Understanding Bad Breath (Halitosis) Causes & Treatments

Halitosis, or bad breath, is something many people experience at some point, but for some, it’s a persistent issue. While it can be caused by simple things like poor oral hygiene, it could also be a sign of an underlying health condition. Understanding the different causes, how to prevent it, and when to seek treatment can help you keep your breath fresh and confidence high. Let's dive into everything you need to know about halitosis.

What Is Halitosis?

Halitosis is the medical term for persistent bad breath or an unpleasant odor in the mouth. It can occur due to poor oral hygiene, but there are other potential causes, such as certain health conditions or lifestyle factors.

Halitosis is very common. It is the third most common reason for visiting a dentist after tooth decay and periodontal disease (gum disease). According to the National Institute of Dental Research, approximately 65 million Americans have halitosis. Worldwide, about 50% of the population has bad breath. However, bad breath can impact daily life by causing embarrassment, social anxiety, decreased self-esteem and confidence, and emotional distress. Severe halitosis can potentially cause problems on the job and in relationships. Moreover, bad breath can be a sign of an underlying disease.

In many cases, it’s possible to treat halitosis by keeping the mouth clean. Mouthwashes, gums, and mints may help, but they don’t address the root cause of the problem. You should see your dentist for chronic halitosis so they can rule out more serious underlying problems.

Note: Morning breath is a bad breath odor that frequently occurs upon awakening from sleep due to mouth dryness and, sometimes, poor oral hygiene. It typically resolves when you brush your teeth. In contrast, halitosis is persistent bad breath that does not go away even after brushing.

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What Are The Causes of Bad Breath?

Depending on the underlying cause, halitosis patients are said to have intraoral halitosis (originating in the mouth due to oral health conditions) or extra-oral halitosis (such as digestive or metabolic conditions). Here are the most common causes of bad breath (oral malodor) or halitosis.

Food Debris and Bacteria

The mouth is home to hundreds of species of bacteria. Halitosis mainly occurs due to microbial metabolism or the breakdown of food particles by anaerobic bacteria in the mouth. When these microorganisms digest food, they release certain foul-smelling substances called volatile sulfur compounds, which cause bad breath.

Poor Oral Hygiene Habits

If you don’t keep your mouth and teeth clean by brushing and flossing daily, food particles remain in your mouth and nourish the odor-causing bacteria, leading to bad breath.

Keep in mind that the tongue can also trap odor-causing bacteria, so use of a tongue scraper is recommended.

People who wear oral appliances such as dentures or braces need to be especially careful about proper oral hygiene. It’s important to make sure the appliances fit well and are cleaned regularly.

Periodontal Disease or Gum Disease

In people with poor oral hygiene, a sticky film of bacteria called plaque forms on the teeth. Over time, plaque can irritate the gums and cause gingivitis (inflammation of gum tissue), which is the early stage of gum disease. Eventually, gum disease can cause your gums to pull away from your teeth, allowing plaque to form deep pockets between your teeth and gums. This is called periodontal disease, and bad breath is one of the main symptoms of the condition.

Xerostomia or Dry Mouth

Saliva helps to keep the mouth clean by washing away food particles that lead to oral halitosis. In people with a condition called xerostomia (dry mouth), bad breath can occur due to decreased saliva production.

Potential causes of dry mouth include dehydration, mouth breathing, certain medications, problems with the salivary glands, and certain medical conditions such as a yeast infection in the mouth, diabetes, stroke, Alzheimer’s disease, HIV/AIDS, and autoimmune conditions such as Sjogren’s syndrome.

Note: Dry mouth naturally occurs during sleep, especially if you sleep with your mouth open, leading to morning breath.

Smoking

Tobacco products can cause an unpleasant odor in the mouth. In addition, smokers are at a high risk of gum disease, which is a known cause of halitosis.

Oral Infections

Infections in the mouth, mouth sores, and surgical wounds in the mouth after tooth removal or oral surgery can cause bad breath. Halitosis can also occur in people with sinus infections and respiratory tract infections that cause nasal obstruction, which can lead to mouth breathing, dry mouth, and bad breath.

Medications

Certain medications can cause halitosis by causing dry mouth. Others can release chemicals that are carried out with exhaled air and give it a bad odor. Examples of drug classes that can cause halitosis include acid reducers, antihistamines, anticholinergics, antidepressants, antifungals, steroids, antispasmodics, chemotherapy drugs, dietary supplements, and organosulfur compounds.

Diet

Eating certain foods can increase your risk of halitosis or bad breath. Examples include onions, garlic, and spices.

Underlying Health Conditions

If your breath still stinks even after brushing your teeth, make an appointment to see your dentist. You may have an underlying health condition causing your bad breath. If you have extra-oral halitosis (the cause is outside the mouth), your dentist may refer you to another healthcare professional. Some of the health conditions that can cause halitosis include:

Sinus infections and upper respiratory infections.
Tonsilloliths or small tonsil stones.
Gastroesophageal reflux disease (GERD) or chronic acid reflux.
Liver disease.
Chronic kidney failure.
Some cancers.
A foreign body lodged in the nostril (in young children).

Common Symptoms of Bad Breath

Symptoms of halitosis can vary from person to person. Some people have mild oral halitosis and worry excessively about it (this is called delusional halitosis). Others have genuine halitosis (strong breath odor) but are not aware of the problem. The best way to find out if you have bad breath is to ask a close friend or family member to check.

Common symptoms that frequently accompany halitosis include:

Dry mouth
Postnasal drip
White tongue coating
Bad taste in the mouth (sour, bitter, metallic taste)
Constant throat clearing

Halitosis and Medical Conditions

Halitosis isn't always just about poor oral hygiene; it can also be a sign of an underlying medical condition, and the type of bad breath you experience can offer clues about the cause. Here’s how to differentiate between different odors to help identify the underlying medical condition.

What does GERD breath smell like?

GERD breath often smells sour, like partially digested food. In people with gastroesophageal reflux disease (GERD), the sphincter (muscle) between the esophagus and stomach doesn't close fully. This allows the acidic contents of the stomach to backflow into the esophagus and throat, giving the breath a sour smell.

What does diabetes breath smell like?

People with a serious complication of diabetes called diabetic ketoacidosis may develop a fruity odor to their breath. The odor is also described as acetone-like or like nail paint.

What does kidney disease breath smell like?

Chronic kidney disease or kidney failure can result in a fishy, urine-like, or ammonia-like odor of the breath.

What does liver disease breath smell like?

People with liver disease sometimes have a type of chronic bad breath that smells musty, pungent, or oddly sweet. It has also been described as smelling of garlic, rotten eggs, or feces (poop). Doctors call it fetor hepaticus and it occurs because a diseased liver cannot remove toxins from the blood.

What does bad breath from cancer smell like?

There is no universal odor linked to cancer. Sometimes, people with cancer develop bad breath due to dry mouth from cancer treatments.

What does lung cancer breath smell like?

People with lung cancer sometimes develop a distinctive type of chronic halitosis described as musty, unpleasant, or even sweet-smelling. This is believed to be due to volatile organic compounds present in exhaled air in lung cancer patients.

What does pancreatic cancer breath smell like?

Pancreatic cancer breath may smell musty, sweet, or pungent due to certain chemicals (volatile organic compounds) present in exhaled air.

Note: Remember that these descriptions serve as general references. Bad breath alone is not a reliable diagnostic tool, as odors can sometimes be indistinguishable between different conditions. If persistent bad breath occurs, consult a healthcare professional for proper evaluation.

Treatment and Remedies

Dental Hygiene

Brushing your teeth twice a day with fluoride toothpaste for at least two minutes each time. Replace your toothbrush every 3-4 months or when it becomes frayed.
Flossing once a day helps to keep the spaces between your teeth clean. You can use dental floss, a special brush, a wooden or plastic pick, or a water flosser.
Mouthwash may improve bad breath due to a buildup of plaque (a sticky film of bacteria) on your teeth. Your dentist may recommend antibacterial mouth rinses.
Tongue Scrapers can remove bacteria from the tongue. Tongue scraping (mechanical tongue cleaning to remove any tongue coating) significantly decreased sulfur compounds by 75%, compared to only 45% with a toothbrush. Volatile sulfur compounds are a common cause of bad breath.
Dental Appliances such as dentures, bridges, mouth guards, and retainers must be cleaned regularly as recommended by your dentist to prevent mouth odor.

Home Remedies and Over-the-Counter Solutions

Water keeps the mouth moist and prevents dryness which causes bad breath.
Parsley has a fresh scent that can mask mouth odor.
Pineapple juice is anecdotally believed to be a good halitosis treatment although the scientific basis for this is unclear.
Yogurt is a probiotic food that contains healthy bacteria that can help fight harmful bacteria in the mouth and gut.
Milk can improve garlicky breath.
Fennel and anise seeds contain aromatic essential oils and are commonly used in some cultures as mouth fresheners.
Oranges contain vitamin C which the body needs for saliva production.
Zinc can counteract bad breath. Look for mouthwashes and chewing gums that have zinc as an ingredient.
Green tea has antibacterial properties and may act as a disinfectant.
Baking soda or sodium bicarbonate can kill harmful bacteria in the mouth. Make a solution of 2 teaspoons baking soda and 1 cup warm water to swish and spit.
Vinegar contains acetic acid that can kill oral bacteria. Add 2 tablespoons of white vinegar or apple cider vinegar to 1 cup of warm water to gargle. However, evidence supporting its use solely for halitosis is limited.

Are There Medications to Treat Bad Breath?

There is no specific treatment of halitosis. The treatment for bad breath depends on the cause. Treating the underlying medical condition usually resolves oral malodor. For example, if you have deep carious lesions (tooth decay), your dentist may recommend root canal treatment. If you have a periodontal abscess, they may prescribe antibiotics.

If there is no underlying medical condition found, your dentist may recommend mouth rinses, lozenges, and toothpastes with antibacterial agents that can help in treating halitosis (oral malodor).

If you have a chronic dry mouth (xerostomia), your dentist may prescribe an artificial saliva product or a medicine to increase saliva flow. Saliva can help reduce the number of harmful bacteria in the mouth.

When to Seek Medical Advice

Make an appointment to see your dentist if your bad breath does not improve with good oral hygiene and other lifestyle changes, such as drinking plenty of water and avoiding odor-causing foods. There may be a more serious underlying medical condition causing your bad breath. Your dentist may refer you to another healthcare provider to identify the cause.

Prevention Tips and Maintenance

Daily Oral Care

The best way to prevent a foul odor in the oral cavity is good dental hygiene. Brush your teeth twice a day, floss daily, use a tongue scraper, and keep dental appliances clean. This will keep breath odour in check. Proper oral hygiene helps to prevent dental caries (tooth decay) and gum disease, which are common causes of halitosis.

Dietary Considerations

Avoid caffeine, alcohol, and spicy food that can cause dry mouth.
Avoid odor-causing foods such as onions and garlic.
Avoid sugary foods that feed bacteria in the mouth.
Stay well hydrated to keep your mouth moist.
Chew sugarless gum or suck on sugarless candy to stimulate saliva production.

Regular Dental Check-Ups

Schedule regular checkups with your dentist once every 6 months. Your dentist may recommend a professional cleaning to prevent oral health issues. They can also recommend treatment of halitosis if lifestyle measures and dental hygiene have not helped.

Addressing Common Questions and Concerns

Can Bad Breath Be Cured Permanently?

Yes, bad breath can be cured permanently. Most people can get rid of chronic halitosis by treating the underlying cause. It could simply mean improving your oral hygiene routine. If this doesn’t help, your healthcare provider may make changes to your medications or run some tests to find out what’s going on.

How Do I Make My Breath Stop Stinking?

To stop your breath from stinking, try improving your oral health routine, including brushing, flossing, scraping off any tongue coating, and using a mouth rinse.

Why Does My Breath Stink Even After Brushing?

If your breath stinks even after brushing, make an appointment to see your dentist. You may have an underlying health condition that is causing bad breath. Treating the condition will likely get rid of your bad breath.