Bad breath: What causes it and what to do about it

Almost everyone experiences bad breath once in a while. But for some people, bad breath is a daily problem, and they struggle to find a solution. Approximately 30% of the population complains of some sort of bad breath. Halitosis (Latin for "bad breath") often occurs after a garlicky meal or in the morning after waking. Other causes of temporary halitosis include some beverages (including alcoholic drinks or coffee) and tobacco smoking.

Some people may not be aware of their own halitosis and learn about it from a relative, friend, or coworker, causing some degree of discomfort and distress. In severe cases, bad breath (as well as bad body odor) may negatively impact personal relationships and a person's quality of life.

What causes bad breath? And what can you do about it?

Bad breath can originate both inside and outside of the mouth. Bad breath is typically caused by bacteria present on the teeth and debris on the tongue. So it's no surprise that most cases of halitosis are associated with poor oral hygiene, gum diseases such as gingivitis and periodontitis, and dry mouth, a condition in which the salivary glands cannot make enough saliva to keep your mouth moist. A visit with a dentist may help rule out periodontal disease and identify any mouth problem that could be contributing to bad breath.

Tonsillitis, respiratory infections such as sinusitis or bronchitis, and some gastrointestinal diseases may be responsible for a small number of cases of bad breath. Advanced liver or kidney disease and uncontrolled diabetes can also lead to unpleasant breath. In these cases, a person is likely to experience significant symptoms beyond bad breath, and should seek medical attention.

Sometimes people think they have bad breath, even when their breath is objectively fine. This is called "pseudo-halitosis." Halitophobia, or fear of bad breath, is real and may persist despite reassurance from a doctor. People with pseudo-halitosis respond well to reassurance, and may benefit from speaking with a therapist or psychiatrist who has expertise in the field.

A person complaining of bad breath can be initially evaluated by a primary care physician (PCP). The doctor will begin with a thorough medical and dental history and an oral exam. Tests may be done to confirm the presence of halitosis by measuring the strength of bad breath on a predefined scale, and by using instruments to detect specific compounds related to halitosis. The intensity of malodor is usually assessed by the doctor smelling the air that the person breathes out through the nose or mouth, or from judging the odor of a tongue scraping, a length of dental floss, or a dental appliance such as a night guard.

Your PCP may refer you to a dentist if there is evidence of dental or gum problems, which is the cause in the majority of people with bad breath. Visits with other medical specialists are warranted when an underlying medical problem requires attention.

Tips to improve bad breath

Here are some helpful tips to improve bad breath:

• Brush your teeth at least twice a day, after meals, with a fluoridated toothpaste.
• Avoid tobacco smoking and chewing tobacco-based products.
• Rinse and gargle with an alcohol-free mouthwash before bed.
• If you have dry mouth, make sure to drink enough fluids throughout the day and use over-the-counter moisturizing agents, such as a dry mouth spray, rinses, or dry mouth moisturizing gel. If you don't see any improvement, you may want to schedule a visit with an oral medicine specialist. Oral medicine doctors provide comprehensive care for mucosal diseases, salivary gland disorders, orofacial pain conditions, and oral complications of cancer therapies, among other things.
• Visit your dentist regularly. Remember, oral causes are responsible for most cases of bad breath!