Bad breath (halitosis) is a fairly common disorder affecting most of us at some point in life. The foul odor in bad breath is not considered to be a medical disorder unless it is a long term condition (chronic) and posing a problem in our lives. Halitosis may go beyond just a dental hygiene issue and can indicate more serious pathologies.
Any odor is a gas that is detected by the receptors in the nose. Volatile chemicals given off from the source of the odor travel through the air and can diffuse over a wide area which is the reason why bad breath can sometimes be detected from a few feet away.
Causes of Bad Breath
A foul odor causing bad breath may emanate from three systems – the mouth, respiratory passage or gut.
1. OroDental Causes
This includes the mouth and the structures within it (teeth, tongue, cheeks, gum, palate and throat). Orodental causes are the most common cause of halitosis with the anaerobic bacteria living in the mouth accounting for the majority of bad breath cases.
- Certain foods with a strong odor including garlic, onions, seafood. (2)
- Dental hygiene – decomposing food within the mouth that is not removed due to improper dental hygiene.
- Tooth cavity
- Dental abscess
- Periodontal disease like gingivitis or conditions affecting the cheek, gum or tongue
- Oral thrush
- Poorly fitted dentures or dental crowns, bridges or implants
- Any condition causing a reduced saliva flow in the mouth resulting in dryness (Itchy Throat).
2. Respiratory Causes
This includes the nasal passages, throat, trachea (air or wind pipe), bronchi and lungs.
- Sinusitis or rhinitis
- An abscess or infection in the nose, throat or lungs. (Staph Infection Symptoms)
- Bronchiectasis – odor due to necrosis of tissue.
- Metabolic causes of halitosis may often cause the odor emanate from the the respiratory passages – diabetes, liver failure, uremia. (1)
3. Gastroesophageal Causes of Bad Breath
Contrary to popular belief, gastroesophageal or digestive causes of halitosis (bad breath) is rare. Foods we eat do not often directly contribute to our breath from within the gut and gas from our gut cannot easily escape through our mouth unless it is forced (belch) or there is an insufficiency of the gastroesophageal valve.
The following articles may provide more information on gastroesophageal and digestive causes of bad breath.
Diagnosing the cause of bad breath (halitosis) is dependent on a good case history, dental examination and assessment and evaluation of dental hygiene regimen. Further investigation may be required if necessary.
Some questions that may be asked to identify the cause of bad breath.
1. How often do you brush your teeth in a day?
Ideally brushing should be after every meal but brushing twice daily (upon waking and before sleeping) is sufficient. Flossing and a good anti-bacterial mouth wash should be used.
2. Does your bad breath occur after eating specific foods or drinks?
Foods with strong odors, commonly the Allium species, onion (allium cepa) and garlic (allium cepa) are known for their strong sulfur compounds which contribute to a characteristic odor hours after consuming these foods (2). Bad breath may also occur after consuming alcohol, even on the following day, as the body breaks down alcohol and releases some of the byproducts through the lungs. Smokers are known for having bad breath due to odor from tobacco as well as a reduced saliva flow in the mouth which allows oral bacteria to thrive.
3. Does you bad breath occur at specific times of the day?
An acetone odor characteristic of diabetics may occur if the diabetic patient has not eaten regular meals also known as diabetic ketoacidosis. This odor is sometimes described as ‘fruity’ or ‘sickening sweet’ and reduces after eating. Bad breath after sleeping or even a short nap may be due to reduced saliva flow which occurs naturally when asleep. Dryness of the mouth accompanied by bad breath can also occur in diabetics and smokers or in certain conditions affecting the salivary glands (not common).
4. Describe the odor of your bad breath?
The description of an odor can be useful in indicating a differential diagnosis and prompting further tests and examination.
- Fetid or putrid odor (purulent, ‘rotting’, ‘decaying’) – may be tooth cavity, dental abscess, tonsillitis, lung abscess or bronchiectasis.
- ‘Mousy’ or damp odor may be indicative of liver failure.
- ‘Urine’ or ammonia like odor in uremia.
- ‘Acetone’ or ‘fruity’ odor may be indicative of diabetes or other causes of ketacidosis like starvation, fasting or dieting.
It is important to seek professional medical advice before attempting to diagnose and treat your chronic halitosis.
5. Does your bad breath disappear after brushing?
Most cases of halitosis are caused by the anaerobic bacteria in the mouth. If a patient is practicing good and regular dental hygiene practices and the bad breath is still persisting, other causes of bad breath should be investigated.
6. Can others smell your bad breath?
Psychogenic halitosis is a condition where the sufferer perceives that he or she is suffering from bad breath. This may revolve around an issue with confidence and in severe cases, it may be associated with psychiatric disorders.
Treatment and Management of Bad Breath
Treatment should be focused on the cause of the bad breath (halitosis). Managing bad breath in most cases involves effective dental hygiene practices.
- Brush regularly, at least twice daily. Ensure that your toothbrush can reach deeper areas.
- Brush the tongue thoroughly.
- Floss daily to remove trapped particles of food.
- An antibacterial mouth wash will reduce the oral bacteria as well as reduce the build up of plaque or tartar.
- Regular dental visits are important and address your dental health needs immediately.
Cure for Bad Breath
The embarrassing nature of the condition (halitosis) often leads sufferers to seek quick fix solutions, easy home remedies or ‘cures‘ for this condition. Bad breath can be treated depending on the underlying cause but there is no cure for the bad breath. Prevention of bad breath is aimed at effective treatment followed by ongoing management as this is essential for long term relief from halitosis.
The use of strong smelling mouth washes, chewing gum, breath sprays and candy only offers short term relief from halitosis and often masks the bad breath rather than treating the cause.
Bad Breath in Children
Bad breath in children is not often associated with serious pathologies. The high intake of refined carbohydrates (sugars and wheat) contributes to an increased incidence of tooth cavities in children may be a major cause. Children do not often practice good dental hygiene if not supervised by an adult. This can allow oral bacteria to thrive in the mouth thereby releasing their offensive gaseous byproducts which is further aggravated by their carbohydrate rich diet.
1. Bad Breath and Metabolic Derangement . Wrongdiagnosis.com
2. Bad Breath (Halitosis). American Dental Association
Article reviewed by Dr. Greg. Last updated on April 12, 2011