Bad Breath... The Causes

Causes for bad breath (halitosis) may be broadly classified into oral and extra-oral causes.

Oral causes:

* Gum disease (Periodontal disease)

* Decayed teeth

* Oral ulcers

* Food impaction

* Poor denture hygiene

* Dry mouth (Xerostomia)

* Smoking

* Dental infections

* Poor Oral Hygiene

Extraoral causes:

*ENT & related conditions – Rhinitis, Sinusitis, Pharyngitis, Tonsillitis, Asthma,

Bronchitis, Bronchiectasis, COPD

*GI Conditions – Acid Reflux, APD, Constipation, Poor GI flora

*Foods – rich / spicy food, garlic, onions etc., coffee


*Systemic diseases – Diabetes, Liver disease, Renal disease

Causes may be local or systemic. The local causes related to halitosis include wearing dentures (complete or partial), faulty dental fillings, drifted, moved or extruded teeth, gingivitis, gum or tooth abscesses, oral cancer and xerostomia or dry mouth.

The human being has over 400 species of different types of bacteria in the mouth of which about fourteen of them, mainly anaerobic bacteria, cause bad breath by releasing sulfur odors. Halitosis is caused by volatile sulfur compounds (VSC – mainly hydrogen sulfide and methyl mercaptan), which are released by the break down of proteins by bacteria. These sulfur compounds are odorous (rotten egg smell) and lousy tasting. Bad breath mostly comes from the back of the tongue, not the stomach or teeth. Most of the odor contributing to bad-breath is produced by anaerobic bacteria, which grow on the back of the tongue. Tongue cleaning reduces mouth odor by 75 percent. The anaerobic bacteria have beneficial effects also as they aid in digestion by breaking down proteins. Persons suffering from badbreath due to oral causes are found to have abnormally high numbers of anaerobic bacteria in the oral cavity. An agent called halimeter is used by some of the specialists which aids in measuring the concentration of sulphide molecules in breath of patients – which in turn gives an assessment about the degree of badbreath the patient has.

Systemic medical conditions contribute to a significant percentage of halitosis cases. Diseases afflicting the nose, sinuses, throat, lungs and the gastrointestinal system – the body parts which are anatomically linked to the mouth – are also found to contribute to halitosis. Eg. conditions like sinusitis, pharyngitis, common cold, bronchitis and asthma, tonsillitis, indigestion and acidity, constipation, etc. are found to cause bad breath. Persons suffering from colds and sinusitis often have postnasal drips of mucus which is rich in protein. Breakdown of the proteins by anaerobes cause release of VSCs causing the bad breath. Medical conditions such as diabetes, renal failure, liver dysfunction, hormonal imbalance etc. are also found to cause halitosis.

Food and tobacco are contributing factors to halitosis but are not a primary cause. Very spicy foods, such as onions and garlic (they contain sulfur compounds called mercaptans), and coffee may be detected on a person's breath for up to 72 hours after digestion. Onions, for example, are absorbed by the stomach and the odor is then excreted through the lungs. Studies even have shown that garlic rubbed on the soles of the feet can show up on the breath. There are 4 categories of food which are found to increase the problem of badbreath by causing an increase in sulfide production by bacteria – drying agents (cigarettes, alcohol), dense protein foods (diary foods, meat and fish) sugars and acids (coffee, fruit juices such as those of citrus, orange, tomato, grapes, pineapple etc.) – all these stimulate growth of anaerobic bacteria. Alcohol being dessicants (drying agents), can only worsen the bad breath. So is the case with alcohol based mouthwashes.

Even stress, dieting, snoring, age and hormonal changes can have an effect on your breath.

Morning breath - Saliva is the key ingredient in your mouth that helps keep the odor under control because it helps wash away food particles and bacteria, the primary cause of bad breath. When you sleep, however, salivary glands slow down the production of saliva allowing the bacteria to grow inside the mouth. To alleviate "morning mouth," brush your teeth and eat a morning meal. Morning mouth also is associated with hunger or fasting. Those who skip breakfast, beware because the odor may reappear even if you've brushed your teeth. Remaining still for long hours with restricted movement of the tongue and jaws such as while traveling long distances, slows down salivary production and will also be associated with bad breath due to the reasons mentioned above.

A few points to be remembered:

* The Happy Hours: A girls' night out or beers with the bros could give you more than a hangover. Even though it's a liquid, alcohol can actually dry out your mouth, which encourages the bacteria that cause halitosis, the medical term for bad breath. Drinks with caffeine, spicy foods, and cigarettes can, too. A dry mouth from not making as much saliva while you sleep also explains "morning breath."

* Your Tongue: Bacteria on the tongue is the leading cause of bad breath. Clean yours with your toothbrush or a tongue scraper. Scrapers will do a slightly better job. Avoid brittle plastic ones, which could snap, as well as metal ones, which can be sharp.

* A Low-Carb Diet: When you cut out carbs and boost the amount of protein you eat, your body starts burning fat for energy. That process makes compounds called ketones, which cause bad breath. In this case, better dental hygiene won't solve the problem, since that's not the root cause. Your best bet is to mask your breath with sugar-free gum.

* The Common Cold: As if they weren't annoying enough, respiratory tract infections like colds and bronchitis can also give you bad breath. That's because odor-causing bacteria like to feed on mucus (yeah, it's gross). And if you have a stuffy nose, you're more likely to resort to mouth-breathing, which can dry out your mouth.

* An Ulcer: OK, the ulcer itself may not be the problem. But a type of bacteria that causes ulcers, Helicobacter pylori, can also trigger bad breath, according to a study in the Journal of Medical Microbiology. Treating the bacteria may get rid of the stink. Your doctor can test you for H. pylori and prescribe antibiotics for it.

* Medications: More than 400 prescription and over-the-counter drugs, including antidepressants and allergy remedies, can stifle saliva flow. This fluid helps wash away food and bacteria, keeping bad breath at bay. Changing your meds isn't always an option, so the American Dental Association recommends you stay hydrated and chew sugarless gum to keep your mouth moist. Special oral rinses can also help.

* Tonsil Stones: These small white-ish clusters -- made up of hardened bacteria, food particles, dead cells, and mucus -- get trapped in the ridges of your tonsils and the back of your tongue. They're generally harmless except for the smell. They'll often dislodge on their own, but you can sometimes speed the process by gargling with salt water. Your dentist may have other options for you.

* Dried Fruit: It’s very high in sugar, and odor-causing bacteria love to feed on the stuff. A reasonable 1/4 cup of raisins has 21 grams of sugar; the same amount of dried apricots has 17 grams. That’s like eating 4-5 teaspoons of pure sugar. Plus, dried fruit is sticky, so it can get trapped on and between your teeth. After a snack, be sure to floss and brush.

* Acid Reflux or Heartburn: These are two symptoms of GERD (gastroesophageal reflux disease), a common digestive disorder. Your bad breath may be from some undigested food coming back up, or it could be that irritation from stomach acid is giving you postnasal drip. Ask your doctor for help if you get heartburn often.

* Cracked Teeth and Fillings: These can trap food particles and breed bacteria, resulting in cavities, gum disease, and bad breath. Ill-fitting dentures can cause the same problems. All the more reason to schedule regular dentist appointments.

* Chronic gum disease: Longstanding gum disease associated with bleeding & pus discharge from the gums will certainly cause halitosis