What is Bad breath?

Bad breath

What is bad breath?

Bad breath is an unpleasant smell on your breath. Other people may notice it when you speak or breathe out. You might not be aware of it yourself.

Everyone gets bad breath occasionally, but some medical problems can mean you have it most of the time or even all of the time. Bad breath is sometimes called halitosis.

Temporary bad breath

Lots of people have bad breath first thing in the morning. That's because saliva usually keeps your mouth clean, and it dries up while you sleep.

Source:
Sanz M, Roldan S, Herrera D.
Fundamentals of breath malodour.
Journal of Contemporary Dental Practice. 2001; 4: 1-17.

"Morning breath" is probably worse in people who tend to breathe through their mouths rather than their noses.

Source:
Scully C, Rosenberg M.
Halitosis.
Dental Update. 2003; 30: 205-210.

² But the problem is easily put right. It will go away as soon as you have something to eat, brush your teeth or rinse your mouth.

You can also have temporary bad breath after:

Source:
Scully C, Rosenberg M.
Halitosis.
Dental Update. 2003; 30: 205-210.

Eating spicy or strong-smelling foods, like garlic, raw onions or chilli
Smoking
Drinking alcohol.

Most people put up with bad breath for a little while if they enjoy these things. But steering clear of alcohol, cigarettes or spicy food can help you avoid bad breath.

Long-lasting bad breath

Bad breath that lasts through the day is usually caused by a problem in your mouth.

Source:
Bollen CM, Rompen EH, Demanez JP.
Halitosis: a multidisciplinary problem.
Revue Medicale de Liege. 1999; 54: 32-36 [in French].

³ For 9 in 10 people, bad breath is caused by either gum disease or bacteria that grow on your tongue.

Source:
Sanz M, Roldan S, Herrera D.
Fundamentals of breath malodour.
Journal of Contemporary Dental Practice. 2001; 4: 1-17.

Source:
Bollen CM, Rompen EH, Demanez JP.
Halitosis: a multidisciplinary problem.
Revue Medicale de Liege. 1999; 54: 32-36 [in French].

However, bad breath is occasionally caused by a medical problem somewhere else in your body. Conditions that can cause bad breath include

sinusitis
If you have sinusitis, you have irritation in the spaces formed by the bones around your nose. These spaces are called sinuses. Sinusitis can cause a feeling tightness or pain. You may also have a fever. You can get these symptoms when you have a cold or an allergic reaction, or when you fly in a plane.

sinusitis,

tonsillitis
Tonsillitis is when your tonsils become inflamed. It happens when your tonsils get infected with viruses or bacteria. Tonsillitis causes a number of symptoms, including a sore throat, pain when you swallow and a high temperature.

tonsillitis, and some lung problems or stomach problems.

Bad breath caused by bacteria

bacteria
Bacteria are tiny organisms. There are lots of different types. Some are harmful and can cause disease. But some bacteria live in your body without causing any harm.

Bacteria can grow on the coating on the back part of your tongue. As they grow, bacteria give off gasses. These gasses can make your breath smell bad.

You may be more likely to have this kind of bad breath if you:

Source:
Porter SR, Scully C.
Oral malodour (halitosis).
BMJ. 2006; 333: 632-635.

⁴

Smoke
Don't brush your teeth every day
Don't produce enough saliva.

Not producing enough saliva can be a problem because saliva helps to keep your mouth clean. You might produce less saliva than usual if you:

Are taking some medications, such as antihistamines,

antidepressant
Antidepressants are medicines used to treat depression and sometimes other conditions. They work by changing the levels of chemicals in your brain called neurotransmitters. There are three main types of antidepressants, which work in different ways: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).

antidepressants or pills for

high blood pressure
Your blood pressure is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure "hypertension."

high blood pressure
Have problems with the

gland
A gland is any group of cells in the body that makes and releases something for use by another part of the body. For example, the thyroid gland makes a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.

glands in your mouth that make saliva
Don't drink enough water
Don't eat regularly enough
Breathe through your mouth too much.

Bad breath caused by gum disease

The most common problem that causes bad breath is gum disease. You get gum disease because of plaque. Plaque is a coating on your teeth. It's mainly made up of bacteria. These bacteria can sometimes infect your gums and make them

inflammation
If your skin or some other part of your body becomes red, swollen, hot or sore, we say it is inflamed. It means that your body is trying to protect you from germs, from something in your body tissues that can hurt you (like a thorn or sliver), or from things that cause allergies (allergens). Inflammation is part of the way the body heals an infection or injury.

inflamed.

There are two main stages of gum disease.

Source:
National Institute of Dental and Craniofacial Research.
Gum (periodontal) diseases.
January 2009. Available at http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/ (accessed on 11 February 2009).

⁵

Gingivitis. This is when your gums become red and swollen. They may bleed easily when you brush your teeth. You can get rid of gingivitis by brushing your teeth at least twice a day. Flossing can also help, by getting rid of plaque from between your teeth. Or you can get your teeth thoroughly cleaned by a dentist or dental hygienist.
Periodontitis. This is a later stage of gum disease. Your gums start to pull away from your teeth and form pockets that are infected. If you don't get treatment, the bones, gums and other tissue that support the teeth can be destroyed. If this happens, teeth may eventually become loose and have to be removed.

Other problems in your mouth that can cause bad breath are:

Source:
Scully C, Rosenberg M.
Halitosis.
Dental Update. 2003; 30: 205-210.

An

infection
You get an infection when viruses, bacteria, fungi or other tiny organisms get into your body. These bugs are so tiny that you can't see them without a microscope. For example, an infection in your airways causes the common cold. And an infection in your skin can cause rashes such as athlete's foot.

infection in the tooth socket after a tooth has been taken out
Canker sores
Bits of food that collect under something in your mouth, such as braces or a bridge.

Bad breath caused by another medical condition

Bad breath can be caused by a condition that affects your throat, lungs or somewhere else in your body. Conditions that can cause bad breath include:

Source:
Sanz M, Roldan S, Herrera D.
Fundamentals of breath malodour.
Journal of Contemporary Dental Practice. 2001; 4: 1-17.

Source:
Scully C, Rosenberg M.
Halitosis.
Dental Update. 2003; 30: 205-210.

Source:
U.S. National Library of Medicine.
Medline Plus: breath odor.
April 2008. Available at http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm (accessed on 11 February 2009).

⁶

Sinusitis. This is an infection of the air spaces behind your nose
Bronchitis. This is an infection in your airways
Tonsillitis. This is a type of throat infection
A blocked nose that lasts a long time
An object that's trapped in your nose. Children sometimes put small objects in their noses
Diabetes. If you have diabetes, your body may burn fat for energy instead of glucose. This is called diabetic ketoacidosis. It can make your breath smell fruity or sweet. Diabetic ketoacidosis is very serious. Anyone who has it should see a doctor right away
Problems with your digestive system. For example,

heartburn
Heartburn is a painful, burning sensation in your chest. It happens, often after meals, when the contents of your stomach pass back up into your esophagus. The esophagus is the tube that runs from the mouth to the stomach.

heartburn can make stomach acid and gas travel back up into your throat
Liver or kidney problems
A condition called trimethylaminuria. This happens when a chemical called trimethylamine can't be broken down by your body. Instead, you get rid of it in sweat and saliva. This causes bad breath and body odor.

Thinking you have bad breath when you don't

Some people worry that they have bad breath when they actually don't. This is called pseudo-halitosis. People with pseudo-halitosis tend to look for signs in other people's behavior to prove to themselves that their breath is bad.

Source:
Scully C, Rosenberg M.
Halitosis.
Dental Update. 2003; 30: 205-210.

Some people with pseudo-halitosis continue to worry that they have bad breath even after they've been examined and reassured. This is sometimes called halitophobia. A

phobia
If you have a phobia of something, you are much more afraid of it than would be expected. You could have a phobia about a thing (such as a dog) or an activity (such as going out in public). Phobias can make you feel panicked. They can also make your heart race or give you an upset stomach.

phobia is when you're very afraid of something.

Thinking you have bad breath can be very upsetting.

Source:
Yaegaki K.
Oral malodor and periodontal disease.
In: Rosenberg M (editor). Bad breath: research perspectives. 2nd edition. Ramot Publishing, Tel Aviv, Israel; 1995.

⁷ It's even been known for people with halitophobia to commit suicide.

Seeing a doctor or dentist

A doctor or dentist can help you with bad breath. If your problem is caused by bacteria or a problem in your mouth, your dentist will be able to suggest treatment. Your dentist will also be able to offer advice if you think you have bad breath but it turns out you don't.

Source:
Yaegaki K, Coil JM.
Examination, classification and treatment of halitosis: clinical perspectives.
Journal of the Canadian Dental Association. 2000; 66: 257-261.

⁸

If your bad breath is caused by a medical condition somewhere else in your body, you'll need to see a doctor. If you have halitophobia, and you feel bad about your breath even though nothing is wrong, your doctor may arrange for you to see a therapist or counselor who can help you.

Sources for the information on this page:

Sanz M, Roldan S, Herrera D.Fundamentals of breath malodour.Journal of Contemporary Dental Practice. 2001; 4: 1-17.

Scully C, Rosenberg M.Halitosis.Dental Update. 2003; 30: 205-210.

Bollen CM, Rompen EH, Demanez JP.Halitosis: a multidisciplinary problem.Revue Medicale de Liege. 1999; 54: 32-36 [in French].

Porter SR, Scully C.Oral malodour (halitosis).BMJ. 2006; 333: 632-635.

National Institute of Dental and Craniofacial Research.Gum (periodontal) diseases.January 2009. Available at http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/ (accessed on 11 February 2009).

U.S. National Library of Medicine.Medline Plus: breath odor.April 2008. Available at http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm (accessed on 11 February 2009).

Yaegaki K.Oral malodor and periodontal disease.In: Rosenberg M (editor). Bad breath: research perspectives. 2nd edition. Ramot Publishing, Tel Aviv, Israel; 1995.

Yaegaki K, Coil JM.Examination, classification and treatment of halitosis: clinical perspectives.Journal of the Canadian Dental Association. 2000; 66: 257-261.

This information was last updated on Apr 09, 2009

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