Bad breath, also known as halitosis, is breath that has an unpleasant odor. This odor can occur from time to time, or it can be long lasting, depending on the cause.
Millions of bacteria live in the mouth, particularly on the back of the tongue. In many people, they are the primary causes of bad breath. The mouth’s warm, moist conditions are ideal for the growth of these bacteria. Most bad breath is caused by something in the mouth.
Some types of bad breath are considered to be fairly normal. They usually are not health concerns. One example is “morning mouth.” This occurs because of changes in your mouth while you sleep. During the day, saliva washes away decaying food and odors. The body makes less saliva at night. Your mouth becomes dry, and dead cells stick to your tongue and to the inside of your cheeks. When bacteria use these cells for food, they produce a foul odor.
Causes of Bad Breath:
- Poor dental hygiene — Infrequent or improper brushing and flossing, allows bits of food that are stuck between the teeth to decay inside the mouth. Poor oral hygiene eventually will lead to periodontal (gum) disease, which also can cause bad breath.
- Infections in the mouth — These can be caused by either a cavity in a tooth or by periodontal (gum) disease.
- Respiratory tract infections — Throat, sinus or lung infections.
- External source — Garlic, onions, coffee, cigarette smoking, chewing tobacco. Smoking and drinking coffee, tea and/or red wine will contribute to your teeth becoming discolored.
- Dry mouth (xerostomia) — This can be caused by salivary gland problems, medicines or “mouth breathing.” A large number of prescriptions and over the counter medicines cause dry mouth.
- Illnesses — Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others.
- Psychiatric illness — Some people may believe they have bad breath, but others do not notice it. This is referred to as “pseudohalitosis.”
You may not always know that you have bad breath. That’s because odor-detecting cells in the nose eventually get used to the smell. Other people may notice and react by stepping away from you as you speak, or making a face.
Other symptoms depend on the underlying cause of bad breath:
- Infections in the mouth — Symptoms depend on the type of infection. They can include:
- Red or swollen gums that may bleed easily, especially after brushing or flossing.
- Pus between teeth or a pocket of pus (abscess) at the base of a tooth.
- Loose teeth or a change in how a denture fits.Painful, open sores on the tongue or gums
- Respiratory tract infections — Symptoms may include:
- Sore throat
- Swollen lymph nodes (“swollen glands”) in the neck
- Stuffy nose
- A greenish or yellowish discharge from the nose
- A cough that produces mucus
- Dry mouth — Symptoms may include:
- Difficulty swallowing dry foods
- Difficulty speaking for a long time because of mouth dryness
- Burning in the mouth
- An unusually high number of cavities
- Dry eyes (in Sjögren’s syndrome)
- Illnesses — Symptoms of diabetes, lung disease, kidney failure or liver disease
A dentist or physician may notice bad breath during an office visit. Sometimes, the smell of the patient’s breath may suggest a likely cause for the problem. For example, “fruity” breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.
Your dentist will review your medical history for conditions that can cause bad breath and for medicines that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms. He or she also will ask who noticed the bad breath and when.
Your dentist will examine your teeth, gums, mouth and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth.
Your dentist may refer you to your family physician if an illness is the most likely cause. In severe cases of gum disease, your dentist may suggest that you see a periodontist (dentist who specializes in gum problems).
You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sjögren’s syndrome. The type of tests you get depends on the suspected illness. You may get blood tests, urine tests, X-rays of the chest or sinuses, or other tests.
How long bad breath lasts depends on its cause. For example, when the problem results from poor dental hygiene, proper dental care will begin to freshen the mouth right away. You’ll have even better results after a few days of regular brushing and flossing. Periodontal disease and tooth abscess also respond quickly to proper dental treatment. Bad breath caused by chronic sinusitis may keep coming back, especially if it is caused by a structural abnormality of the sinuses.
Bad breath that results from an illness may be a long-term problem. It often can be controlled with proper medical care.
Bad breath caused by dental problems can be prevented easily with proper home and professional care.
- Brush your teeth, tongue and gums after meals and floss daily. This is the most important factor if your bad breath is caused by dental problems.
- If your dentist recommends it, rinse with a mouthwash approved by the American Dental Association (ADA).
- Visit the dentist regularly (at least twice a year) for an exam and tooth cleaning.
You also can combat bad breath by drinking plenty of water every day to help your body make saliva. An occasional swish of the mouth with water can loosen bits of food. Sugar-free gum or sugar-free breath mints can help you keep breath fresh and prevent plaque from forming. But be aware that consuming large amounts of sugar-free gum and/or mints that contain sorbitol may cause side effects. These can include diarrhea and bloating.
Call your dentist promptly if you have bad breath with loose teeth or painful, swollen gums that bleed easily. Also, call your doctor if you have bad breath along with any of the following symptoms:
- Sore throat
- Postnasal drip
- Discolored nasal discharge
- Cough that produces mucus
Even if you have none of these symptoms, call your dentist or physician if your bad breath continues despite a good diet and proper dental hygiene.
Sometimes bad breath can be a sign that a medical condition needs attention right away. If you have diabetes, gastroesophageal reflux disease (GERD) or chronic liver or kidney disease, ask your doctor what bad breath may mean for your condition.
The outlook for fresh breath is usually excellent if you stick to your dentist’s or physician’s treatment plan.