Bad breath

Definition

Store shelves are overflowing with mints, mouthwashes and other products designed to help people combat and prevent bad breath. Yet these products help control bad breath (halitosis) only temporarily.

Certain foods, health conditions and habits are among the causes of bad breath. In many cases, you can improve bad breath with proper dental hygiene. But, if simple self-care techniques don't solve the problem, you may want to see your dentist to be sure a more serious condition isn't causing your bad breath.

Symptoms

The precise kind of bad breath odor varies depending on the source or the underlying cause of the bad breath.

When to see a doctor
See your dentist if you have tried self-care techniques and have not had good results, and to be sure that you don't have a more serious condition that's causing your bad breath.

Causes

Most bad breath originates in your mouth. The causes of bad breath are numerous. They include:

• Food. The breakdown of food particles in and around your teeth can cause a foul odor. Eating foods containing volatile oils is another source of bad breath. Onions and garlic are the best-known examples, but other vegetables and spices also can cause bad breath. After these foods are digested and the pungent oils are absorbed into your bloodstream, they're carried to your lungs and are given off in your breath until the food is eliminated from your body. Onions and garlic can cause bad breath for as long as 72 hours after you've eaten them.

• Dental problems. Poor dental hygiene and periodontal disease can be a source of bad breath. If you don't brush and floss daily, food particles remain in your mouth, collecting bacteria and emitting hydrogen sulfide vapors. A colorless, sticky film of bacteria (plaque) forms on your teeth.

  If not brushed away, plaque can irritate your gums (gingivitis) and cause tooth decay. Eventually, plaque-filled pockets can form between your teeth and gums (periodontitis), worsening this problem — and your breath. Dentures that aren't cleaned regularly or don't fit properly also can harbor odor-causing bacteria and food particles.

• Dry mouth. Saliva helps cleanse and moisten your mouth. A dry mouth enables dead cells to accumulate on your tongue, gums and cheeks. These cells then decompose and cause odor. Dry mouth naturally occurs during sleep. It's what causes "morning breath." Dry mouth is even more of a problem if you sleep with your mouth open. Some medications as well as smoking can lead to a chronic dry mouth, as can a problem with your salivary glands.
• Diseases. Chronic lung infections and lung abscesses can produce very foul-smelling breath. Other illnesses, such as some cancers and certain metabolic disorders, can cause a distinctive breath odor. Kidney failure can cause a urine-like odor, and liver failure may cause an odor described as "fishy." People with uncontrolled diabetes often have a fruity breath odor. Chronic reflux of stomach acids from your stomach (gastroesophageal reflux disease, or GERD) also has been associated with bad breath.
• Mouth, nose and throat conditions. Bad breath is also associated with sinus infections because nasal discharge from your sinuses into the back of your throat can cause mouth odor. A child with bad breath may have a foreign object lodged in his or her nose. A bean or small item stuck in the nose can cause persistent nasal discharge and a foul odor. Throat infections can cause bad breath until they clear. Bronchitis and other upper respiratory infections in which you cough up odorous sputum are other sources of bad breath.
• Tobacco products. Smoking dries out your mouth and causes its own unpleasant mouth odor. Tobacco users are also more likely to have periodontal disease, an additional source of bad breath.
• Severe dieting. Dieters may develop unpleasant "fruity" breath from ketoacidosis, the breakdown of chemicals during fasting.

Bad breath can usually be eliminated with good dental hygiene.

Preparing for your appointment

Because it's difficult to assess how your own breath smells, ask someone close to you to confirm your breath problem. Once your bad breath has been confirmed, try making lifestyle changes and reviewing your oral hygiene habits.

If, despite practicing proper dental hygiene, your bad breath persists, see your dentist. If the cause isn't dental, see your doctor to rule out a possible medical cause. You may need a physical examination and testing to pinpoint the underlying cause.

What you can do
Don't eat, drink, chew gum, smoke or brush your teeth for three hours before your appointment. Also, don't wear perfume, scented lotions, or scented lipstick or lip gloss to your appointment, as these products could mask any odors. If you've taken antibiotics within the last month, check with your doctor or dentist to see if your appointment needs to be rescheduled. Antibiotics can sometimes temporarily reduce the number of odor-causing bacteria.

What to expect from your doctor
Your doctor or dentist is likely to ask you a number of questions, such as:

• When did you first begin to experience symptoms?
• Are your symptoms occasional or continuous?
• How often do you brush your teeth or clean your dentures?
• How often do you floss?
• What kinds of foods do you eat?
• What medications do you take?
• Do you breathe through your mouth?
• Do you snore?
• Do you have allergies or sinus problems?
• What do you suspect might be causing your bad breath?
• Have other people noticed and commented on your bad breath?

Your doctor or dentist will likely smell both the breath from your mouth and the breath from your nose, and he or she will rate the odor on a scale of 0 to 5, with 0 being no odor. He or she may also scrape the back of your tongue with a plastic spoon, and rate its odor. Researchers are currently trying to develop a machine that could more objectively assess odors, but none are currently sufficiently reliable.

Lifestyle and home remedies

Try the following steps to improve or prevent bad breath:

• Brush your teeth after you eat. Keep a toothbrush at work to brush after eating. Be sure to brush at least twice a day, for two to three minutes at a time.
• Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth.
• Brush your tongue. Giving your tongue a gentle brushing removes dead cells, bacteria and food debris. Use a soft-bristled toothbrush or a flexible tongue scraper. Try to clean as far back as you can without gagging because the bacteria tend to collect toward the back.
• Clean your dentures well. If you wear a bridge or a partial or complete denture, clean it thoroughly at least once a day or as directed by your dentist.
• Drink plenty of water. To keep your mouth moist, be sure to consume plenty of water — not coffee, soft drinks or alcohol. Chewing gum (preferably sugarless) or sucking on candy (preferably sugarless) also stimulates saliva, washing away food particles and bacteria. If you have chronic dry mouth, your dentist or doctor may additionally prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
• Use a fairly new toothbrush. Change your toothbrush every three to four months, and choose a soft-bristled toothbrush.
• Schedule regular dental checkups. At least twice a year, see your dentist to have your teeth or dentures examined and cleaned.
• Chew fresh parsley or suck on a sugarless mint. Doing so may temporarily improve bad breath.

You can teach your school-age children to brush and floss their teeth regularly and to brush their tongues to prevent bad breath. But, don't let children use mouthwash, because many mouthwash products contain alcohol and can pose a risk for children if swallowed.