THE BLOG
03/18/2010 05:12 am ET | Updated Nov 17, 2011

Mouth Health: Bad Breath

Bad breath (or otherwise known as "Halitosis") is, in simple terms, the unpleasant odor that emanates from the mouth. The causes of bad breath, which this article will explore in more detail, range from pre-existing medical conditions to something as straightforward as what one ate for lunch (woe to those who choose an onion sandwich on garlic bread with vinegar dressing...)

As one would likely suspect, bad breath of some sort is fairly common. Severe halitosis can affect one out of 10 unlucky people. Combined with a portion of the population with "merely unpleasant" breath, we have one out of five people with some form of bad breath.

As expected, the effect on a person's life from bad breath is quite significant, especially in societies concerned (if not obsessed) with personal hygiene. Those who are self conscious about their breath become reluctant to participate in normal social activities and thus increase their suffering past any initial negative reactions from other people.

Other individuals affected by bad breath can go their entire life completely unaware that their breath is bad. They can experience negative reactions from people in their social circle, with no hint as to what the cause is. While it is possible that someone will clue them to their bad breath, most people feel uncomfortable in being so direct. It's just not an easy thing to do. Think about it: Would it really be easy for you to tell your neighbor, boss, or co-worker that they have bad breath?

Regular trips to the dentist could help detect bad breath, but here's where we run into an interesting problem. People tend to put on their best "date mouth" when visiting the dentist. Teeth are brushed with extra care, mouthwash is swished around a bit longer, and those with an extra bit of fear may even use a breath mint. While considering the poor dentist's nose as he works near the mouth is a considerate, all the cover ups do is hide the existence of bad breath from the dentist, preventing him or her from alerting the individual to the existence and cause of their bad breath, as well as treat the condition.

Combine the desire to put one's best tooth forward at the dentist with society's desire to spare someone's feelings, most people can remain unaware to the fact that they have bad breath (but the people around them certainly will). Since they'll never know, they'll never work to fix the cause of their bad breath.

On the opposite side on the coin, there are people who are quite "aware" of their bad breath despite the fact that their breath is actually acceptable (perhaps even pleasant)! These people suffer from Halitophobia which is the exaggerated fear that one has bad breath. With the social stigma over bad breath being so severe, it's no wonder that one out of four people seeking information on bad breath have this condition. Unfortunately, the "phantom bad breath" while being all in their mind, still results in a very real embarrassment and liability to one's social life very similar to real bad breath sufferers.
So whether one does have bad breath or wants to alleviate their concerns because they might have halitosis, learning the true causes of bad breath is quite important (if not critical for disease sufferers). Mints, mouthwashes, chewing gum and other similar breath sweeteners are useful masks but they only cover up the problem and offer a temporary solution at best. So now that we know why learning the causes of bad breath is so important, we can learn to treat it.

Obviously, if someone thinks they or someone they know has bad breath, they'll want to put a stop to it. As with curing most medical conditions, you need to look at the cause. So let's look at the general causes of bad breath and then move into more specific causes to help clear the air.

Causes of Bad Breath / Treatments
As you know, bad breath is the result of outside or internal factors. In other words, you may have either eaten or drank something that causes people to wince as you share a story. If brushing and flossing is neglected, the scent will stay and get worse. Of course, periodontal disease is a factor. Another not so obvious possibility is a pre-existing internal condition such as diabetes which carries symptoms like bad breath. As we get into the different possibilities, keep in mind that it's a good idea to check with a doctor. After all, one could have bad breath from their diet but still have additional bad breath due to periodontal disease or a respiratory illness.

Gum Disease
The first cause to cover is the bad breath that arises from gum disease (also known as periodontal disease or gingivitis). Gum disease comes in many different severities but it is generally classified into two different stages: Gingivitis and periodontitis. Gingivitis is the beginning stage and therefore the less severe stage of periodontal diseases. Untreated gingivitis will eventually become periodontitis (which has many different forms as well) if left untreated. Periodontitis (literally meaning "inflammation around the teeth") is a common aliment. It's estimated that 30 - 50 percent of the population suffers from periodontitis. However, only roughly 10 percent of the population has severe periodontitis and the accompanying bad breath.

Periodontal disease sufferers have spaces between the teeth and the gums. The severity of the gaps depends on the stage of the disease. No matter the size of the gaps, food becomes trapped between the gums and teeth and eventually bacteria will arise. As the bacteria eat the bits of food, volatile sulfur compounds (VSCs) are emitted, causing the bad breath in periodontal disease sufferers. Due to the gaps between the teeth and the gums, additional odors can originate from eating traditionally odorous food. Under normal circumstances the food that would be brushed or rinsed away stays.

Does this mean the person has bad breath due to periodontal disease? First, look at the symptoms common to gum disease. Sufferers of gingivitis and/or periodontitis tend to bleed after brushing. The flow of the blood depends on the stage of the disease with severe gum disease sufferers having more blood loss. Many sufferers complain of a continuous "metallic taste" in their mouth. This is from the iron in the blood which produces the metallic taste. With the blood loss, the breath can become worse. First it'll have an iron or metallic smell and then change into a more foul scent as the blood decomposes. While checking for bad breath, check to see if there's inflammation of the gums and blood. This will be a good indicator that the bad breath is due to gum disease.

Plaque and tartar is another sign of bad breath due to gum disease. Bacteria form on the teeth and turn into plaque within 24 hours if untreated. With enough time, the plaque eventually turns into tartar. As tartar is made from rotted food and bacteria, the combination will stink and give the person bad breath.

Due to the seriousness of gum disease, the best treatment is to see your dentist every six months (or more often for those with severe cases). He or she can easily detect and reduce (if not eliminate) the odor causing bacteria (not to mention save your teeth and gums), and eliminate the bad breath it causes. In addition, good dental care and a home treatment suggested by a dentist can improve your breath and keep the dangers of lost (and loose) teeth at bay.

"Morning Breath"
As evidenced from the smelly plaque of gum disease, debris and bacteria help create bad breath. Similar debris and bacteria on the tongue is the cause of the ever so common "morning breath." Sometime called dry mouth, it's the unpleasant odor that someone and/or their partner experience in the morning. This assumes they sleep during the night. People working during nighttime shifts will have "evening mouth" instead when they wake. No matter the time they sleep, the bad breath is due from the non production of odor fighting saliva.

Saliva is nature's odor and cleaning agent for the mouth. It is normally produced by conscious desire (such as when your throat is dry) or though the action of chewing (which helps in the digestion of food). No matter the cause, the body produces less saliva as one sleeps. Saliva is needed to wash away dead food particles and other debris, while also fighting bacteria with chemicals and proteins found in the saliva. This is why a person with normally pleasant breath will wake up to breath most foul. Their saliva keeps their breath pleasant during the day but clocks out when the person goes to sleep. Without the saliva's cleaning power, bacteria happily munch the dead cells on your tongue, teeth, and gums while releasing volatile sulfur compounds (VSCs) which generate morning breath. Bad Bacteria!
So now that you know what causes morning/dry mouth, what's the best way to see if someone is suffering from it? Despite any social embarrassment, they best way is to ask someone if the breath smells different after waking up verses several hours later. For those without someone to ask (or are too shy), there are a few traditional methods one can use.

A popular "home remedy" of determining bad breath is cupping one's hand and sniffing the exhaled air, which gives poor results. A proper air sample can't be obtained of the VSCs from the back of your mouth since it's difficult to direct the air toward the nose. At best, they'll only get a partial sample which could suggest bad breath from what little air they can smell. Licking the wrist and waiting for ten seconds while the saliva dries is a better method, as some of the sulfur will transfer. If the wrist smells foul, then that's a good indicator. The best cheap home remedy is to take a cotton swab and rub the back of your tongue and the inside of the cheeks. This works best because the swab is picking up the VSCs from the back of the tongue that generate bad breath. For those wanting more accurate results, an at-home testing kit can give you results within minutes.

If the test shows positive for bad morning breath due to debris and bacteria, here are suggestions on how to address the situation. Flossing and brushing at least two times a day will remove most but not all of the odor causing agents. Using a bacteria killing mouth rinse is helpful (especially before going to bed). Using a tongue scraper will literally scrape the debris and bacteria off the tongue (hence the name). Using a toothbrush on the tongue should be avoided since bacteria and food particles can remain embedded between the bristles and transfer on to the tongue after spoiling for hours. Drinking water will help with the dry mouth as will a high protein diet (since saliva uses proteins to fight bacteria).

Post Nasal Drip
In addition to rotting food particles and VSCs, the effects of morning/dry mouth can be combined with mucus from post-nasal drip or other sinus or respiratory related illnesses. While this happens during sleep to many bad breath sufferers, mucus can still accumulate during the day thus resulting in constantly bad breath. Even if it isn't the sole cause of morning mouth, nasal drip sufferers are more likely to have bad breath.

Bad breath from post-nasal drip is due to the bacteria which are attracted to the mucus and phlegm. Just like with human food, the bacteria feed and emit the foul smelling compounds (VSCs) from the amino acids within the mucus and phlegm. While post-nasal drip can result from sinus or respiratory related illnesses, there could be other reasons for excessive mucus and phlegm production. People who eat dairy rich foods and drink and/or smoke have more mucus and phlegm in their throat, thus increasing bad breath. Children are very susceptible to post-nasal drip. While children are already susceptible to colds (and the creation of odor causing bacteria), the presence of the tonsil provide room for the bacteria to live. Since more children than adults have tonsils, this cause of bad breath is more common in children.

Testing for post-nasal drip as a cause is quite easy. If the nasal passages are constantly blocked with mucus (both during sleep and while away), it's quite likely that they have post-nasal drip. A feeling of mucus and phlegm in the back of the throat is another trusted indicator. A white coating on the back of the tongue and a constant bad taste in the mouth suggest post-nasal drip as well. The need to constantly swallow and a continuous sore throat is another good indication. Last we have constant bad breath which is a good indicator since it's the mucus and phlegm that feed the bacteria that produce the smell.

So if the bad breath is from post-nasal drip, what's the best way to fight it? Unfortunately, the nasal decongestants (while advertised as cures) may cure the drip, but can also increase the bad breath. If the decongestant is too strong, it will dry out the mouth. As mentioned earlier, dry mouth produces its own conditions for bad breath. In many cases the mucus returns with the same potency when the decongestant usage stops. Therefore, decongestants should only be used in temporary situations such as during a cold or allergy season. Waiting for the illness to be over will clear the post-nasal drip and bad breath problem for most people.

While this may seem obvious, blowing the nose often will reduce the amount of mucus in the throat and therefore the odor level. The point is to reduce it to a level where the body can more easily fight the amount of bacteria in the mucus and phlegm.

For those with persistent post-nasal drip, a specialist in respiratory tract infections and a visit to your dentist is best. Regardless of the chance of respiratory infections, a visit your dentist twice a year to ensure something more serious isn't going on is always a good idea for everyone to follow and keeps the bad breath at bay.

Other Causes
Speaking of external conditions such as respiratory infections, bad breath can be an indicator of an illness in your body far more serious than a cold or reaction to sinus infections. Different smells can be indicators of different medical conditions. Since our breath is the result of different compounds, different diseases will produce different smells due to the production of different by products. For example, a person with diabetes will have fruity or citrusy breath, someone with acidic breath may have asthma or cystic fibrosis, while a patient with kidney problems may have the scent of ammonia in their breath.

As you can see, the scent of the breath can be an indicator of the body's general state. Whether one is sick from a disease or even dieting, the breath can change. Dieters in particular have high instances of bad breath. This of course depends on the type of diet. If a low-carb dieter has bad breath, it may be due to the body's production of ketones. Ketone production occurs when the body is burning fat. Since the breath now contains new compounds, the breath will changed to a fruity and/or acetone smell. Since ketone production is the cause (which is due to dieting), stopping the diet, the weight loss, or changing diets may reduce the smell. Since losing weight may be more desirable than bad breath, most people are loath to give up the diet. In this case, drinking extra water is the only viable solution. This will flush out the body and reduce the bad breath from excess ketones.

While a person may not be on a diet, the breath is still related to their food habits or specifically what goes into their body. Smelly food such as onions, garlic, and certain cheeses will give you bad breath especially if the debris remains on the tongue. A proper cleaning will remove the offending food and the cause of the bad breath.

Wrapping it up
As we can see, there are many causes to Bad Breath. However, overwhelmingly, the most common cause of bad breath is from poor dental habits - either from an unclean mouth, or the formation of preventable gum disease. If you have rotting food in your mouth, and don't floss or clean your tongue, it is easy to contract bad breath. It is important to brush and floss teeth twice a day. Use a tongue scrapper, and gargle with a bacteria killing mouth wash. Doing such religiously will also help keep gum disease in check, which will further fight bad breath. And, of course, see your dentist.
The above will not only keep your mouth feeling fresh and clean, but will help everyone involved breathe a little easier.