Bad breath, also known as “halitosis”, is an unpleasant and embarrassing condition that can lead to social problems. Poor oral hygiene is the most common cause. Also, it can be caused by medical conditions such as respiratory diseases, gastrointestinal tract diseases, and metabolic imbalance in diabetes mellitus. The treatment depends on the underlying cause. In most cases, bad breath disappears with proper oral hygiene.
In our oral cavity, there are more than 300 different types of bacteria. They decompose food debris and produce sulfur-containing metabolites, which are the actual cause of bad breath. In a healthy oral cavity, the decomposition activity is low, so there is no noticeable mouth odor arises. However, when bacteria find an oversupply of food and good living condition, the multiply rapidly and produce sulfur odor.
Bacteria prefer places with little oxygen and places that can’t be reached by toothbrush such as interdental spaces. The tongue surface is the favorite place for bacterial activity. Dentists assume that more than two-thirds of bad breath cases are due to tongue coating.
Bad Breath Causes
In about 85 to 90% of cases, bad breath causes occur in the oral cavity, nose, and throat. Bacteria produce sulfur-containing metabolites which are the actual cause of bad breath. There are many possible causes, include:
- Poor oral hygiene: it is the most common cause of bad breath. With poor oral hygiene, bacteria will build up on teeth surfaces, gums, the tongue, and in interdental spaces. These bacteria will produce sulfur-containing metabolites, causing an unpleasant smell. Poor oral hygiene is also responsible for dental caries and gum disease.
- Xerostomia: it is also known as dry mouth condition. The decreased salivary production caused by mouth breathing, snoring, some medication, and dehydration can cause unpleasant mouth odor.
- Poor denture cleaning: removable dentures should be cleaned every day to prevent bad breath.
- Some foods and drinks: foods with strong flavors such as onion, garlic, and spices can cause an unpleasant smell. Also, drinks with strong smell such as coffee, and alcohol can cause an unpleasant smell. Usually, the smell caused by these foods or drinks is temporary and can be avoided by maintaining a good oral hygiene and limiting these types of foods and drinks.
- Tobacco products: tobacco chewing and smoking can cause unpleasant mouth odor. Also, tobacco smoking triggers some oral problems such as gum disease, and dry mouth condition (other sources of bad breath).
- Dental conditions: some oral problems such as dental caries, gum disease, and wounds after tooth extraction or oral surgery can cause bad breath.
- Medications: some medications promote the colonization of the oral mucosa with bacteria or fungi. Also, certain medications can cause dry mouth condition.
- Medical conditions: in some cases, bad breath can be caused by certain medical conditions such as:
- Salivary gland disease such as Sjogren’s syndrome which leads to a strong decrease in the salivary production in addition to dry mouth condition, and problems with eating, swallowing and talking.
- Tumors in the oral cavity and throat.
- Fungal infection by Candida albicans.
- Sexually transmitted diseases such as syphilis can cause wounds in the oral cavity which are the ideal places for bacterial colonization.
- Tonsillitis, sinusitis, and nasal polyps.
- Respiratory disease such as pneumonia, bronchiectasis, and lung abscess.
- Metabolic imbalance as a part of diabetes mellitus, severe renal, and hepatic dysfunction.
- Gastrointestinal tract diseases such as foreign bodies in the esophagus, bowel obstruction, infection of the stomach lining and small intestine, and gastro-oesophageal reflux disease (GERD).
- Poisoning with substances such as phosphorus, arsenic, and selenium.
Symptoms of Bad Breath
Unfortunately, many people don’t know that they have bad breath because it’s difficult to assess how your own breath smells. Therefore, they can’t do anything about it. If someone from your family or your close friend is suffering from unpleasant mouth odor, make a friendly attention to the problem. If you are not sure that you suffer from bad breath, ask your family, friend, or dentist.
Bad breath symptoms depend on the underlying cause. If poor oral hygiene is the cause, bacteria in the oral cavity and throat will produce sulfur compounds that lead to a foul odor. The nature of mouth odor may indicate the possible underlying disease for example:
- Fruit-like smell: in the case of diabetes mellitus, the breath is fruit-like smell similar to rotten apples.
- Urine odor: it can indicate abnormal kidney function.
Diagnosis of Bad Breath
Your dentist can diagnose bad breath by the smell of exhaled air. The diagnosis is simple but the identification of the underlying cause is more difficult because there can be many causes of bad breath. The dentist will examine the oral cavity, searching for the underlying cause to eliminate it. He/She will:
- Check if poor oral hygiene, dental caries, or gum disease is the cause of bad breath.
- Examine the fillings and crown edges.
- Examine the salivary flow.
The dentist will refer you to a physician if he/she suspects a certain medical condition is causing your bad breath.
Treatment of Bad Breath
The treatment depends on the underlying cause. In most cases, bad breath disappears with proper oral hygiene. The treatment of this condition may include:
- Improve your oral hygiene: the regular use of toothbrush, floss, and tongue scraper make a significant improvement in the oral hygiene. Your dentist may also recommend a toothpaste and mouth rinse that contain an antibacterial agent.
- Treatment of dental diseases: your dentist may perform the following procedures to treat the unpleasant mouth odor problem:
- Professional cleaning, to treat gum disease.
- Removal of dental caries and placement of tooth fillings.
- Replacement of broken tooth restorations.
- Denture cleaning: clean your denture using soap and warm water to remove bacteria and food debris.
- Treatment of dry mouth condition: chew sugar-free gum to increase the salivary flow. Also, drink plenty of water to keep your oral cavity moist.If bad breath is caused by a medical condition such as diabetes mellitus, sinusitis, and bronchitis, you dentist will refer you to a physician for an appropriate therapy. The bad breath progress depends on how successful is the treatment of the underlying disease.
Prevention of Bad Breath
In order to prevent bad breath, you should follow this instruction:
- Maintain a good oral hygiene:
- Brush your teeth twice a day especially after meals. Also, use a toothpaste with an antibacterial agent to reduce or prevent bad breath.
- Floss your teeth at least once a day to remove food debris and bacteria from between your teeth.
- Brush your tongue with a soft toothbrush or tongue scraper to remove food debris and bacteria especially in the back of the tongue.
- Use a mouthwash with an antibacterial agent to reduce or prevent bad breath. Mouthwashes with antibacterial agents shouldn’t be used for more than 2 weeks because it may disturb the oral flora balance. Also, it can cause stains on teeth and taste disturbance.
- Clean your dental appliance: clean your bridge, denture, retainer, or mouth guard at least once a day.
- Avoid dry mouth condition: chew sugar-free gum to stimulate the salivary flow. Saliva contributes in the fighting against oral bacteria. Apple eating has the same effect as chewing sugar-free gum. Also, drink plenty of water to keep your oral cavity moist and wash down bacteria and food debris. Soft drinks and alcohol can cause dry mouth condition.
- Eat a balanced diet: eat vegetables and fruits. Avoid sticky and sugary foods. Also, avoid alcohol drinking.
- Avoid smoking or chewing tobacco.
- Regular dental checkups: visit your dentist at least twice a year for professional cleaning and treatment of existing dental problems.