Halitosis, also known as bad breath (and Fetor ex ore medically), is by definition where an unpleasant odor is omitted from the mouth – but you knew that already. What you may not be aware of, is the variety of possible causes - and it is those that we will discuss in this article.
While there are many possible causative factors, the most common source is something in the mouth. Bad breath is something we all may have from time-to-time, say after a spicy meal or first thing in the morning. But for some, the problem can be a chronic, persistent one.
The chief underlying cause of halitosis for most people?… Bacteria.
There are millions of bacteria on every oral surface. Bacteria builds up forming plaque on the teeth, on the gums and on the tongue. There are lots of areas in the mouth where bacteria can live and multiply, helped by the warm and wet oral environment. When bacterial levels are high, or certain types of bacteria grow orally, smelly gases are released.
Everyone’s breath will vary in terms of odor throughout the day and after various foods/drinks. For example, we all might suffer somewhat from ‘morning breath’. During the night, there is a reduced level of salivary flow. Saliva is important in clearing away food debris, old body cells and bacteria, so when there is less saliva there are more bacteria and more things to feed on. The malodor comes from gases released by bacteria (Volatile Sulfur Compounds) as they feed.
Halitosis Causes: The Common Culprits
As well as normal build-up of bacteria, chronic halitosis can also be compounded or caused by the following:
Factors from inside the mouth:
- Inadequate oral hygiene — Allows plaque build-up and food debris to collect. This, along with tartar build-up from allowing plaque to gather, will cause odor release. Better oral hygiene is a fast halitosis remedy for many sufferers!
- Gaps where food and plaque can build up. These gaps may be caused by decay, broken fillings, tipping of teeth and gum disease.
- Gum disease, in particular advanced (periodontal) disease. Here the total area where bacteria can gather is greatly increased, as well as the gums being much harder to clean.
- ANUG, a type of gingivitis common in young smokers. This characteristically produces a very strong odor.
- Any oral infections including tooth abscesses.
- Dry mouth (also called xerostomia). This is a reduction in saliva and there are many causes. The reduced saliva reduces the body’s natural ability to clean the oral cavity.
From outside the mouth:
- Smoking (and chewing) tobacco.
- Strong flavored foods such as garlic and onions.
- Medications that cause dry mouth.
Other medical bad breath causes:
- Infections of the respiratory tract, i.e. infections in the lungs, throat or sinuses. Post-nasal drip. A common cause in children.
- Illnesses affecting other parts of the body. These include stomach diseases (acid reflux, Zenker’s diverticulum) kidney failure, diabetes, liver disease and lung disease (e.g. bronchitis).
- Medical problems that cause xerostomia.
- Tonsil stones – tonsillolith is a calcium build-up on the tonsils.
- Eating disorders. Here the body breaks down fat and protein with resultant ‘ketones’ being released. These give rise to ‘ketone breath’.
- So-called ‘mouth-breathing’ whereby one constantly breaths through the lips and not the nose. Some people do this while asleep and it results in dry mouth.
- Sometimes someone can be convinced they have chronic bad breath even when it is not present. This can be a symptom of psychiatric illness.
Here’s a helpful video from the ADA.
Do you Have Halitosis? How Might you Find Out?
A lot of people with oral malodor may not be aware of its presence. It can be hard to know if you have the problem. Your nose usually adapts to smells so that it becomes less sensitive to smells that persist. In the same way, after wearing cologne or perfume for a few hours, you won’t notice the smell.
However there may be a few subtle social clues to warn you of bad breath. For example, do you notice people:
- Stepping back when you are close?
- Turning their cheek as you kiss them hello or goodbye?
- Making a face if you are close?
- Have children made any comments (they can be brutally honest!!)?
If you are concerned there are a few things you can do to help find out if you have halitosis:
- The best way is to ask a close friend or family member. Ask them to be honest!
- Lick the inside of your wrist. Then smell your wrist. A bad smell here is usually diagnostic of a problem.
- Ask your dentist/hygienist. Don’t be embarrassed! They will be very used to dealing this issue and people’s embarrassment.
Another way of telling if you may have bad breath is if you have other dental problems:
- Bad taste will often be accompanied with halitosis.
- Symptoms of dry mouth such as difficulty swallowing and speaking.
- Gum problems. Including red, swollen gums or gums that appear ‘rotting’ as in ANUG.
- Swellings and abscesses intra-orally.
- Loose teeth.
- Holes in the teeth/decay.
- Having areas where food traps and is hard to clean away.
- Poorly fitting and/or grubby dentures.
Symptoms of health problems that may cause ‘fetor ex ore’ can include:
- Respiratory infections: sore throat, stuffy or runny nose, mucus on coughing, fever or swollen glands in the neck.
- Dry eyes as well as dry mouth (‘Sjögren’s syndrome’).
- Stomach disease involving acid reflux may give a burning taste in the throat, or a sore throat. This may be worst on wakening in the morning.
Particular types of odor may indicate an underlying health cause:
- A ‘fruity’ odor may be a sign of poorly controlled diabetes.
- A hint of ammonia on the breath can indicate kidney failure.
- A foul fruity malodor can accompany anorexia nervosa.
There are many common halitosis causes and a variety of clues available to tell if you have the problem. See the next page on bad breath treatment for advice on how to cure and get rid of halitosis.