Bad breath, medically known as halitosis, can be embarrassing and in some cases may even cause anxiety. If you’ve ever gotten that not-so-fresh feeling on a date, at a job interview or just talking with friends, you’re not alone.
Bad breath is a common problem that can cause significant psychological distress. Anyone can suffer from bad breath. It is estimated that 1 in 4 people globally have bad breath on a regular basis.
There are a number of reasons you might have foul breath. While many causes are harmless, bad breath can sometimes be a sign of something more serious.
Halitosis is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. Halitosis is not infectious.
Halitosis is the third most common reason that people seek dental care, after tooth decay and gum disease.
Causes of Halitosis
Apart from the sulphur-producing bacteria that colonise the back of the tongue, the other major causes of halitosis are:
Dental factors – such as periodontitis (infection around the teeth) or poor oral hygiene
Dry mouth – caused by medicines, alcohol, stress or a medical condition
Smoking – this starves the mouth of oxygen.
Less common causes of halitosis include:
Acid and bile reflux from the stomach
Post-nasal discharge – for example, due to chronic sinusitis
Kidney failure, various carcinomas, metabolic dysfunctions, and biochemical disorders, together account for only a very small percentage of halitosis suffers
Gum Disease - Bad breath that just won’t go away or a constant bad taste in your mouth can be a warning sign of advanced gum disease, which is caused by a sticky, cavity-causing bacteria called plaque.
Foods - such as onions, garlic or cauliflower, which induce certain odours. The list of breath-offending foods is long, and what you eat affects the air you exhale. However, these effects are only short-lived.
Features of Halitosis
The features of halitosis can include:
A white coating on the tongue especially at the back of the tongue
Build up around teeth
Post-nasal drip, or mucous
Morning bad breath and a burning tongue
Thick saliva and a constant need to clear your throat
Constant sour, bitter metallic taste.
Having halitosis can have a major impact on a person. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem.
When should someone see a health care professional about bad breath?
If proper oral hygiene does not get rid of bad breath, see a dentist or doctor for a diagnosis if bad breath is accompanied by
persistent dry mouth,
sores in the mouth,
pain or difficulty with chewing or swallowing,
broken teeth or dental pain,
white spots on the tonsils, and/or
fever or fatigue.
Also see a doctor or dentist if bad breath develops after taking a new medication, after recent dental surgery, or any other symptoms develop that are of concern.
Diagnosis of Halitosis
Often, a dentist will simply smell the breath of a person with suspected halitosis and rate the odour on a six-point intensity scale. The dentist may scrape the back of the tongue and smell the scrapings as this area can often be a source of the stench.
There are a variety of sophisticated detectors that can rate odour more precisely.
They include the following:
Halimeter: This detects low levels of sulphur.
Gas chromatography: This test measures three volatile sulphur compounds: Hydrogen sulphide, methyl mercaptan, and dimethyl sulphide.
BANA test: This measures levels of a specific enzyme produced by halitosis-causing bacteria.
Beta-galactosidase test: Levels of the enzyme beta-galactosidase have been found to correlate with mouth odour.
The dentist will then be able to identify the likely cause of the bad breath.
There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis.
Keep the mouth moist by drinking water and chewing sugarless gum or sugar-free hard candy to stimulate the production of saliva. Eat a diet of foods that need to be thoroughly chewed to keep saliva flowing. Foods that require a lot of chewing, such as apples or carrots, are good options.
Gentle but effective tongue cleaning may also be required. A variety of tongue brushes and scrapers have been produced in recent years. The tongue should be brushed in a gentle but thorough manner, from the back towards the front of the tongue, keeping in mind that the hardest to reach back portion smells the worst.
People with chronic sinusitis may find the regular use of a saline nasal spray helpful. A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help. Speak to your dentist, doctor or chemist to identify the cause of your halitosis and to find the most effective treatment for you.
What is the Prognosis for People with Halitosis?
Most of the time, bad breath can be cured and prevented with proper oral hygiene. It is rarely life-threatening, and the prognosis is good. However, bad breath may be a complication of a medical disorder that needs to be treated.
How Can I Keep Bad Breath Away?
Brush and Floss Brush daily and clean between your teeth daily with floss to get rid of all that bacteria that’s causing your bad breath. Brush using fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odours.
Take Care of Your Tongue Don’t forget about your tongue when you’re taking care of your teeth. If you stick out your tongue and look way back, you’ll see a white or brown coating. That’s where most of bad breath bacteria can be found. Use a toothbrush or a tongue scraper to clear them out.
Mouthwash Over-the-counter mouthwashes can help kill bacteria or neutralize and temporarily mask bad breath. It’s only a temporary solution, however. The longer you wait to brush and floss away food in your mouth, the more likely your breath will offend.
Clean Your Dentures If you wear removable dentures, take them out at night, and clean them thoroughly before using them again the next morning.
Keep That Saliva Flowing To get more saliva moving in your mouth, try eating healthy foods that require a lot of chewing, like carrots or apples. Drink lots of water as this will keep your mouth moist. You can also try chewing sugar-free gum or sucking on sugar-free candies. Your dentist may also recommend artificial saliva.
Quit Smoking Giving up this dangerous habit is good for your body in many ways. Not only will you have better breath, you’ll have a better quality of life.
Regularly Get a New Toothbrush Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush.
Visit Your Dentist Regularly If you’re concerned about what’s causing your bad breath; make an appointment to see your dentist. Regular checkups allow your dentist to detect any problems such as gum disease or dry mouth and stop them before they become more serious.
It is recommended that individuals visit the dentist for a check-up and cleaning twice a year.
Below are some tips on how to brush your teeth and keep your mouth healthy. You should:
use dental floss to clean between your teeth and remove trapped food that could cause tooth decay – brushing on its own only cleans about 60% of the tooth's surface
choose a small or medium-sized toothbrush with soft, multi-tufted synthetic bristles
replace your toothbrush every three to four months
brush all areas of your teeth, paying particular attention to where your teeth and gums meet – your dentist or oral hygienist may recommend using a special single-tufted brush for specific problem areas of your mouth
use a separate toothbrush or a tongue scraper to lightly brush your tongue. Some toothbrushes have a tongue cleaner on the back of the brush head
avoid brushing your teeth for 30 minutes after drinking an acidic drink, such as fruit juice, or eating acidic fruit, such as oranges, to help prevent tooth abrasion
Your dentist may recommend that you rinse your mouth daily using an antibacterial or anti-odour mouthwash. This shouldn't replace brushing, but can be included as part of your daily routine.
If you wear dentures, you should take them out at night to give your mouth a chance to rest. Clean your dentures thoroughly before putting them in the next morning:
don't use toothpaste to clean your dentures as it can scratch the surface and cause stains
clean your dentures thoroughly using soap and lukewarm water, denture cream, or a denture-cleaning tablet
use a separate toothbrush to clean your dentures
Your dentures should stay clean and fresh if you follow this routine. It will also help prevent the build-up of plaque, which can cause bad breath.