Bad Breath

1 Bad Breath Summary

Bad breath or halitosis is a very common problem and is seen one in four people worldwide. It is one of the most common reasons for visiting a dentist’s office, next only to tooth decay and gum disease.

Bad breath causes considerable embarrassment and anxiety in some people. The main issue with bad breath is that the affected person may not notice it unless pointed out by others. The bad odor is produced by the bacteria that build up in the space between teeth in the mouth. Many other problems may also lead to bad breath.

For some people, morning breath is the only problem and this solves with proper brushing. Some people have dry mouth that results in bad breath.

The breath odor may vary depending on the underlying cause of the symptom. Five different types of bad breath are commonly recognized – breath smelling like moth balls, fruits, sour milk, dirty diaper, and rotting.

The bad breath may arise from causes within the mouth, by the accumulation of debris or germs in the mouth.

Most common causes for the buildup of germs and debris in the mouth are: 

  • Food stuck in the space between teeth
  • Gum disease
  • Plaque and tartar
  • Coating containing bacteria present at the back of tongue
  • Tonsil stones

Reduced flow of saliva, or dry mouth, may also result in bad breath. This condition resolves with hydration, or when the underlying medical condition that cause dryness of mouth is solved. Many foods, medicines, and drinks are known to cause a foul smell in a breath. For example, garlic, spicy foods and alcoholic drinks are known culprits for bad breath. Many medications are also implicated in the development of bad breath. This includes chloral hydrate, nitrites, and some chemotherapy medications. Smoking is yet another important cause of bad breath. Crash dieting and fasting release ketones which give a sickly smell to the breath. Many medical conditions also result in halitosis. This includes polyps in the nose, sinusitis, and fish odor syndrome.

Many foods, medicines, and drinks are known to cause a foul smell in a breath. For example, garlic, spicy foods and alcoholic drinks are known culprits for bad breath. Many medications are also implicated in the development of bad breath. This includes chloral hydrate, nitrites, and some chemotherapy medications. Smoking is yet another important cause of bad breath. Crash dieting and fasting release ketones which give a sickly smell to the breath. Many medical conditions also result in halitosis. This includes polyps in the nose, sinusitis, and fish odor syndrome.

This includes chloral hydrate, nitrites, and some chemotherapy medications. Smoking is yet another important cause of bad breath. Crash dieting and fasting release ketones which give a sickly smell to the breath. Many medical conditions also result in halitosis. This includes polyps in the nose, sinusitis, and fish odor syndrome.

During diagnosis of the underlying cause of bad breath, doctor depends on the odor of breath from mouth and nose. Presently, many detectors are used to identify the chemicals that cause bad breath. This includes halimeter, gas chromatography, BANA test, and beta-galactosidase test.

Good oral hygiene is the best way to reduce and prevent bad breath. Best oral practices help to reduce the sticking of food onto the space between teeth, and also the probability of gum diseases. Home remedies to reduce bad breath include flossing, brushing, clean dentures, brushing tongue, avoiding dry mouth, and a well-balanced diet. Toothpaste and mouth wash containing antibacterial agents are recommended to control the symptom. Bad breath that persists even after home remedies needs a dentist’s visit. This is to diagnose the underlying condition that causes bad breath. Medical conditions that cause bad breath needs specific treatment for resolving the symptom. Quit smoking, if that is the cause of bad breath. Alcohol, coffee, and sugary drinks should be reduced as much as possible.

Home remedies to reduce bad breath include flossing, brushing, clean dentures, brushing tongue, avoiding dry mouth, and a well-balanced diet. Toothpaste and mouth wash containing antibacterial agents are recommended to control the symptom. Bad breath that persists even after home remedies needs a dentist’s visit. This is to diagnose the underlying condition that causes bad breath. Medical conditions that cause bad breath needs specific treatment for resolving the symptom. Quit smoking, if that is the cause of bad breath. Alcohol, coffee, and sugary drinks should be reduced as much as possible.

Bad breath that persists even after home remedies needs a dentist’s visit. This is to diagnose the underlying condition that causes bad breath. Medical conditions that cause bad breath needs specific treatment for resolving the symptom. Quit smoking, if that is the cause of bad breath. Alcohol, coffee, and sugary drinks should be reduced as much as possible.

2 Causes

Bad breath may be caused by:

Tobacco – products containing tobacco are implicated in foul mouth odor. Moreover, tobacco products increase the chances of gum disease, which further increases bad odor in the mouth.

Dry mouth – decreased the flow of saliva in mouth reduces natural mouth cleansing, leading to dry mouth and bad breath. Dry mouth is usual after sleep as mouth gets dry and stagnate overnight. This may resolve on its own in the morning when saliva flow resumes.

Dry mouth may also be caused by dehydration, certain medications, and radiotherapy of head and neck region. Some medical conditions like Sjögren's syndrome are known to cause dryness in the mouth.

Foods – Certain food contains chemicals that escape along with exhaled air. Garlic, spicy foods and alcoholic drinks are some examples of these foods.

Some medications also cause bad breath including:

  • Chloral hydrate
  • Dimethyl sulfoxide
  • Disulfiram
  • Phenothiazines
  • Amphetamines
  • Chemotherapy medications
  • Nitrites and nitrates

Smoking – smoking is a common cause of bad breath, and it is easy to distinguish a non-smoker from a smoker. Smoking also increases the risk of gum diseases, a common cause of bad breath.

Dieting and fasting – crash dieting and fasting lead to the production of ketones by breaking down fats. This leads to a sickly smell in a breath as ketones are breathed out with exhaled air.

Medical conditions – Nasal problems like polyps, sinusitis, foreign object stuck in the nose may all cause bad breath. Mouth, throat and tonsil infections are also implicated in the development of bad breath.

These medical conditions are always associated with other symptoms like fever, sinus pain, and blocked nose. Fish odor syndrome is a rare medical condition that causes a bad odor in breath and body. This results from the inability of the body to break down trimethylamine present in certain foods.

Dental hygiene – germs and debris accumulating in the mouth are the most common cause of bad breath. Bacteria in the mouth break down the proteins in the mouth, releasing chemicals that contribute to the bad smell in the breath.

This may result from food stuck in the space between teeth, plaque, tartar, and gum disease. In some people, mucus may drip from the back of the mouth forming a coat on the tongue.

This coat contains bacteria that contributes to the bad breath in the mouth. Plaque, a whitish coat that forms on teeth surface, contain bacteria that cause bad breath. Infection and inflammation of the tissue surrounding teeth cause gum disease.

Small stones that form in the tonsil crevices are also implicated in bad breath. These stones called tonsil stones or tonsilloliths are mostly formed of calcium, magnesium, or phosphorous.

Some rare causes of bad breath include: 

  • Bowel obstruction – bowel obstruction may lead to persistent vomiting, leading to bad breath. The breath may smell like a dirty diaper.
  • Chronic kidney failure – this condition leads to the accumulation of waste materials in blood, causing urine- or ammonia-like smell in a breath.
  • Bronchiectasis – this condition is characterized by wider-than-normal airways which allow buildup of mucus. This accumulation of mucus in airways causes a foul smell in the breath.
  • Aspiration pneumonia – infection of lungs due to inhalation of vomit, saliva, food, or liquids leads to aspiration pneumonia, a rare cause of bad breath.

3 Diagnosis and Treatment

The smell of breath from nose and mouth is used in the diagnosis of the underlying cause of bad breath. The dentist usually rates the smell from the two regions on an odor intensity scale. Scrapings from the back of the tongue may also be taken for identifying the cause of bad breath.

Specialized detectors are now available to identify the causative chemical of bad breath, this includes: 

BANA test – this test is used to measure the amount of enzyme produced by the bacteria accumulated in the mouth.

Halimeter – this detector is used to measure the levels of Sulphur in a breath. Gas chromatography detects three different volatile compounds of Sulphur including hydrogen sulphide and methyl mercaptan.

Beta-galactosidase – beta-galactosidase enzyme is related to bad odor in the mouth. This test measures the level of enzyme in the mouth.

Good oral hygiene is the best way to treat bad breath. Good oral practices reduce the chances of cavities and gum diseases. Other treatment options for controlling bad breath may depend on the underlying cause of the symptom.

If the bad breath is caused by a medical condition, specific treatment may be recommended to reduce the foul smell in a breath. The dentist may refer to a primary physician or a specialist for treating the underlying condition.

Routine oral hygiene should include brushing teeth and cleaning the space between teeth. Teeth should be cleaned twice a day using a soft brush. Special care should be taken to clean the area where teeth meet the gum.

Brushing just before eating or one hour after eating helps to prevent erosion of tooth. Cleaning the space between teeth, twice a day helps to prevent the formation of plaque. Flossing is the best way to clean the space between teeth. This helps to remove the debris that gets stuck in the space.

Food and drinks are common causes of bad breath, to avoid this: 

  • Reduce the number of sugary drinks and foods
  • Reduce fizzy drinks and fruit juices as they increase the acid contact of teeth. Drinks that are low on acids like milk, tea, and coffee are better.
  • While drinking fruit juices, drink without swishing the content inside the mouth to reduce acid contact.
  • Avoid brushing within an hour of vomiting. This is because vomiting may contain a part of stomach acid in them and brushing may help to spread the same within the mouth.
  • Quit smoking as it increases the chance of bad breath and gum disease
  • Use sugar-free medicines
  • Have regular dental check-ups

Persisting bad breath may be treated with mouthwashes and tongue cleaning. Mouthwashes with antibacterial agents help to prevent the buildup of bacteria in the mouth. Clean the back of tongue every day to remove the bacterial coat at the back.

Chewing sugar-free gum is also found to be good in reducing bad breath. It increases the flow of saliva which flushes the mouth of any debris. Dentures should be cleaned properly to avoid a foul smell in the breath.

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