Overview

What is bad breath (halitosis)?

Chronic bad breath, which is sometimes called halitosis, is often a sign of poor dental hygiene or dry mouth. The condition may also be a sign of a more serious mouth disease or an illness in another part of your body, including gastric reflux, diabetes, kidney disease and liver disease.

Possible Causes

What are the causes and symptoms of bad breath?

Poor hygiene - This is the most common cause of bad breath. When food particles are stuck between your teeth or elsewhere in your mouth, they get broken down by bacteria that grow there. That process releases a foul smell. The bacteria can also cause tooth decay and gum disease. Brushing your teeth and tongue and flossing help to remove the food residue and control the bacteria.
Dry mouth - Saliva helps to wash your mouth, so if your body isn’t making enough saliva, your breath can smell bad. Smoking can cause dry mouth and also increases the possibility of gum disease. Certain medications can cause your mouth to be dry.
Cancer in your mouth, or between your nose and your mouth - Other symptoms of oral or oropharyngeal cancer (the 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 fluids leak back into the esophagus, the tube that takes food from your mouth to your stomach.
Tonsil stones - When food gets stuck in your tonsils, which are at the back of your mouth on both sides, it sometimes hardens into calcium deposits called tonsil stones or tonsilloliths.
Gum disease - Gingivitis is an inflammation of the gums that can cause them to be red, swollen and bleed easily. It is caused by plaque, a sticky film that builds on your teeth and can be removed by brushing and flossing. Trench mouth is an advanced form of gingivitis 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.) Untreated gingivitis can lead to periodontitis, which damages gum tissue and can lead to tooth and bone loss around the teeth.
Infections in the nose, throat or lungs - Patients 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 - These can lead to bad breath because of the smell of toxic substances that would be filtered out of your body by properly functioning kidneys or liver.
Sjögren’s syndrome - This is an autoimmune disease that can lead to dry mouth, dry eyes and dry skin, as well as muscle pain.

Care and Treatment

What can be done to prevent or control bad breath?

Brush twice a day, for at least 2 minutes each time, and floss once a day. Remember to clean your tongue with your brush, or ideally, a tongue scraper, available at drug stores.
Use antibacterial mouthwash.
See your dentist regularly, every 6 months, for checkups and to have your teeth and mouth professionally cleaned.
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. Salagen® is one prescription drug for this purpose. Evoxac® is another that is used for patients who have Sjögren’s syndrome.
Avoid alcohol, caffeine and tobacco products because they can dry out your mouth.

What is the best technique for brushing teeth?

Use a soft toothbrush of a size and shape that allows you to reach all areas of your mouth.
Replace that toothbrush at least every 3 or 4 months – more often if it looks worn.
Hold the brush at a 45-degree angle to the 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 the brush. That is hard on your gums, and the brush won’t work as well if the bristles are flattened against your teeth.

What is the best technique for flossing?

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 is an inch or two of it between your fingers. Guide that middle section between teeth and rub gently, wrapping it around the sides of your teeth. If you haven’t been flossing, there might be some discomfort for the first few days, but that should go away.

When to Call the Doctor

When is it time to see a doctor?

If you are following good dental hygiene practices and taking care that your mouth is not too dry, and you’re still having issues with persistent bad breath, you should make an appointment to see a dentist.

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Bad Breath (Halitosis)