Most adults will suffer from some degree of bad breath at some time in their lives.
Myths abound on its cause and treatment. Here are some of the facts:
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It is easy for someone to tell if their own breath smells
FALSE. We cannot smell our own breath because we become accustomed to our own smell.
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Bad breath comes from the stomach
FALSE. Only in rare cases do stomach or digestive problems contribute to bad breath. Most bad breath comes from the back of the mouth.
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Tooth brushing will always eliminate bad breath
FALSE. Good brushing and flossing habits will help reduce bad breath. However, most people do not brush their teeth properly as it takes nearly 3 minutes to do so and most spend 45 to 60 seconds. Furthermore, bad breath can come from bacteria residing deep within crevices on the back of the tongue and thus a tongue scraper is required.
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Mouthwashes are effective in treating bad breath
FALSE. Mouthwashes will only provide temporary relief from bad breath. In fact, most mouthwashes contain alcohol, which has a drying effect in the mouth allowing bacteria to grow better. There are newer mouthwashes without alcohol as well as those which have compounds that react with and neutralize odorous volatile sulfur compounds produced by bacteria in the mouth.
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To prevent bad breath we should focus on the food we eat
POSSIBLY. Temporary bad breath most commonly comes from the foods we eat such as onions, garlic and cabbage which will produce high amounts of sulfur compounds. The digested sulfur compounds are absorbed and carried by blood into the lungs where they are exhaled to produce bad breath. However, chronic bad breath is most commonly caused by bacteria that break down food debris left in the mouth.
What are the causes of bad breath?
Bad breath is a common problem that can be due to many causes.
- Inadequate oral hygiene. Poor oral hygiene from infrequent brushing of teeth or cleaning of dentures will lead to food debris left in the mouth, around teeth, on dentures, tongue and cheek surfaces, which will be broken down by bacteria resulting in unpleasant breath.
- Foods that cause odor. Most commonly, the smell is a result of breakdown of proteins by various bacteria in the mouth. For example, volatile sulfur compounds and other substances like cadaverine and putracine are produced by certain anaerobic bacteria . Foods including garlic, onions and some spices as well as tea and coffee can contribute towards bad breath.
- Tooth decay or periodontal (gum) disease. Gum disease and tooth decay will often lead to accumulations of bacteria that can cause bad breath. If there is gum disease or tooth decay, then treatment should be sought to eliminate these problems first. Your dentist will examine you and take some radiographs (Xrays) to check for the presence and extent of such problems. Early detection, diagnosis and treatment of gum disease and tooth decay will help keep teeth functional for life. Preventive maintenance is essential to ensure continued good oral health.
- Prolonged mouth dryness
- Use of tobacco products
- Sinus or respiratory infections
- Medications e.g. antidepressants, diuretics (used for high blood pressure)
- Medical disorders e.g. GERD, chronic tonsil infections
- Certain bacteria that produce foul smelling compounds. The bad smell can also come from the back of the surface of the tongue. The scraping obtained by the dentist from this portion of the tongue may suggest that this may be the primary source of bad breath in the individual. In such cases, it will help to use a tongue scraper daily to clean the tongue surface and reduce and prevent the accumulation of bacteria and foul smelling, bacterial products.
Possible causes of various problems:
Problem: Odor after fasting, dieting, prolonged speaking, exercise, sleeping or taking medications.
Possible Cause: Dryness in the mouth caused by insufficient saliva flow.
Problem: Gums that bleed and bad breath.
Possible Cause: Gum disease caused by poor cleaning between teeth.
Problem: Odor when talking.
Possible Cause: Postnasal drip onto back of tongue.
Problem: Small whitish stones with foul odor appearing on tongue.
Possible Cause: Tonsilloliths from crypts in tonsils.
Problem: Odor appears suddenly from mouth of young child.
Possible Cause: Onset of throat infection.
Problem: Odor in denture wearers.
Possible Cause: Dentures kept in mouth all night or not cleaned properly.
Problem: Odor from nose.
Possible Cause: Sinusitis, polyps, dryness, foreign body, hindered air or mucous flow.
Problem: Bad taste all day long.
Possible Cause: Poor oral hygiene, gum disease, excessive bacteria on tongue surface.
Can bad breath be treated?
The key to effective treatment and management of this condition is proper diagnosis. Recent research has enabled dentists to understand the causes of bad breath and therefore treat it more effectively. The main problem is accepting that one has bad breath as most individuals cannot smell their own breath. Asking friends or seeking other’s opinion is usually the best way. If flossing, brushing and tongue combing do not resolve the problem, then you will need to investigate further.
The DOs and DON’Ts of bad breath
DO…
- Check with family or friends on the status of your breath
- Floss and clean between your teeth as advised by your dentist
- Brush your gums and teeth using the proper technique
- Practice regular cleaning of your tongue, either by scraping or brushing
- Visit your dentist and have your teeth cleaned regularly
- Use a mouthwash regularly that doesn’t contain alcohol
- Drink plenty of liquids
- Chew gum that doesn’t contain sugar (xylitol is the exception) especially when your mouth feels dry. Alternatives include parsley, mints, fennel seeds or dill seeds.
- Clean your mouth after eating or drinking milk products, fish or meat
- Keep your dentures clean and soak them overnight in antiseptic solution
- Eat fibrous vegetables and fruits to stimulate saliva flow and reduce accumulation of food particles.
DON’T…
- Ignore the problem
- Drink too much coffee
- Let young children use mouthwash as they tend to swallow it
- Rely solely on mouthwashes. Practice good oral hygiene and eating habits
- Let your concern about bad breath affect your life adversely.
Risk factors for Bad Breath (Halitosis)
Allergy / Intolerance to Foods (Hidden)
Food allergy is a common cause of heavy and foul breath. [Food Allergy: Its Manifestations and Control and the Elimination Diets by Dr.s Rowe and Rowe, 1972, pp.104]
Regular/occasional/absence of flossing of teeth
Bad Breath (Halitosis) suggests the following may be present
Recommendations for Bad Breath (Halitosis)
Oral Hygiene / Dental Care
The most common cause of bad breath is bacteria on the back of the tongue and between the teeth. Both flossing and tongue brushing may be required to remove bad breath. While bacteria between the teeth is a commonly-recognized cause of bad breath, if flossing does not resolve the condition then tongue cleaning/brushing should be tried in addition.
Tongue brushing involves scrubbing the tongue with a toothbrush. Tongue cleaning utilizes a U-shaped scraper which is drawn over the tongue from back to front. Tongue cleaning causes significantly less gagging than tongue brushing and is a common practice in some cultures. To greatly reduce bad breath, brush, floss and scrape at least daily.
Therabreath is a site dedicated to explaining what causes bad breath, halitosis, dry mouth, taste disorders (sour, bitter, metallic) and how to get rid of these problems using therapies and products based on research. If you’ve been frustrated with commercial products that falsely claim they can attack the germs that cause bad breath, or if you scraped your tongue and still have bad breath, you’ve come to the right place. Since 1994, no one has helped more people with Bad Breath than Dr. Katz — nearly 22,000 have been successfully treated through his California Breath Clinics in the US and internationally, and over 100,000 people in 57 different countries worldwide have used his TheraBreath System formulas to eliminate Halitosis and regain their lost confidence..
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Highly recommended |
Glossary
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Bacteria
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Protein
Compounds composed of hydrogen, oxygen, and nitrogen present in the body and in foods that form complex combinations of amino acids. Protein is essential for life and is used for growth and repair. Foods that supply the body with protein include animal products, grains, legumes, and vegetables. Proteins from animal sources contain the essential amino acids. Proteins are changed to amino acids in the body.
Anaerobic
Of, relating to, or being activity in which the body incurs an oxygen debt (for example weight training or resistive exercises) and does not immediately burn off a lot of calories and fat.
Diuretic
An agent increasing urine flow, causing the kidneys to excrete more than the usual amount of sodium, potassium and water.
Gastric Reflux Disease
Gastro-Esophageal Reflux Disease (GERD). A common relapsing condition affecting approximately 10% of the U.S. population and caused by an abnormal exposure of the lower esophagus to refluxed gastric contents, causing irritation and injury to the esophageal tissues. GERD develops as a result of relaxations of the transient lower esophageal sphincter. Typical presenting symptoms are heartburn, an epigastric burning sensation and acid regurgitation. However, some patients may present with atypical symptoms such as chest pain, shortness of breath, wheezing, and coughing.
Polyp
A usually nonmalignant growth or tumor protruding from the mucous lining of an organ such as the nose, bladder or intestine, often causing obstruction.
Antiseptic
Inhibiting growth of infectious organisms.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.