Bad breath or halitosis might be an indicator of poor oral hygiene or a symptom of a serious underlying health condition. Either way, understanding the causes of bad breath is essential in prevention and management.
Possible reasons for bad breath
1. Food debris
One of the most common causes of bad breath is leftover food particles in the mouth, especially those trapped in between teeth or those left on the surface of the tongue and cheeks, under the tongue, or the gums.
Food debris promotes the growth of odor-causing bacteria, and they are noticeable as biofilms or dental plaque found on the surface of teeth and tongue. Preventing or managing bad breath usually requires good oral hygiene that includes regular brushing of teeth and mouth, as well as flossing and gargling using an antiseptic mouthwash.
2. Tooth decay
Decaying and rotten teeth can trap food particles inside the cavities. Furthermore, these cavities promote further the growth of bacteria due to the absence of oxygen, thus leading to the accumulation of dental plaque. Tooth decay may spread further inside and causes pulp death that will result in the emission of a foul odor.
The best solution to treat bad breath from decaying and rotten teeth or dental carries is to have them checked by a dentist. Depending on the severity of the decay, a dentist may either extract the affected tooth or apply a dental filling. Prevention of tooth decay and dental carries and thus, prevention of associated halitosis involve good oral hygiene. Note that acids made by bacteria cause tooth decay.
3. Gum disease
Periodontal disease or gum disease is the inflammation of the gums or tissues surrounding the teeth. An early stage of gum disease is called gingivitis while a more serious form is called periodontitis in which the gums may pull away from the tooth that may lead further to the development of gum pockets and loosening of involved teeth.
The gum pockets can host the growth of bacterial and accumulation of dental plaque due to the absence of oxygen, thus leading to the emission of foul odors. Similar to tooth decay, the best way to solve bad breath from gum disease is to seek the help of a dentist. Oral hygiene that involves regular brushing and flossing is the best prevention route.
4. Dry mouth
Xerostomia or dry mouth can be another cause of bad breath. Remember that a dry mouth marks the absence or low production of saliva in the mouth. Aside from having antibacterial properties, saliva neutralizes the acids produced by bacteria and washes away the dead cells accumulating on the tongue, gums, and cheeks.
Hence, a dry mouth promotes the growth of bacteria and dental plagues and also is one of the causes of other oral health problems. Certain medications cause dry mouth. Other causes include dehydration, partial obstruction of the upper respiratory track, autoimmune disease, and stress or anxiety. Nonetheless, preventing or solving associated bad breath requires treating the particular cause of dry mouth.
5. Food intake
Certain types of food containing sulfur compounds such as garlic and onions can cause bad breath that can last for hours. The unfavorable odor comes from the breakdown of these sulfur compounds that are released through the respiratory system. Hence, brushing and mouthwash merely cover up the odor temporarily.
Other specific causes of bad breath related to food intake include consumption of fish and seafood, and cheese or other dairy products. Digesting these foods result in the emission of a foul odor from the stomach. Intake of sugary treats such as candies and sweetened beverages, as well as starchy foods such as potatoes and bread promote the further growth of odor-causing bacteria and accumulation of dental plaques. Avoiding or lessening the intake of these foods and observing proper oral hygiene is the most common solution for addressing the associated halitosis.
6. Mucus build-up
Infection from bacteria or viruses resulting in colds and flu, as well as inflammation resulting in rhinitis or sinusitis can cause the build-up of mucus and post-nasal drip. Sulfur-producing anaerobic bacteria residing in the throat or the back of the tongue can feast on the amino acids cysteine and methionine found in mucus.
Solving bad breath due to mucus build-up requires treating the specific underlying medical cause to stop mucus secretion or prevent post-nasal drip. In the case of colds and flu due to bacterial or viral infection, cough medicines and nasal decongestants are the common over-the-counter medicines. Rhinitis and sinusitis are treated with antihistamines and decongestants. Of course, it is important to seek the advice of a physician to treat either one of these health conditions.
7. Sore throat
Another cause of bad breath is sore throat due to pharyngitis or inflammation of the throat, or tonsillitis or inflammation of the tonsils. However, inflammation caused by bacterial infection or strep throat, as well as a viral infection can produce foul smelling odor. Hence, treating halitosis due to sore throat requires seeing a physician who can provide antibacterial or antiviral medications.
A throat or tonsils infected by a bacteria or virus result in the development of pus due to the accumulation of dead white blood cells. The decaying cells emit an odor that is similar but less severe to the odor emitted from tonsil stones. Note that sore throat can also promote mucus build-up and thus, promote the growth of odor-causing bacteria.
8. Tonsil stones
Tonsil stones or tonsilloliths cause bad breath. Tonsil stones are the whitish to yellowish small deposits found lodging on the tonsils or coming off from the throat. They are essentially an aggregate of calcified cellular and bacterial debris formed in the tonsillar crypts. Pharyngitis and tonsillitis are the common causes of tonsil stones. Nonetheless, these small deposits emit a strong putrid odor.
No treatment is often needed to remove tonsil stones. Oral irrigation can effectively clean tonsil crypts. However, individuals who frequently develop these deposits, specific medical procedures might be needed. Examples of such include laser resurfacing to decrease the surface area of the tonsils or tonsillectomy or the surgical removal of the tonsils.
9. Acid reflux
Medical conditions such as hiatal hernia and gastroesophageal reflux disease or GERD cause the acid and gasses found in the stomach to enter the esophagus and reflux further into the throat and mouth. This is called acid reflux. Essentially, it is the backward flow of stomach contents. This backward flow can have a foul-smelling odor due to the inclusion of regurgitated bile and undigested food.
Treating bad breath due to acid reflux requires management of either hiatal hernia or GERD. Note that these conditions have different causes ranging from smoking, alcohol intake, poor eating habits, obesity, and reaction to medication, among others. Thus, it is better to consult a physician to get a proper diagnosis and treatment.
10. Systemic disease
Other causes of bad breath are non-oral or unrelated to oral diseases, respiratory track inflammations, and general problem in the digestive system. In these instances, bad breath is an indicator or symptoms of more serious underlying medical conditions.
Examples of diseases resulting in halitosis include fetor hepaticus due to chronic liver failure, kidney infection and kidney failure, diabetes mellitus, the rare metabolic disorder called trimethylaminuria that results in the emission of fishy odor, and carcinoma or cancers affecting the mouth or throat, among others.
Conclusion: A note on the causes of bad breath
While bad breath or halitosis is commonly caused by bacterial growth in the mouth due to poor oral hygiene and oral health problems, as well as respiratory track problems or food intake, there are other causes the warrant serious medical attention.
Regularly brushing and flossing, as well as the use of antiseptic mouthwash can resolve most of the common causes of halitosis. However, if bad breath persist despite these efforts, it is important to consult a dentist or a physician to determine the underlying cause and resolve the problem.
