Halitosis Or Bad Breath

Overview

Halitosis is the medical word for bad breath. It means the air you breathe out has an unpleasant smell, usually because of bacteria (tiny germs) living in your mouth. These bacteria break down bits of food, dead skin cells and mucus, and release smelly gases as they do. Most of the time the cause is in the mouth itself, especially on the back of the tongue, between the teeth, or around the gums. Less often, bad breath comes from the nose, throat, stomach or a general health problem. The good news is that most cases can be improved a lot with simple daily mouth care and a visit to a dentist.

Yes. Bad breath is one of the most common reasons people ask a dentist or pharmacist for help. Studies suggest that roughly one in three adults has bothersome bad breath at some point, and many more have it now and then, for example after certain foods or when their mouth is dry.

Anyone can get bad breath, at any age. It tends to be more common in people who smoke, have gum disease, have a dry mouth, wear dentures (false teeth) or braces, breathe through their mouth, or have conditions such as diabetes or problems with their nose, sinuses or throat. It is not a sign of laziness or poor character, and it can happen to very careful people too.

Symptoms

Common symptoms

• An unpleasant smell from the mouth that other people notice, even if you cannot smell it yourself
• A bad or bitter taste in the mouth
• A white or yellowish coating on the tongue
• Dry mouth, or a sticky feeling in the mouth
• The smell coming back soon after brushing
• Needing mints, gum or mouthwash often to feel comfortable talking close to others
• Bleeding gums when brushing, or loose teeth, which often point to gum problems

Symptoms in children

• Bad breath is often linked to brushing being rushed or skipped, so food stays between the teeth
• Mouth breathing because of a blocked nose or big tonsils, which dries the mouth
• A smelly, often one-sided, discharge from the nose can sometimes mean a small object is stuck in the nose, which needs medical care
• Sore or swollen gums, or a sore tooth, which may make a child avoid brushing that area
• Less often, conditions such as reflux or an infection in the throat or tonsils

Symptoms in older adults

• Dentures that are not cleaned well, or that no longer fit properly and trap food
• Dry mouth caused by medicines for other health problems, which is very common in later life
• Gum disease, receding gums or decay at the roots of teeth
• Difficulty brushing or flossing because of arthritis, tremor, or trouble holding a brush
• Less often, health conditions such as diabetes or problems with the digestion or kidneys

Causes

Main causes

• Bacteria on the tongue, especially the back of the tongue, breaking down food and cells and giving off smelly gases
• Gum disease (infection of the gums and the bone that holds the teeth), which can also cause bleeding and loose teeth
• Food trapped between the teeth, in gaps, under dentures or around braces
• Tooth decay, a broken filling, or an abscess (a pocket of infection) in a tooth
• Dry mouth, when there is not enough saliva to wash the mouth clean; saliva is the mouth's natural rinse
• Smoking and other tobacco use, which dries the mouth and adds its own smell
• Strong foods and drinks such as garlic, onion, spices, coffee and alcohol
• Poor cleaning of dentures, retainers or braces
• Small white lumps in the tonsils, sometimes called tonsil stones, which can smell strong
• Problems in the nose and sinuses, such as a long-term infection or a drip down the back of the throat
• Acid reflux, where stomach acid comes back up into the throat
• Less often, a general health condition, such as diabetes, or liver or kidney problems, or a side effect of a medicine

Risk factors

• Smoking or chewing tobacco
• Dry mouth, whether from medicines, mouth breathing, or a health condition
• Gum disease or a history of gum problems
• Dentures, braces or other dental work that traps food
• A diet high in sugar and starchy snacks, which feed bacteria
• Drinking a lot of alcohol or coffee
• Taking medicines that reduce saliva, such as some for allergies, blood pressure or mood
• Long-term blocked nose, hay fever or sinus problems
• Diabetes or a weakened immune system
• Finding it hard to brush or floss because of pain, disability or reduced dexterity

When to see a doctor

See a doctor urgently if:

• Facial or neck swelling, fever, or trouble swallowing or breathing — call your local emergency number
• A tooth infection with pus, or pain that keeps you awake and is getting worse
• Bad breath with unexplained weight loss, night sweats, or a fever that lasts more than a few days
• A child with a smelly one-sided nasal discharge, or a child who seems unwell

Book a routine appointment if:

• Bad breath that continues for a few weeks even with careful brushing, cleaning between the teeth, and tongue cleaning
• Bleeding gums, loose teeth, or gums that have pulled away from the teeth
• A bad taste, a sore in the mouth, or a tooth that hurts when you bite
• Dry mouth that bothers you, especially if you take regular medicines
• Dentures that no longer fit well, or that you find hard to keep clean
• Heartburn or a sour taste coming up into the throat
• Bad breath in a child that does not improve with good brushing

Diagnosis

A dentist is usually the best person to start with, because most causes are in the mouth. They will ask about your brushing habits, what you eat, whether you smoke or drink alcohol, which medicines you take, and any health conditions you have. They will then look closely at your teeth, gums, tongue and the inside of your mouth, and may gently measure the small gaps between your gums and teeth to check for gum disease. Sometimes they will simply smell your breath, or ask you to smell a piece of dental floss or your own wrist after licking it, to see how strong the smell is. If your mouth looks healthy, they may suggest you see a doctor to check for other causes, such as a sinus problem, reflux, or diabetes.

Tests that may be done

• A dental examination of the teeth, gums, tongue and any dentures or braces
• Measuring gum pockets with a small probe to look for gum disease
• Dental X-rays to check for decay, infection or problems under the gum
• A simple breath smell assessment, which is the most common check
• A review of your medicines and health history by a doctor or pharmacist
• Blood tests ordered by a doctor if a general health cause is suspected, for example checking blood sugar
• A check of the nose and throat if symptoms point that way

What to expect at your appointment

The visit is quick and painless. Most people find out the likely cause at their first appointment, and many are given practical cleaning advice and a scale and polish the same day. If a filling, gum treatment or denture adjustment is needed, the dentist will explain the options and costs, and you can ask questions before deciding. If you are referred to a doctor, it is usually a routine appointment rather than anything urgent.

Treatment

Treatment depends on the cause, and most people see a big improvement within a few weeks. The main approach is to remove the places where bacteria hide, and to keep the mouth moist. If a dental problem is found, such as gum disease or decay, fixing it usually settles the smell. If the mouth is healthy, the focus moves to other causes, such as a sinus problem, reflux or a medicine that dries the mouth.

Self-care at home

• Brush your teeth for about two minutes, twice a day, using a fluoride toothpaste — last thing at night and at one other time
• Clean between your teeth once a day with floss, interdental brushes or a water flosser, following advice from your dentist
• Gently clean your tongue each day with a toothbrush or a tongue scraper, working from the back towards the front
• Use a fluoride mouthwash at a different time from brushing, if your dentist advises it — not straight after brushing, as it can wash away the toothpaste
• Drink water regularly through the day to keep your mouth moist
• Chew sugar-free gum or suck sugar-free lozenges to help saliva flow, especially after meals
• Clean dentures, retainers and braces every day as instructed, and take dentures out at night
• Rinse your mouth with water after eating if you cannot brush
• Cut down on sugary snacks and drinks between meals
• Stop smoking if you can — ask your doctor, pharmacist or local stop-smoking service for support

Medical treatments

Your dentist may carry out a thorough clean above and below the gum line (sometimes called a deep clean or scale and polish), treat decay with a filling, repair a broken tooth, or adjust or replace dentures. Gum disease may need a series of cleaning appointments and a home routine your dentist teaches you. If the mouth is healthy, your doctor may look for and treat other causes, such as a sinus infection, an allergy, acid reflux or diabetes. If a medicine is causing a dry mouth, your prescriber can review it — never stop or change a medicine on your own without asking. Your dentist or pharmacist can also suggest products that help keep the mouth moist, but always check with them before trying something new, especially if you take other medicines.

When is surgery considered?

Surgery is rarely needed for bad breath. It may be discussed if you have repeated, troublesome tonsil stones and other treatments have not helped, or for severe gum disease that has not responded to cleaning treatment. Removing a badly damaged tooth is a common dental procedure, not usually classed as surgery, and can be the best way to clear infection. Any procedure will be explained to you fully, including the risks and the alternatives, before you decide.

Living with this condition

Bad breath can feel embarrassing, but it is a normal health issue and not something to feel ashamed about. Build a simple routine you can keep up: brush morning and night, clean between the teeth once a day, clean your tongue, and keep water nearby. Keep a small kit with you if it helps you feel confident — a brush, floss and sugar-free gum. Tell your dentist honestly how it is going, including the parts of the routine you find hard, so they can help you find a plan that works for you.

Lifestyle tips

• Keep up regular dental check-ups at the interval your dentist recommends
• Limit alcohol, which dries the mouth and adds its own smell
• Avoid tobacco in all forms
• If you take medicines that dry your mouth, ask your pharmacist for practical tips
• If you have diabetes, keeping your blood sugar steady helps your mouth stay healthy
• Consider a humidifier in the bedroom if you breathe through your mouth at night
• Replace your toothbrush every few months, and use one with a small head to reach the back of the mouth

Diet and exercise

Eat regular meals and include crunchy fruit and vegetables, such as apples and carrots, which help stimulate saliva. Choose water or milk rather than sugary or fizzy drinks, and keep sweet treats to mealtimes rather than snacking all day. Foods like garlic, onion and strong spices can affect your breath for a day or so — this is normal and not a sign of a problem. Staying active and drinking enough water helps keep saliva flowing; a dry mouth from not drinking enough is a common and easily fixed cause of bad breath.

Mental health and emotional wellbeing

Many people with bad breath feel self-conscious — they may cover their mouth when talking, avoid close conversations, or worry about what others think. That worry can affect confidence, relationships and mood, and sometimes leads to anxiety or low mood. It is worth mentioning this to your dentist or doctor, because the problem is usually treatable and the worry often lifts once it improves. If bad breath is affecting your mental health, please speak to a healthcare professional. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away, or reach out to someone you trust.

Prevention

Largely, yes. Most bad breath can be prevented or greatly reduced by cleaning the whole mouth every day — teeth, gums, the spaces between the teeth and the tongue — keeping the mouth moist, not smoking, and having regular dental check-ups. Fixing small dental problems early stops them becoming bigger ones.

Vaccines

There is no vaccine for bad breath. Vaccines do not play a part in preventing or treating it.

Screening programmes

Routine dental check-ups are the closest thing to screening: your dentist can spot early gum disease, decay or a denture problem before it causes trouble. Ask your dentist how often you should come — for most people it is somewhere between every six and twelve months, but some people need more frequent visits.

Complications

If left untreated

• Gum disease may get worse, and in time teeth can become loose or be lost
• Tooth decay and infection can spread and become painful, and occasionally spread beyond the tooth
• A health condition behind the bad breath, such as diabetes, reflux or a sinus problem, may go unnoticed for longer
• Ongoing self-consciousness, which can affect work, relationships and mood
• Denture problems may make eating and speaking harder

Long-term outlook

The outlook is very good. Most people who follow a simple daily mouth-care routine, get any dental problems treated, and keep their mouth moist notice a clear improvement within a few weeks. If the cause lies elsewhere, such as a sinus problem or reflux, treating it usually helps too. Bad breath is common, it is treatable, and getting it checked is a normal, sensible step.

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