Bad breath: Causes and management| Nepal

Bad breath, also called Halitosis is a condition in which a person emanates an unpleasant or offensive odor from their mouth. This undesirable condition is a common complaint but still can be a source of social embarrassment. Halitosis is estimated to affect one in five people globally. No wonder the store shelves are filled with mouthwashes and other products designed to fight bad breath. But, these products only provide a temporary measure and don’t address the actual cause of malodor.

bad breath

There are a number of possible causes of bad breath, but the vast majority come down to oral hygiene. So, if you have bad breath review your oral hygiene habits. Try making lifestyle changes like brushing effectively, flossing, cleaning the tongue, and drinking plenty of water. If your bad breath persists, you need to visit your dentist. In fact, Halitosis is the third most frequent reason for seeking dental care, following tooth decay and gum disease. On rare occasions, bad breath can be a sign of a more serious medical condition so it is important not to ignore the problem.

Causes of Bad breath

The foul smell in the majority of cases starts in and around the mouth. Sometimes, it can be due to underlying medical problems.

  1. Poor oral hygiene: This accounts for almost 90% of the causes. If you don’t maintain good oral hygiene, food particles stick between your teeth, around the gums, and on the surface of the tongue and they begin to rot causing bad breath. Poor oral hygiene also causes tooth cavity and gum diseases which adds up the foul smell.
  • Tongue coating: sometimes, despite maintaining good teeth, people experience foul smell because of the coating on the dorsal surface of the tongue. Your tongue especially near the throat can trap bacteria that produce odors.
  • Infection in and around the mouth including throat:  Infections, inflammations, ulcers, and even oral cancer can cause foul-smell. Abscessed or impacted tooth, infected sites after tooth removal, faulty fillings, Ill-fitting dentures, ill-fitting crown, and bridge can cause food accumulation and bad smell. Inadequate cleaning of oral appliances can harbor food particles and odor-causing bacteria. Infections of nose, sinus, and throat can lead to excessive mucus and postnasal drip. This drip accumulates in the throat and helps form tonsil stones. These tonsil stones are also a cause for chronic bad breath.
  • Dry mouth: Saliva helps cleanse your mouth, removing unwanted particles that cause bad odors. Less saliva and less oxygen create an environment that is perfect for the bacteria to produce more sulfur compounds. Certain medications or the use of alcohol-based mouthwashes can also contribute to dry mouth. Dry mouth is quite common in elderly people. It naturally occurs during sleep, leading to morning bad breath and more so if you sleep with your mouth open. In certain salivary gland disease, there is a chronic dry mouth.
  • System Causes: Some medical conditions like diabetes, gastro diseases, respiratory infection, liver or kidney disease can cause a distinctive odor as a result of the chemicals they produce. These chemicals are released in the blood from where they escape via lungs during breathing hence the bad breath.
  • Physiologic Halitosis

Bad breath under the following circumstances is only short-lived and considered normal.

  • Morning breath odor
  • Hunger
  • Dehydration
  • Vitamin deficiency
  • Menstruation
  • Eating certain foods: When you eat onions, garlic, or other foods with strong odors, your stomach absorbs oils from the foods during digestion. These oils pass into your bloodstream and travel to your lungs and affect your breath. This produces an odor that others can notice in your breath for up to 72 hours.  High protein diet, dairy food, and acidic food also causes halitosis.  Drinking beverages with strong odors, such as coffee, can also contribute to bad breath.
  • Consuming tobacco products: Tobacco products leave malodor on your breath. They also increase the chance of gum disease. In addition, smoking causes dry mouth.
  • Consumption of alcohol
  • Certain medications break down to release foul-smelling chemicals while certain medicines contribute to dry mouth. E.g. anti-allergic, blood pressure medicines, etc.

Note: Bad breath in children can be caused by a foreign body, such as a piece of food, lodged in a nostril.

Diagnosis of Bad breath

  • Self-examination:
  • Hand-cupping:  Cover your mouth using both hands and exhale. Then smell in.
  • Wrist-licking: Lick a small portion of your wrist. Let it dry for 5 seconds and smell it.
  •  Cotton swab: Gently rub a piece of cotton at the back of your tongue. Wait 5 seconds and smell the cotton.
  • The oldest way for unpleasant odor detection is by smelling with the nose. It is a simple way for the detection of halitosis. Ask a trusted friend or family member to gauze your mouth odor.
  • Dentist examination: the patient should avoid eating odiferous foods for 48 hours before the assessment and both the patient and the examiner should refrain from drinking coffee, tea or juice, smoking, and using scented cosmetics before the assessment. The dentist will smell both the breath from your mouth. They will also scrap the back of your tongue. They will also inspect your whole mouth.
  •  In addition, there are sophisticated detectors like Halimeter and Gas Chromatography which measures the release of volatile sulfur compounds from the mouth. However, these detectors aren’t always available.

Management of bad breath

  • Self-management

There are some lifestyle changes that you can do on your own to prevent bad breath.

  1. Proper brushing twice a day with fluoridated toothpaste especially after meals. You have to effectively clean all surfaces of the tooth including gum-line. These ensure that cavities are avoided and gum tissue remains healthy. Floss at least once a day to remove food from between your teeth.
  2. Clean your tongue: Because of the extensive accumulation of bacteria on the dorsum of the tongue, gentle cleaning of the tongue should be emphasized.  It can be carried out with a normal toothbrush that has a built-in tongue cleaner but preferably with a tongue scraper. It is best to clean as backward as possible keeping in mind that the hardest to reach back portion has most coatings and smells the worst
  3. Change your toothbrush frequently:  change your toothbrush after every 3 months.
  4. If you use a mouthwash, swish it around in your mouth for 30 seconds before spitting it out. These approaches should be only used as a temporary solution to relieve and improve the satisfaction of the patient. Use only a non-alcohol based mouthwash.
  5. If you wear any removable mouth appliances or prostheses like denture or retainer, you need to clean them daily to eliminate any plaque build-up.
  6. Dietary adjustment: Don’t miss breakfast. Take meals at regular intervals and include fresh fibrous food like a carrot. Chew parsley, mint, clove, fennel seeds as these releases pleasant-smelling oils. Limit the intake of odor-producing food like garlic, onion, vinegar. Avoid beans and a high-protein diet. Avoid fats if indigestion is the source of malodor.
  7. Stay hydrated: Get rid of dry mouth by drinking plenty of water. Stimulate saliva production by chewing sugarless gum for a minute or two. Limit the use of dry-mouth causing alcohol, tobacco, and coffee.
  8. Visit your dentist twice a year to have professional teeth cleaning.

However, if these simple self-care techniques don’t solve the problem, see your dentist. Together, you can track down what the cause may be. With a proper clinical exam, your dentist can help rule out any oral health problems and advise you on next steps. If a dentist suspects an underlying medical cause for the bad breath, they will refer you to your physician.

  • Dental management

It may include

  1. Full-mouth professional teeth cleaning.
  2. Non-treated cavities and gum tissues pockets help hide odor-producing bacteria. So, filling and gum therapy will be needed.
  3. Existing conditions of tooth fillings must be reviewed. Faulty prosthesis and fillings can be the cause of food retention, creating a reservoir area for bacteria. Replacement of old fillings with proper restoration provides the prevention of these reservoir areas.
  4. Proving artificial saliva substitutes for dry-mouth.
  5. Professional irrigation of nasal passage using neti- pot
  6. Tonsillectomy

Some individuals are concerned about their breath even though they may have little or no mouth odor. This condition is called halitophobia and can lead to obsessive mouth-cleansing behavior. In such a situation, consultation with a psychologist is required.

For questions about halitosis, or any of our other services, please reach out to us at Shangrila Dental Clinic today!


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    Reading your article helped me a lot and I agree with you. But I still have some doubts, can you clarify for me? I’ll keep an eye out for your answers.

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