Bad breath facts

What is the definition of bad breath?

The definition of bad breath, or halitosis, is an unpleasant odor of the mouth. It can occur on occasion, or it can be a chronic condition. It may be caused by foods a person eats, poor oral hygiene, medical conditions, or other factors.

What are the causes and risk factors of bad breath?

• Food: Food is a primary source of bad odors that come from the mouth. Some foods, such as garlic, onions, and spicy foods, exotic spices (such as curry), some cheeses, fish, and acidic beverages such as coffee can leave a lingering smell. Most of the time this is short term. Other foods may get stuck in the teeth, promoting the growth of bacteria, which causes bad breath odor. Low carbohydrate diets may also cause "ketone breath." These diets cause the body to burn fat as its energy source. The end-product of making this energy is ketones, which cause a fruity acetone-like odor on the breath when exhaled.
• Tobacco products: Smoking and chewing tobacco can leave chemicals that remain in the mouth. Smoking can also precipitate other bad-breath causes such as gum disease or oral cancers.
• Poor dental hygiene: When a person does not brush or floss regularly, food particles remaining in the mouth can rot and cause bad odors. Poor dental care can lead to a buildup of plaque in the mouth, which causes an odor of its own. Plaque buildup can also lead to periodontal (gum) disease. The mild form of gum disease is called gingivitis; if gingivitis is not treated, it can advance to periodontitis.
• Health problems: Sinus infections, pneumonia, sore throat (pharyngitis) and other throat infections, tonsil stones (tonsilloliths), thrush, bronchitis, postnasal drip, diabetes, acid reflux, lactose intolerance, other stomach problems, and some liver diseases or kidney diseases may be associated with bad breath.
• Dry mouth: Also called xerostomia, dry mouth can also cause bad breath. Saliva helps moisten and cleanse the mouth, and when the body does not product enough saliva, bad breath may result. Dry mouth may be caused by salivary gland problems, connective tissue disorders (Sjögren's syndrome), medications, or breathing through the mouth.
• Mouth infections: Cavities, gum disease, or impacted teeth may cause bad breath.
• Dentures or braces: Food particles not properly cleaned from appliances can rot or cause bacteria and odor. Loose-fitting dentures may cause sores or infections in the mouth, which can cause bad breath.
• Medications: Many medications, including antihistamines and diuretics, can cause dry mouth (see above), which can cause bad breath. Other medications that may lead to bad breath may include triamterene (Dyrenium) and paraldehyde.
• "Morning breath": Bad breath in the morning is very common. Saliva production nearly stops during sleep, which allows bacteria to grow, causing bad breath.
• Pregnancy: Being pregnant in itself does not cause bad breath, but the nausea and morning sickness common during pregnancy may cause bad breath. In addition, hormonal changes, dehydration, and eating different foods due to cravings may also contribute to bad breath during pregnancy.
• Other causes of bad breath: Objects stuck in the nose (usually in children), alcoholism, and large doses of vitamin supplements may also cause bad breath.

What are the symptoms of bad breath?

It is generally simple how to tell if you have bad breath. Others may notice someone has bad breath before they do, so they may tell him or her about their bad breath or give them a larger than normal personal space. The most obvious sign or symptom is noticing an unpleasant odor coming from the mouth.
Other signs and symptoms of bad breath include

1. unpleasant or sour taste or changes in taste,
2. dry mouth,
3. coating on the tongue.

How is bad breath treated? What can be done to prevent bad breath?

Treatment of bad breath depends on the cause.

1. Brush and floss teeth regularly. Remember to brush the tongue, too. This can help with bad breath caused by foods a person has eaten.
2. See a dentist regularly to ensure dentures or braces are properly fitted and cleaned.
3. Quit smoking or using chewing tobacco.

Keep the mouth moist by drinking water and chewing sugarless gum or sugar-free hard candy to stimulate the production of saliva. Mouthwash may temporarily mask bad breath odors, but it may not treat the underlying cause.
Natural remedies to treat bad breath include chewing on mint or parsley.
If bad breath is due to a health problem such as a sinus infection, diabetes, acid reflux, etc., then the underlying medical issue needs to be treated.
If bad breath is a side effect of taking a medication, discuss with a doctor whether there are other options for medication that can be taken. Never stop taking a medication without first consulting a doctor.
For patients who suffer from dry mouth (xerostomia), artificial saliva may be prescribed by a dentist.

What products can be used to eliminate or mask bad breath?

Bad breath that is due to simple causes such as foods may be more easily masked or eliminated than bad breath due to medical conditions, infections, or medication side effects.
There are some things a person can do to eliminate or at least temporarily mask bad breath.

1. Brushing the teeth and tongue, and flossing, can often get rid of bad breath, at least in the short term.
2. Mouthwash may temporarily mask bad breath and can help with oral hygiene.
3. Chewing sugarless gum or sucking on sugar-free mints may temporarily mask bad breath odor.
4. For more serious cases of bad breath, dentists can prescribe special toothpaste and mouthwash that can improve the symptoms of bad breath.

When should someone see a doctor about bad breath?

Most of the time, bad breath can be cured and prevented with proper oral hygiene. It is rarely life-threatening, and the prognosis is good. However, bad breath may be a complication of a medical disorder that needs to be treated.
If proper oral hygiene does not get rid of bad breath, see a dentist or doctor for a diagnosis if bad breath is accompanied by

1. persistent dry mouth,
2. sores in the mouth,
3. pain or difficulty with chewing or swallowing,
4. broken teeth or dental pain,
5. white spots on the tonsils,
6. fever.

Also see a doctor or dentist if bad breath develops after taking a new medication, after recent dental surgery, or any other symptoms develop that are of concern.
Bad breath in babies or young children may be a sign of infection or undiagnosed medical problems. Consult a child's pediatrician or dentist if an infant or young child has bad breath. 

SOURCE:

          Rosenberg, Mel. "Bad Breath." UpToDate.com. June 2015. <http://www.uptodate.com/contents/bad-breath?source=search_result&search=tonsil+stones&selectedTitle=3~3>.