Bad Breath (Halitosis)

Symptoms

The odours associated with bad breath can vary based on the underlying cause. Some individuals are often too concerned about their breath, even if there is little to no noticeable odour, while others may have bad breath without even realising it.

Since it can be difficult to tell if your breath is bad, it’s advisable to ask a friend or family member to confirm whether you have bad breath.

Causes

Many cases of bad breath usually originate in the mouth and can result from different factors such as:

• Food: Food particles breaking down in and near the teeth can increase bacterial growth, leading to foul odours. Also, consuming particular foods, like garlic, onions, and spices, can contribute to bad breath. Once digested, these foods enter the bloodstream, are transported to the lungs, and affect breath.
• Tobacco products: Smoking usually results in a foul mouth odour. In addition, using tobacco products increases the risk of gum disease, another significant cause of bad breath.
• Poor oral hygiene: Not brushing and flossing every day leaves food particles in the mouth, which can cause bad breath. Plaque (a colourless and sticky film of bacteria) develops on the teeth and can irritate gums if not brushed off. Over time, it can create plaque-filled pockets between gums and teeth. Early-stage gum disease is called gingivitis, while the later stage, accompanied by bone loss, is known as periodontitis.

Bacteria that cause odours can also become trapped on the tongue. In addition, dentures and other removable or fixed oral appliances, like braces, can harbour odour-causing food particles and bacteria if not cleaned frequently or if they don’t fit well.

• Dry mouth: Saliva plays a vital role in cleansing the mouth by eliminating particles that contribute to bad odours. Dry mouth (xerostomia) is a condition that occurs when saliva production is reduced and can contribute to bad breath. It often occurs while sleeping, resulting in “morning breath”. This can be worse for people who sleep with their mouths open. Persistent dry mouth may also result from issues with the salivary glands or certain diseases.
• Medications: Some medications can make the mouth dry, resulting in bad breath. Also, as the body metabolises certain drugs, it can release chemicals that affect your breath.
• Mouth infections: Bad breath can result from surgical wounds from oral surgery, including tooth extractions, gum disease, and mouth sores.
• Other oral, nasal, and throat conditions: Disorders like tonsil stones, which are small stones forming in the tonsils and contain bacteria, can contribute to bad breath. Persistent swelling or infections in the sinuses, nose, or throat can result in postnasal drip, where fluid from the nose drips down the back of the throat. This problem could also lead to bad odour.
• Other factors: Health conditions like certain cancers can contribute to distinctive unpleasant odours. Disorders associated with the body’s breakdown of food into energy can also cause bad breath. Chronic heartburn, a sign of gastroesophageal reflux disease (GERD), is also known to cause halitosis. In young children, a foreign object, like a segment of food stuck in a nostril, can be a source of bad breath.

Risk Factors

The risk of having bad breath increases if you consume foods causing unpleasant odours, including onions, garlic, and spices. Smoking, poor oral hygiene, certain medications, mouth infections, and dry mouth can also contribute to foul breath. Additionally, conditions like cancer or GERD can increase the possibility of bad breath.

Diagnosis

To diagnose bad breath, your dentist can start by assessing the odour from both your mouth and nose and then rate it on a scale. Since the back of the tongue is usually the source of the foul odour, the dentist might also scrape it and analyse the smell.

In addition, some specialised devices can help detect specific chemicals responsible for bad breath, although these tools might not always be accessible.

Treatment

To minimise bad breath, prevent cavities, and reduce the risk of developing gum disease, it is essential always to keep your mouth and teeth clean. Moreover, halitosis treatment often varies. If your dentist suspects that a different medical condition is contributing to bad breath, you may be referred to a primary healthcare specialist.

If bad breath is due to oral health issues, your dentist will collaborate with you to manage the condition better. Dental approaches they might recommend include:

• Mouth rinses and toothpaste: If bad breath is caused by plaque (bacteria accumulation) on teeth, the dentist might suggest a mouth rinse to destroy bacteria. A toothpaste containing antibacterial properties may also be recommended to kill bacteria causing plaque collection.
• Dental disease treatment: The dentist can refer you to a periodontist (an expert in gums) if you have signs of gum disease. Gum disease may result in the pulling away of the gums from the teeth, creating deep pockets that harbour odour-causing bacteria. In some cases, only specialised cleaning can eliminate these bacteria. Your provider may also suggest replacing defective fillings, which can become breeding areas for bacteria.

Lifestyle and Home Remedies

To prevent or minimise bad breath, consider these useful remedies:

• Brushing teeth after eating: Have a toothbrush at your workplace that you can use after meals. Try brushing your teeth at least twice daily with fluoride toothpaste, particularly after eating. Toothpaste containing antibacterial properties is known to effectively minimise bad breath.
• Flossing daily: Flossing every day helps remove plaque and food particles between teeth. This helps reduce bad breath.
• Brushing the tongue: Bacteria can accumulate on the tongue. Therefore, brushing it carefully can help reduce unpleasant smells. For those with a coated tongue, often due to bacterial overgrowth from dry mouth or smoking, using a tongue scraper can be helpful. Alternatively, you can use a toothbrush with an in-built tongue cleaner.
• Cleaning dental appliances: If you use bridges or dentures, ensure that you thoroughly clean them once daily or as instructed by your provider. Also, if you wear a mouth guard or dental retainers, it’s advisable to clean them every time before placing them in the mouth. If necessary, your dentist can suggest the most appropriate cleaning products.
• Keeping the mouth moist: Avoid tobacco products and drink plenty of water. Limit your intake of spicy foods, caffeine, and alcoholic beverages, as these can dry out your mouth. Chewing sugarless gum or sucking on sugar-free candy can stimulate saliva production. If you have chronic dry mouth, your provider may recommend an artificial saliva preparation or oral medication to increase saliva flow.
• Dietary changes: Avoid foods like onions and garlic, which are known to cause foul breath. Also, don’t consume too many sugary foods as they contribute to bad breath.
• Replacing your toothbrush: Consider changing your toothbrush once it is frayed, at least every 3 to 4 months, or sooner if necessary. It’s also important to use a soft-bristled toothbrush.
• Schedule routine dental check-ups: Visit your dentist frequently, at least twice per year. Check-ups enable your dentist to examine your teeth or dentures and provide professional cleaning.

Preparing for Your Appointment

If you have an appointment with your dentist concerning bad breath, the following tips will help you prepare:

• Dentists often prefer to assess bad breath during morning appointments, as this reduces the possibility that foods consumed throughout the day will alter the examination.
• Avoid wearing scented lotions, perfume, or scented lip gloss or lipstick to your dental visit, as these could conceal any bad smell.
• If you have used any antibiotics during the past month, consult your dentist to determine if you should postpone your visit.

What to Expect from Your Dentist

During your appointment, your dentist will probably inquire about your medical history. They will also ask questions like:

• When did you first notice your bad breath?
• Does your bad breath occur occasionally, or is it constant?
• How frequently do you brush your teeth or clean your dentures?
• How frequently do you floss?
• What types of foods do you often consume?
• What medications and supplements are you taking?
• Which medical conditions do you have?
• Do you mostly breathe with your mouth?
• Do you snore when sleeping?
• Do you have any allergies or sinus problems?
• What do you think may be contributing to your bad breath?
• Have others noticed and commented on your foul breath?

Being prepared to provide answers to these questions will help maximise the duration of your appointment.