Bad Breath (Halitosis)

Bad breath, also called halitosis, can be embarrassing and in some cases may even cause anxiety. It's no wonder that store shelves are overflowing with gum, mints, mouthwashes and other products designed to fight bad breath. But many of these products are only temporary measures because they don't address the cause of the problem.

Certain foods, health conditions and habits are among the causes of bad breath. In many cases, you can improve bad breath with consistent proper dental hygiene. If simple self-care techniques don't solve the problem, see your dentist or physician to be sure a more serious condition isn't causing your bad breath.

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Most bad breath starts in your mouth, and there are many possible causes. They include:

  • Food. The breakdown of food particles in and around your teeth can increase bacteria and cause a foul odor. Eating certain foods, such as onions, garlic and spices, also can cause bad breath. After you digest these foods, they enter your bloodstream, are carried to your lungs and affect your breath.
  • Tobacco products. Smoking causes its own unpleasant mouth odor. Smokers and oral tobacco users are also more likely to have gum disease, another source of bad breath.
  • Poor dental hygiene. If you don't brush and floss daily, food particles remain in your mouth, causing bad breath. A colorless, sticky film of bacteria (plaque) forms on your teeth. If not brushed away, plaque can irritate your gums and eventually form plaque-filled pockets between your teeth and gums (periodontitis). Your tongue also can trap bacteria that produce odors. Dentures that aren't cleaned regularly or don't fit properly can harbor odor-causing bacteria and food particles.
  • Dry mouth. Saliva helps cleanse your mouth, removing particles that cause bad odors. A condition called dry mouth or xerostomia (zeer–o-STOE-me-uh) can contribute to bad breath because production of saliva is decreased. Dry mouth naturally occurs during sleep, leading to "morning breath," and it worsens if you sleep with your mouth open. Chronic dry mouth can be caused by a problem with your salivary glands and some diseases.
  • Medications. Some medications can indirectly produce bad breath by contributing to dry mouth. Others can be broken down in the body to release chemicals that can be carried on your breath.
  • Infections in your mouth. Bad breath can be caused by surgical wounds after oral surgery, such as tooth removal, or as a result of tooth decay, gum disease or mouth sores.
  • Other mouth, nose and throat conditions. Bad breath can occasionally stem from small stones that form in the tonsils and are covered with bacteria that produce odor. Infections or chronic inflammation in the nose, sinuses or throat, which can contribute to postnasal drip, also can cause bad breath.
  • Other causes. Diseases, such as some cancers, and conditions such as metabolic disorders, can cause a distinctive breath odor as a result of chemicals they produce. Chronic reflux of stomach acids (gastroesophageal reflux disease, or GERD) can be associated with bad breath. Bad breath in young children can be caused by a foreign body, such as a piece of food, lodged in a nostril.

A person with bad breath is rarely aware of his offense. He cannot detect his own mouth odor even when he exhales against his hand, or licks it to test the quality of the odor--both methods are unreliable. He usually only becomes aware that he has it when he notices (as in the example) that people are avoiding him or when someone tells him. All of us are more or less vulnerable at one time or another. Bad breath can come when you least expect it, and it tends to get worse and more frequent as you get older. The intensity of the odor is variable, but researchers usually record the aroma as mild, moderate, pungent, objectionable and very objectionable. I leave it to your imagination to select appropriate examples of this classification. 

Halitosis, the technical term for bad breath, or malodor or Fetor ex Oris, as dentists sometimes call it, can curse those which consume those foods or substances which often cause bad breath: garlic, raw onions, cabbage, horse radish, eggs, broccoli, Brussels sprouts, fish, red meat, peppers, cigarettes, alcohol and coffee, but bad breath can occur even if your diet does not include the above named foods, for the basic causes are always present in the human mouth: when bacteria in your mouth decompose food, evil smelling putrefaction products result. 

Medical risks for bad breath include bronchial and lung infections, chronic sinusitis, post-nasal drip, tonsillitis. The mucous discharge which comes during cold or flu can create bad breath. Also implicated are untreated nasal polyps, diabetes, syphilis, diseases of the stomach and lungs, liver, kidneys, and there is a type of halitosis which is caused by a gallbladder dysfunction. Altering the diet to reduce the amount of fat intake will often eliminate this type of “pungent” heavy odor. There is a fetid and “fishy” odor associated with chronic renal or kidney failure. Some medications can cause or exacerbate bad breath. Various carcinomas can cause malodor. You should consult your physician if bad breath becomes chronic and the simple treatments detailed in this report don’t work. However, these problems taken altogether affect a very small percentage of people. 

Stress or nervous tension is a major enhancer of bad breath. In fact, there seems to be a stress component to most bad breath. One major effect of stress is drying of the mouth, but stress also aggravates the fulsome odor in other subtle ways. If you have lived through a stressful or unpleasant experience you may have noticed that a case of bad breath also went along with the ordeal. One person developed bad breath during airplane trips. The halitosis promptly went away after a safe arrival. A woman developed bad breath when a man she was dating made advances. Having to give a speech or take an examination or endure some other stress inducing situation may also bring out a malady, so monitor your emotional state for cues. 

Some women have a distinctive and mousy odor associated with the onset of menstruation. This particularly common in the women who suffer from dysmenorrhea or painful menstruation. The cause is thought to be caused by the rise in estrogen which triggers sloughing of the body’s lining tissues, including those of the mouth. More sloughed tissue means more food for bacteria. Usually the woman is unaware of the odor, but is readily apparent to her spouse. 

Be aware of the fact that some people don’t have bad breath at all, but merely think they do. That is, they imagine that their oral aroma is more intense and offensive than it really is. Such cases of “imaginary” bad breath are sometimes associated with psychological problems. These sufferers may withdraw from society, develop anti-social behavior, and may even contemplate suicide.

Bad breath odors vary, depending on the source or the underlying cause. Some people worry too much about their breath even though they have little or no mouth odor, while others have bad breath and don't know it. Because it's difficult to assess how your own breath smells, ask a close friend or relative to confirm your bad-breath questions.

Your dentist will likely smell both the breath from your mouth and the breath from your nose and rate the odor on a scale. Because the back of the tongue is most often the source of the smell, your dentist may also scrape it and rate its odor.

There are sophisticated detectors that can identify the chemicals responsible for bad breath, though these aren't always available.

To reduce bad breath, help avoid cavities and lower your risk of gum disease, consistently practice good oral hygiene. Further treatment for bad breath can vary, depending on the cause. If your bad breath is thought to be caused by an underlying health condition, your dentist will likely refer you to your primary care provider.

For causes related to oral health, your dentist will work with you to help you better control that condition. Dental measures may include:

  • Mouth rinses and toothpastes. If your bad breath is due to a buildup of bacteria (plaque) on your teeth, your dentist may recommend a mouth rinse that kills the bacteria. Your dentist may also recommend a toothpaste that contains an antibacterial agent to kill the bacteria that cause plaque buildup.
  • Treatment of dental disease. If you have gum disease, you may be referred to a gum specialist (periodontist). Gum disease can cause gums to pull away from your teeth, leaving deep pockets that fill with odor-causing bacteria. Sometimes only professional cleaning removes these bacteria. Your dentist might also recommend replacing faulty tooth restorations, a breeding ground for bacteria.

To reduce or prevent bad breath:

  • Brush your teeth after you eat. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odors.
  • Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath.
  • Brush your tongue. Your tongue harbors bacteria, so carefully brushing it may reduce odors. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth, for example) may benefit from using a tongue scraper. Or use a toothbrush that has a built-in tongue cleaner.
  • Clean dentures or dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product.
  • Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water — not coffee, soft drinks or alcohol, which can lead to a drier mouth. Chew gum or suck on candy (preferably sugarless) to stimulate saliva. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
  • Adjust your diet. Avoid foods such as onions and garlic that can cause bad breath. Eating a lot of sugary foods is also linked with bad breath.
  • Regularly get a new toothbrush. Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush.
  • Schedule regular dental checkups. See your dentist on a regular basis — generally twice a year — to have your teeth or dentures examined and cleaned.

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