Bad Breath

Bad breath is breath that has an unpleasant odor, otherwise known as halitosis. This odor can occur from time to time, or it can be long lasting, depending on the cause.

Millions of bacteria live in the mouth, particularly on the back of the tongue.

In many people, the primary causes of bad breath is the bacteria leaving in the mouth, particularly below the tongue, necessitated by the mouth's warm, moist conditions favoring growth of these bacteria. Most bad breath is caused by something in the mouth.

Some types of bad breath are considered to be fairly normal. They usually are not health concerns. One example is "morning mouth." This occurs because of changes in your mouth while you sleep. During the day, saliva washes away decaying food and odors. The body makes less saliva at night. Your mouth becomes dry, and dead cells stick to your tongue and to the inside of your cheeks. When bacteria use these cells for food, they produce a foul odor.

Other causes of bad breath:

Poor dental hygiene - Infrequent or improper brushing and flossing, allows bits of food that are stuck between the teeth to decay inside the mouth. Poor oral hygiene eventually will lead to periodontal (gum) disease, which also can cause bad breath.

Infections in the mouth- These can be caused by either a cavity in a tooth or by periodontal (gum) disease.

Respiratory tract infections - Throat, sinus or lung infections

External source- Garlic, onions, coffee, cigarette smoking, chewing tobacco. Smoking and drinking coffee, tea and/or red wine will contribute to your teeth becoming discolored.

Dry mouth (xerostomia)- This can be caused by salivary gland problems, medicines or "mouth breathing." A large number of prescriptions and over the counter medicines cause dry mouth.

Illnesses- Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others

Psychiatric illness- Some people may believe they have bad breath, but others do not notice it. This is referred to as "pseudohalitosis."


You may not always know that you have bad breath. That's because odor-detecting cells in the nose eventually get used to the smell. Other people may notice and react by stepping away from you as you speak, or making a face.

Other symptoms depend on the underlying cause of bad breath:

Infections in the mouth- Symptoms depend on the type of infection. They can include:

*Red or swollen gums that may bleed easily, especially after brushing or flossing

*Pus between teeth or a pocket of pus (abscess) at the base of a tooth

*Loose teeth or a change in how a denture fits

*Painful, open sores on the tongue or gums

Respiratory tract infections- Symptoms may include:

*Sore throat

*Swollen lymph nodes ("swollen glands") in the neck


*Stuffy nose

*A greenish or yellowish discharge from the nose

*A cough that produces mucus

Dry mouth- Symptoms may include:

Difficulty swallowing dry foods

Difficulty speaking for a long time because of mouth dryness

Burning in the mouth

An unusually high number of cavities

Dry eyes (in Sjogren's syndrome)

Illnesses- Symptoms of diabetes, lung disease, kidney failure or liver disease


*A dentist or physician may notice bad breath during an office visit. Sometimes, the smell of the patient's breath may suggest a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.

*Your dentist will review your medical history for conditions that can cause bad breath and for medicines that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms. He or she also will ask who noticed the bad breath and when.

*Your dentist will examine your teeth, gums, mouth and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth.

*Your dentist may refer you to your family physician if an illness is the most likely cause. In severe cases of gum disease, your dentist may suggest that you see a periodontist (dentist who specializes in gum problems).

*You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sjogren's syndrome. The type of tests you get depends on the suspected illness. You may get blood tests, urine tests, X-rays of the chest or sinuses, or other tests.

When Do I call a professional?

Call your dentist promptly if you have bad breath with loose teeth or painful, swollen gums that bleed easily. Also, call your doctor if you have bad breath along with any of the following symptoms:


*Sore throat

*Postnasal drip

*Discolored nasal discharge

*Cough that produces mucus

Even if you have none of these symptoms, call your dentist or physician if your bad breath continues despite a good diet and proper dental hygiene.

Sometimes bad breath can be a sign that a medical condition needs attention right away. If you have diabetes, gastroesophageal reflux disease (GERD) or chronic liver or kidney disease, ask your doctor what bad breath may mean for your condition.