Bad Breath (Halitosis)

Overview

What is halitosis?

Halitosis is the medical term for bad breath. Everyone gets bad breath from time to time — especially after eating garlic, onions or other strong foods. But bad breath that doesn’t go away (chronic halitosis) could mean you have an oral health issue or a condition that’s affecting another part of your body.

Halitosis is a symptom of many different conditions. In other words, it’s like a warning message from your body. Finding the root cause of halitosis is the first step in treating the issue.

How common is halitosis?

Halitosis is a widespread condition, affecting approximately 1 out of 4 people around the globe. One research study, which combined the findings of 13 medical journal articles, found that halitosis affects about 31.8% of the population.

Symptoms and Causes

What are the symptoms of halitosis?

The main halitosis symptom is foul-smelling breath that doesn’t go away. The odor may be strong enough for other people to notice.

What is the most common cause of bad breath?

The most common cause of halitosis is poor oral hygiene. Without proper oral hygiene — like brushing, flossing and routine dental cleanings — harmful bacteria invade your mouth and multiply out of control. This can lead to several oral health issues like halitosis, cavities and gum disease.

What are other halitosis causes?

While poor oral hygiene is the most common cause of halitosis, it’s not the only one. There are several other conditions that can cause bad breath, including:

  • Dry mouth: Saliva helps to wash your mouth, so if your body isn’t making enough saliva, it can lead to halitosis. Smoking can cause dry mouth, and it also increases your risk for gum disease. Additionally, certain medications can cause dry mouth.
  • Head and neck cancers: Symptoms of oral or oropharyngeal cancer (your oropharynx is between your nose and mouth) include sores that don’t heal, mouth pain, difficulty swallowing, a lump in your neck and unexplained weight loss.
  • Gastroesophageal reflux disease (GERD): This is a digestive disorder in which stomach acid or fluid leaks back into your esophagus, the tube that takes food from your mouth to your stomach.
  • Tonsil stones: When food gets stuck in your tonsils (located in the back of your throat), it sometimes hardens into calcium deposits called tonsil stones or tonsilloliths.
  • Gum disease: Gingivitis is an inflammation of your gums that can cause redness, swelling and bleeding. It’s caused by plaque, a sticky film that builds up on your teeth and can be removed by brushing and flossing. Untreated gingivitis can lead to periodontitis, which damages gum tissue and can lead to tooth and bone loss around your teeth. Trench mouth is an advanced form of gum disease that can involve intense pain, bleeding, fever and fatigue. (It’s called “trench mouth” because it was a common illness for soldiers in the trenches during World War I.)
  • Infections in your nose, throat or lungs: People with pneumonia, for example, cough up liquid that smells bad.
  • Diabetes: People with diabetes have an increased risk of gum disease — and gum disease can make it harder to control diabetes because it can increase blood sugar.
  • Liver disease or kidney disease: When your liver and kidneys are working properly, they filter toxins out of your body. But in people with liver or kidney disease, these toxic substances aren’t being cleared out. This can result in halitosis.
  • Sjögren’s syndrome: This autoimmune disease can lead to muscle pain, dry eyes, dry skin and dry mouth (which is often linked to halitosis).

What does it mean if you have bad breath all the time?

If you have chronic halitosis, it could mean you have gum disease. This isn’t always the case, though. Halitosis can also be a symptom of the conditions listed in the section above.

If you have bad breath that doesn’t go away, schedule an appointment with your dentist. If halitosis is due to poor oral hygiene, a dental cleaning or periodontal (gum) procedure should help. If you have healthy teeth and gums, then halitosis may be linked to an issue in another part of your body.

Diagnosis and Tests

How do I know if my breath stinks?

If you have a bad taste in your mouth, you probably have a mouth odor that others can smell. To find out for sure, have an assessment with your dentist.

Management and Treatment

How is halitosis treated?

Halitosis treatment depends on the root cause of the issue. For example, if bad breath is due to poor oral hygiene, a dental cleaning and improved oral hygiene at home will likely help.

But if halitosis is a symptom of another condition somewhere else in your body, your primary healthcare provider can help you with proper diagnosis and treatment.

Occasionally, your dentist may recommend special mouth rinses to combat certain bacteria in your mouth.

How can I permanently get rid of bad breath?

As mentioned above, treating the underlying condition is the only halitosis cure. Gum and breath mints only cover up the problem.

Once your healthcare provider determines what caused halitosis, they can create a treatment plan tailored to your specific needs.

Prevention

How can I prevent halitosis?

Proper oral hygiene is the best way to keep your breath smelling clean and fresh. Here are some general guidelines:

  • Brush twice a day, for at least two minutes each time, and floss once a day. Remember to clean your tongue with your brush or a tongue scraper, which you can buy in the oral health aisle.
  • Use an alcohol-free antibacterial mouthwash.
  • See your dentist regularly for checkups and cleanings. For some people, this may be every six months. But others may need more frequent visits to keep their oral health in check.
  • Drink a lot of water to help prevent dry mouth.
  • Boost the production of saliva by using sugar-free chewing gum, sucking on sugar-free candy or eating healthy foods that require a lot of chewing. Your dentist might recommend or prescribe products that can produce artificial saliva or help your body produce saliva.
  • Avoid alcohol, caffeine and tobacco products because they can dry out your mouth.

What’s the best technique for brushing my teeth?

Here are some tips and tricks for brushing your teeth properly:

  • Use a soft-bristled toothbrush. Be sure its size and shape allow you to reach all areas of your mouth.
  • Replace your toothbrush at least every three or four months — or more often if it looks worn.
  • Hold your toothbrush at a 45-degree angle toward your gums and use short strokes, about the width of a tooth. Make sure you get to the outside, inside and top of each tooth.
  • Don’t press down hard on your brush. Aggressive brushing or using a hard-bristled brush could cause gum recession.

What’s the best technique for flossing my teeth?

Cleaning between your teeth is just as important as brushing. Floss can clean places that your toothbrush can’t reach. To floss properly:

  • Break off about 18 inches of floss and wrap it around your middle fingers.
  • Use your thumbs and forefingers to hold the floss tightly so there’s an inch or two of it between your fingers.
  • Guide that middle section between your teeth, wrap the floss around one tooth (in a “C” shape), and rub up and down the length of that tooth seven to 10 times. (Note: Friction is necessary to remove plaque from your teeth surfaces. Water flossers are great for removing large pieces of food and debris. But if you use a water flosser, be sure you also use regular floss.)
  • Now, wrap the floss around the neighboring tooth and repeat these steps.

If you haven’t been flossing, there might be some bleeding and discomfort for the first few days, but that should go away.

Outlook / Prognosis

What can I expect if I have halitosis?

Most people can get rid of chronic halitosis by treating the underlying condition. That could be as simple as improving your oral hygiene routine.

If chronic bad breath is due to an underlying health condition, then there may be some trial and error to figure out what works for you. Your healthcare provider may need to try different medications or change your dosages. Or they may ask to run more tests to determine the exact cause.

Living With

When should I see my healthcare provider?

If you practice good hygiene and you still have halitosis, schedule an appointment with your dentist. Some people build up plaque faster than others and may just need more frequent cleanings. You can also schedule an appointment with a periodontist (gum disease specialist) who can see if gum disease is the cause of halitosis.

If your dentist doesn’t find any oral health issues — such as cavities or gum disease — then your primary care physician can determine if another condition is causing halitosis.

A note from Cleveland Clinic

Halitosis is a common condition that can cause embarrassment or low self-esteem. But bad breath isn’t something to be ashamed of. It’s often just your body’s way of telling you that something isn’t quite right. The good news is that you can usually get rid of halitosis by treating the underlying health condition. Your dentist and primary care physician can work together to find out what’s effective for you.

Last reviewed by a Cleveland Clinic medical professional on 07/18/2022.

References

  • American Dental Association. Bad breath: Causes and tips for controlling it. (https://www.ada.org/~/media/ADA/Publications/Files/for_the_dental_patient_sept_2012.ashx) Accessed 7/18/2022.
  • American Dental Association. Brushing Your Teeth. (https://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth%29) Accessed 7/18/2022.
  • American Dental Hygienists’ Association. Proper Flossing. (https://www.adha.org/resources-docs/7222_Proper_Flossing.pdf) Accessed 7/18/2022.
  • Silva MF, Leite FRM, Ferreira LB, et al. Estimated prevalence of halitosis: a systematic review and meta-regression analysis. (https://pubmed.ncbi.nlm.nih.gov/28676903/) Clin Oral Investig. 2018 Jan;22(1):47-55. Accessed 7/18/2022.
  • U.S. National Library of Medicine. Oral malodour (halitosis). (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570844) Accessed 7/18/2022.

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