Why do I have bad breath? Here are 10 possible reasons
Sponsored by Aga Khan University Hospital
By Dr Fatema Ahmedali, Consultant Dental Surgeon at Aga Khan University Hospital, Nairobi
Bad breath or halitosis is a common problem that can cause significant psychological distress.
Anyone can suffer from bad breath. It is estimated that one in four people have bad breath regularly. Some studies show that approximately 30 percent of the population complains of some sort of halitosis.
Bad breath is the third most common reason people seek dental care, after tooth decay and gum disease.
But what causes bad breath?It can originate from both inside and outside the mouth.
Here are 10 reasons why you are likely to suffer from bad breath
- Food: The breaking down of food particles stuck in the teeth can cause odours. Some foods such as onions and garlic can cause bad breath. After they are digested, their breakdown products are carried in the blood to the lungs, where they can affect the breath.
- Poor dental hygiene: Brushing and flossing ensures the removal of small particles of food that can build up and slowly break down, producing odour. A film of bacteria called plaque builds up if brushing is not regular. The plaque can irritate the gums and cause inflammation between the teeth and the gums. Dentures that are not cleaned regularly or properly can harbour bacteria that may cause halitosis. Other causes of bad breath include dental cavities, healing or infected extraction sockets, oral infections, or oral ulcers.
- Tobacco: Tobacco products can cause their types of mouth odour. Additionally, they increase the chance of gum disease, which can cause bad breath.
- Dry mouth, also known as xerostomia: Saliva naturally cleans the mouth. If the mouth is naturally dry or because of a specific medical condition, odours can build up.
- Stress and anxiety can lead to halitosis.
- Crash diets: Fasting and low carbohydrate eating programmes can produce halitosis. This is due to the breaking down of fat-producing chemicals called ketones, which have a strong odour.
- Drugs: Certain medications can reduce saliva and therefore increase oral odours. Other drugs can produce odours too as they break down and release chemicals in the breath. Examples include nitrates used to treat angina, some chemotherapy chemicals, and some tranquillizers such as phenothiazines. Individuals who take vitamin supplements in large doses can also be prone to halitosis.
- Mouth, nose and throat conditions: Sometimes small bacteria-covered stones can form on the tonsils at the back of the throat and produce odour. Infections or inflammation in the nose, throat, or sinus, can cause halitosis. This includes tonsillitis and sinusitis.
- Diseases: Some cancers, liver failure, and other metabolic diseases can cause halitosis due to the specific mixes of chemicals that they produce. Gastroesophageal reflux disease can cause bad breath due to regular reflux of stomach acids.
- Psychological causes: Sometimes individuals think they have bad breath, even when they are just fine. This is called pseudo-halitosis. Halitophobia or fear of bad breath is real and may persist despite reassurance from a doctor. People with pseudo-halitosis respond well to reassurance, and may benefit from speaking with a therapist or psychiatrist who has expertise in this field.
I still have bad breath after brushing, why?
There are several causes of bad breath after brushing, such as certain health conditions, dental cavities, oral ulcers or infections, certain foods, and some habits, all of which are explained above. Fortunately, these can be treated.
If you’re experiencing chronic bad breath after brushing, a good first step is to visit your dentist. It may be that you are not cleaning your teeth properly, and they can help you with tips to improve your oral care routine, including the correct brushing and flossing technique. If there isn’t anything obvious to them, they will likely refer you to a physician to help you get to the bottom of your halitosis.
Either way, bad breath should not be ignored, and the rule of thumb is to get a dental check-up at least every six months.
How can I improve my oral health to reduce bad breath?
To reduce or prevent bad breath, observe the following:
Brush your teeth after you eat. Keep a toothbrush at work to use after eating. Brush using a fluoride-containing toothpaste at least twice a day, especially after meals. Toothpaste with antibacterial properties has been shown to reduce bad breath odours.
Floss at least once a day. Proper flossing removes food particles and plaque from between your teeth, helping to control bad breath.
Brush your tongue. Your tongue harbours bacteria, so carefully brushing it may reduce odours. People who have a coated tongue from a significant overgrowth of bacteria (from smoking or dry mouth, for example) may benefit from using a tongue scraper. Alternatively, use a toothbrush that has a built-in tongue cleaner.
Clean dentures or dental appliances. If you wear a bridge or a denture, clean it thoroughly at least once a day or as directed by your dentist. If you have a dental retainer or mouth guard, clean it each time before you put it in your mouth. Your dentist can recommend the best cleaning product.
Avoid dry mouth. To keep your mouth moist, avoid tobacco and drink plenty of water – not coffee, soft drinks or alcohol, which can lead to a drier mouth. Chew gum or suck on candy (preferably sugarless) to stimulate saliva. For chronic dry mouth, your dentist or physician may prescribe an artificial saliva preparation or an oral medication that stimulates the flow of saliva.
Adjust your diet. Avoid excess amounts of foods such as onions and garlic, which can cause bad breath. Eating a lot of sugary foods is also linked with bad breath.
Regularly get a new toothbrush. Change your toothbrush when it becomes frayed, about every three to four months, and choose a soft-bristled toothbrush.
Schedule regular dental check-ups. See your dentist on a regular basis, generally twice a year, to have your teeth or dentures examined and cleaned.
Quit the tobacco habit. Besides causing cancer, smoking can damage your gums, stain your teeth, and give you bad breath. Over-the-counter nicotine patches can help tame the urge. If you need a little help, make an appointment with your doctor to talk about quit-smoking programmes or prescription medications that can help you give up tobacco for good.
Skip after-dinner mints and chew gum instead. The bacteria in your mouth love sugar. They use it to make acid. This wears down your teeth and causes bad breath. Chew sugarless gum instead. Gum stimulates saliva, which is the mouth's natural defence mechanism against plaque acids that cause tooth decay and bad breath.
How often should I brush my teeth each day?
The American Dental Association recommends brushing your teeth twice a day with fluoride toothpaste for two minutes each time.
When you brush your teeth, you help remove food and plaque – a sticky white film that forms on your teeth and contains bacteria.
After you eat a meal or a snack that contains sugar, the bacteria in plaque produce acids that attack tooth enamel. Eventually, the acid can break down tooth enamel, causing cavities. Plaque that isn't removed can also harden into tartar, making it harder to keep teeth clean. Tartar build-up on your gums leads to inflammation that causes gum disease.
In choosing when to brush your teeth, you might also consider your diet. If you've eaten an acidic food or drink, avoid brushing your teeth right away. These acids weaken tooth enamel, and brushing too soon can remove the enamel.
