentist may recommend an antibacterial mouthwash to kill the bacteria. Mouth rinses that contain ingredients such as cetylpyridinium chloride and chlorhexidine can help to prevent the production of odors that cause bad breath. Your dentist may also advise a toothpaste containing an antibacterial agent to get rid of the bacteria that causes plaque buildup.
  • Treatment of dental disease: If your dentist diagnoses a gum disease, you may be referred to a gum specialist (periodontist). Gum diseases result in retraction of the gums away from the teeth, leaving behind deep pockets that collect odor-causing bacteria. This bacteria can be removed only by professional scaling and cleaning done by your dentist. Your dentist might also recommend replacement of faulty teeth that can serve as a breeding ground for the bacteria.

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with

Here are some self-care tips that can help reduce or prevent your bad breath:

  • Brush your teeth after eating food: Keep a toothbrush at work to used every time after eating your meal. Brush your teeth using a fluoridated toothpaste at least twice in a day, partcularly after meals. Toothpaste with antibacterial properties can reduce bad breath odors.
  • Floss at least once in a day: Proper flossing technique helps to remove food particles and plaque stuck in between your teeth, and thereby helps to control bad breath.
  • Brush your tongue: Your tongue hold in several bacteria, so brushing the tongue gently may help reduce breath odor. People with a coated tongue resulting from a significant bacterial overgrowth may use a tongue scraper or use a toothbrush with a built-in tongue cleaner.
  • Maintain your dentures or dental appliances clean: If you wear a dental bridge or a partial or complete denture, clean it thoroughly at least once in a day or as directed by your dentist. If you wear a dental retainer or a mouth guard, clean it every time you place it back into your mouth. Your dentist will recommend the best cleaning product available.
  • Try to avoid dry mouth: Avoid the use of tobacco and drink lots of water to keep your mouth moist. Avoid coffee, soft drinks or alcohol, which can lead to dry mouth. Chew on gum or suck on a sugarless candy to stimulate the release of saliva. If you have a chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that can stimulate the salivary flow.
  • Modify your diet: Avoid the foods and beverages known to cause bad breath. Also minimize sticky and sugary foods.
  • Change your toothbrush at regular intervals: Replace your toothbrush as soon as its bristles become frayed or every three to four months, and use a soft-bristled toothbrush.
  • Regular dental checkups: Visit your dentist on a regular basis, usually once in 6 months to have your teeth or dentures examined and cleaned.