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Medical Conditions Causing
Bad Breath
- Diabetes mellitus (gives an acetone-like smell to the breath)
- Fasting (during periods of fasting, fat and protein break down; the resulting odor comes from the waste products of this metabolism)
- Infections, especially of the sinuses or lungs
- Kidney failure (can give a fishy odor to the breath)
- Liver disease
- Metabolic disorders (foul, fish-like odor that comes and goes and may be difficult to diagnose)
Food Particles
Any food debris left in between the teeth are subject to bacterial breakdown and subsequent bad breath. This breakdown also decalcifies the enamel of adjacent teeth.
Treatment - It’s important to clean all surfaces of the teeth and maintain good oral hygiene. See our section on
oral hygiene.
Cavities
Enamel decalcification eventually leads to a breakdown in the underlying layer of dentin, resulting in cavity formation. Cavities produce a characteristic pungent, sweet smell.
Treatment - See our section on
cavities.
Dental Abscess
If a dental abscess is left untreated, the swelling (acute phase) may resolve until the abscess eventually destroys the surrounding bone to the point where the infection actually discharges out through the gum (chronic phase). This is commonly called a "gum boil." Any discharge will have an unpleasant foul odor. All facial swellings should be examined immediately by a dentist and treated as soon as possible.
Treatment - See a dentist for possible endodontics [root canals] or extraction. See our section on
cavities and
endodontics.
Gingivitis
Food debris left in contact with the gum will eventually inflame the gum tissue. Untreated inflammation may lead to an acute ulceration of the gums.
Treatment - See your dentist. Often antibiotics are prescribed to contain the acute phase. This would be followed up by regular oral hygiene visits and instruction. See our section on
periodontology.
Periodontal
Disease
Any space that develops between the teeth and the gums due to bone and attachment loss has the capacity to trap food debris and result in bad breath. Periodontal disease creates new hiding spots in the gums for odor-causing bacteria. Often bone loss occurs very slowly; patients are usually unaware of its progression. It cannot be emphasized enough how important regular dental checkups are for treating gum disease.
Treatment - See your dentist.
Signs and Symptoms
- Red or swollen gums
- Loose teeth
- Sensitive teeth
- Pus coming from around the teeth
- Pain on chewing
- Tender gums
- Bleeding gums
Acute
Pericoronitis
Partly erupted wisdom teeth trap food debris around them. If this is not removed, infection will eventually set in around the wisdom teeth and a unpleasant odor is often produced.
Treatment - See a dentist to ascertain whether your wisdom teeth have enough space to erupt, or whether they need to be removed. Antibiotics may be required to control any existing infection.
The Tongue
(Bacteria Heaven)
It may actually be your tongue that's causing your bad breath. Bacteria responsible for bad breath, gingivitis, and tooth decay are removed from teeth and gums by normal brushing and flossing. But, as much as 50% of the bacteria within our mouths, lives on our tongue! For bacteria, the tongue is a safe-haven where they can escape the toothbrush’s wrath.
During each brushing you should remove bacteria from your tongue with one of several commercially available tongue cleaners. What you’ll be scraping off is a whitish layer of bacteria, plaque, and food debris. This simple procedure can greatly improve the condition of your breath.
Brushing your tongue with your toothbrush will remove some of the bacteria and food debris, but tongue cleaners do a much more thorough job.
Saliva (The
Original Mouthwash)
A dry mouth is the perfect environment for odor causing bacteria. Saliva plays a number of roles in keeping the mouth moist, washing away bacteria, and dissolving foul smelling volatile sulfur compounds.
Conditions which reduce salivary flow or which make the mouth dry often lead to bad breath. In fact, morning breath is predominately caused by a reduction in salivary flow that occurs when we sleep. (That is, assuming you brushed the night before.)
Dieting, fasting, or talking for long periods of time reduce saliva flow and contribute to bad breath. In addition, certain medications, breathing through the mouth during exercise, and alcohol consumption also have a drying effect and can contribute to the problem.
How do you make sure your saliva flow is adequate and that your mouth stays moist? Drink water. Saliva flow increases when we eat or drink. If you are dieting or fasting, drinking water is a good way to stimulate the flow of saliva. The water will also help wash away food and bacteria
Placing a drop of lemon juice on the tip of your tongue or chewing sugarless gum are also effective ways to stimulate saliva flow. Mints and breath-freshening gums work not by masking odor, but by stimulating saliva flow.
Mouthwashes
Surprise! Most commercial mouthwashes are useless in eliminating bad breath.
Studies have shown that mouthwashes at best only temporarily mask the odor of bad breath (for as little as 10 minutes after brushing.) In fact, the high concentrations of alcohol in most mouthwashes has a drying effect on the mouth and creates a more hospitable environment for bacteria.
There are mouthwashes on the market which contain chlorine dioxide which have proven very effective in combating bad breath. Instead of masking bad breath like conventional mouth washes, the chlorine dioxide in these rinses actually aids in neutralizing the volatile sulfur compounds responsible for the problem.
Tonsils
As a primary organ for fighting infection, tonsils very often become infected themselves (usually resulting in ulceration and subsequent bad breath.)
Acute Infections - The human body is constantly under attack from infection; many infections are dealt with by our immune system without us even realizing it. In the vast majority of cases, antibiotics are not required and the infection resolves on its own. Most acute tonsil infections are viral in nature and do not respond to antibiotics.
Treatment - See a dentist. Also, consider gargling with warm salt water.
Chronic
Tonsilar Infections
Sometimes an acute tonsil infection will not resolve on its own and a
chronic ulcer develops on the tonsil. This can lead to chronic bad breath
and require treatment.
Treatment - Any unexplained chronic halitosis, especially where the
tonsils are present should be examined by an ENT (Ear, Nose, and Throat Specialist)
Sinusites
A sinus is a tissue-lined space surrounded by bone. Your sinuses produce a fluid made by the secretion of their lining cells. This fluid normally drains into the nose via a small hole or foramen. If the sinus becomes blocked, the retained fluid often becomes infected, resulting in condition known as sinusitis. Usually this occurs in the two maxillary sinuses. It’s characterized as pain in the check bones or as a toothache in the upper back teeth. Sinusitis can also occur in the frontal sinus where it presents as pain above the bridge of the nose or as a dull persistent headache. Chronic untreated sinusitis often leads to a continual discharge of fluid down the back of the throat. This is commonly referred to as "post nasal drip" and results in halitosis.
Treatment - If this condition is suspected, referral to a physician is indicated.
Post Nasal
Drip
The nose can also contribute to bad breath. Colds, allergies, and medications all are capable of producing mucus which can collect on the back of the tongue. Bacteria break down the proteins in the mucus and create volatile sulfur compounds.
Treatment - Using an over-the-counter nasal spray often helps thin out post-nasal drip making it less useful to odor-causing bacteria. Drinking lots of water may also aid in making mucus less viscous and less likely to collect on the back of your tongue.
Gastro
Intestinal Causes
Most people have varying degrees of breath odor on waking in the morning. This is because the stomach contents from the previous night's meal will have been digested leaving byproducts which have not been washed away and are noticeable on the breath. During sleep, saliva production stops. Salivary secretion helps to flush these byproducts away. Food remnants in the stomach may also ferment while you sleep to produce odors.
Treatment - The solution to the above is usually to increase fluid intake and flush unpleasant odors out of the stomach.
Esophageal
Folds
These are small crevices or invaginations in the lining of the esophagus. Food particles often become trapped here; bacterial action leads to the production of noxious odors and bad breath.
Treatment
- Usually just by drinking plenty of fluids will flush these food particles
away
Bad Breath
Treatment
Though most commercial products may claim to make your breath fresher, at best they only temporarily mask the odor. If you find yourself constantly using breath mints, breath sprays, or mouthwashes in an effort to cover up bad breath, you may have an underlying dental or medical problem which should be addressed.
How can you get rid of of bad breath ? One option is to avoid the foods that cause bad breath such as cabbage, garlic, and onions. Alternatively, you can use one of several new products on the market which attack and neutralize the sulfur compounds while they are in the digestive system or in the bloodstream.
Good oral hygiene must be stressed, including cleaning the tongue. Once the oral infection is treated and cured, mouthrinses and toothpastes may have some effectiveness in managing any remaining odor.
Keep A Log. It’s a good idea to record the foods you eat and any medications you may be taking. While garlic and onions cause bad breath, the odor is actually coming from your lungs as you breathe, not from your mouth itself. The odor from these foods is temporary, and will be gone once the food is out of your bloodstream.
Brush Twice A Day with a fluoride toothpaste to remove food debris and plaque. Don’t forget to clean your tongue. Atleast once a day use floss to clean between your teeth. If you wear removable dentures, take them out at night. Clean them thoroughly before replacing them the next morning.
Mouthwashes are generally cosmetic and have little effect on bad breath. However, new mouthwashes are available containing chlorine dioxide which neutralize volatile sulfur compounds.
Drink Plenty Of Water - A dry mouth is the ideal home for odor-causing bacteria to flourish. Saliva normally keeps the mouth moist. Additionally, saliva helps wash away the food particles bacteria feed on and dissolves odorous volatile sulfur compounds. Actions which dry the mouth and/or reduce salivary flow can increase breath odor. These include:
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Dieting - Hunger contributes to bad breath. As your body converts fat and protein into energy, bad breath is often an unavoidable consequence.
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Drinking alcohol or using mouthwashes containing alcohol
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Excessive talking
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Exercising
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Prescription medications including anti- histamines and decongestants
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Smoking
Chew Sugarless Gum - If you can't brush after a meal or snack, consider chewing sugarless gum. The chewing action helps cleanse the teeth and stimulate the flow of saliva which aids in cleansing the mouth and dissolving odor-causing volatile sulfur compounds. Make sure only to chew gum which does not contain sugar.
Get a Dental Checkup At Least Once A Year - All too often patients aren’t aware of dental problems until considerable damage has occurred. Your dentist can recognize potentially damaging problems early. In addition, your dentist can diagnose other problems which cause bad breath including abscesses, periodontal disease, and impacted teeth. Treatment for halitosis should begin with a complete oral examination and health history. Any existing periodontal disease should be treated and all cavities restored.
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