Bad breath almost always occurs in the mouth. The most common cause of bad breath is that you have bacterial coatings around your teeth or tongue.

Most people get a bad breath at some point, for example after eating heavily spiced foods or smoking cigarettes. But you can also get bad breath from some medications, dental problems, and illnesses.

Bad breath is also called halitosis. It can be treated to get rid of the bad smell. You can prevent bad breath by keeping your mouth clean.

When and where should I seek care

Contact a dental clinic if you have the following problems:

  • You think the breath smells bad.
  • You have a coating on your tongue that you can’t remove yourself.
  • You have had dry mouth for a long time.
  • You think a lot about having bad breath.

If you suspect that it is a medicine that causes you to have bad breath, it is good to tell it to the doctor who prescribed the medicine.

What is the reason for bad breath?

Bad breath usually occurs in the mouth. It is not so common for bad breath to come from the stomach as many believe.

The saliva contains different types of bacteria. When the bacteria break down proteins, a gas that contains sulfur and smells bad is created. The proteins come from the food you have eaten and from the mouth, in the form of dead cells. It is the sulfur compounds that give the special smell that is perceived as bad breath.

It is a common problem that the breath smells worse if saliva production decreases. This is because of the bacterial coatings in the mouth increase.

If you have dry mouth, saliva also becomes more viscous and loses its cleansing effect and protective properties in the mouth.

The coating protects the bacteria

On the upper side of the tongue there are short, dense small straws called papillae. Between the papillae, food debris and dead cells can become trapped. Together with bacteria, they form a coating where the bacteria can remain.

The bacteria thrive in the coating, where they can multiply and produce smelly substances. The coating gives the tongue a color that is often greyish-white, yellow, or brownish.

Medications and illnesses can cause bad breath

Medications can cause bad breath. Many medications make you dry in the mouth and then the bacteria thrive. Some medications can give rise to smelly substances that are excreted through the lungs and give bad breath. Antibiotics and some vitamins can cause bad breath.

Diseases such as diabetes,  kidney failure, and cirrhosis of the liver can sometimes cause worse breathing because you are breathing out substances that are secreted through the lungs. It also applies to tumor diseases and other diseases of the respiratory tract and lungs such as sinusitis, trachea, asthma, and pulmonary emphysema.

Disorders of acid reflux and vomiting can also cause the breath to deteriorate.

The coating on the tonsils

The tonsils, which are also commonly called the tonsils, often have indurations, creases, and furrows. When the tonsils are enlarged, for example, because you have an infection, the spaces become especially deep. Protected spaces are created where bacterial plaque can accumulate and cause bad breath.

Nose and sinus infections

Bad odors can also come from the nose. For example, it may be because the mucous membranes of the nose are dry or that the secretion that is supposed to clean the throat is hindered by something, such as polyps.  

The sinuses in the upper jaw are in communication with the respective nasal passages. If you have varicose veins in the sinus, it can cause were to come against the throat through the nasal passages. In this way, the exhaled air comes in contact with the smelly stuff, and it can give bad breath.

The food affects quite a bit

It is unusual for what you eat to give you long-term bad breath. Dairy products, meat, and fish contain proteins containing sulfur compounds, which can be released by the bacteria in the mouth.

Garlic and strong cheeses can affect the breath for several hours after eating it. The characteristic smell of garlic is not due to bacteria in the mouth but rather that the substances in the garlic reach the blood and then go out through the lungs.

The sharp odor from some cheeses can affect the breath for a while. This is usually because cheese remains in the mouth, for example between the teeth.

Bad breath in young children

Young children can sometimes have bad breath. This is because they get a lot of milk and milk products, such as breast milk and yeast, which contain very high sulfur-containing proteins. When the diet becomes more varied, the smell disappears from the mouth.

Hormone changes in women affect

Women may have worse breath during menstruation, pregnancy, and menopause. It is due to hormone changes in the body. The hormones reach the saliva where they affect the bacterial composition in the mouth.

What can I do for myself?

It is important to brush all tooth surfaces clean morning and evening to avoid the coating of bacteria. With dental floss, gum brushes, or toothpicks, you can remove any coatings between the teeth.

Tooth brushing or use of dental floss should not be made so hard that it bleeds. If you have an infection of the gums, brush gently. A dentist or dental hygienist can advise if the gums often bleed when you clean your teeth.

In addition to keeping your teeth clean, there are several things you can do to avoid bad breath:

  • Scrape your tongue.
  • Avoid dry mouth.
  • Eat food that needs to be chewed and drink water.
  • Chew sugar-free chewing gum.
  • Use mouthwash.

Scrape off coatings on the tongue

You can remove the coating on the tongue with a tongue scraper when brushing your teeth.

A regular soft toothbrush also works, but the tongue scraper is specially designed to scrape the entire tongue in one move. The scraper is easy to clean.  

Be careful of tongue scraping if you have any tongue disease or suffer from dry mouth.

It is not necessary to scrape the tongue if there is no coating and if the breath does not smell.

Your dentist can advise if you have a sensitive tongue that hurts or bleeds when using the scraper. Then you can instead use a special mouthwash to treat bad breath.

Protect the saliva

If you have problems with dry mouth, you should have a dentist examine you and measure your saliva production. They can also provide advice on how to protect your teeth and give you a referral to a doctor for examination.

Many drugs cause dry mouth. If you are not sure if your medicine is causing dry mouth, you can find information in the package leaflet, which comes with the medicine. You can also ask your doctor or pharmacist.

Liquid or saline saliva may be a sign that saliva production is low. Then the nasal cavity secretion gets stuck in the throat instead of being swallowed down with the saliva. It increases the risk of bacteria getting trapped in the pharynx and giving bad breath.

You can use a nasal spray with a saline solution to dissolve the secretion so that it can be swallowed down. Talk to your dentist or dental hygienist before doing so.

Eat  and drink at regular intervals

The breath is usually worst in the morning. This is because the body pulls down on saliva production during the night and then you smell more out of your mouth.

The same thing happens between meals. The saliva is excreted as you eat, both by chewing and by the taste, smell and appearance of the food. A bit of good advice is to eat at regular times and to eat foods that need to be chewed.

It is also good to drink water or use a saliva stimulant between meals. Saliva stimulants are available at pharmacies.

You may get worse breath if you talk a lot in your work or breathe a lot through your mouth. Then you get dry in your mouth. Then it helps to drink water or eat fruit.

Chewing gum is good after eating

You can use sugar-free chewing gum or lozenges if you have bad breath or dry mouth. Chewing gum after a meal cleans the teeth and also reduces the risk of holes in them.

Mouthwash and zinc can help

There are mouthwashes containing zinc. They reduce the bad breath by binding sulfur compounds.

Mouthwashes containing a combination of zinc salt and bactericidal agents can also reduce the smell from the mouth.

The use of rinse aid should always be combined with careful cleaning of teeth and tongue. Using only mouthwashes only briefly helps against bad breath.

Investigations

When you go to the dentist or dental hygienist, you first have to fill out a questionnaire. The form contains questions about oral hygiene, diseases, medicines, eating habits, and work situations.

Some issues are specifically addressed to women because hormonal changes during menstruation, pregnancy, and menopause can affect the breath.

Sometimes you can record and report to the dentist what and when you have eaten and drank for at least a day. You write down when the day’s breath has been at its best and worst.

The dentist also addresses the places in the mouth where there may be bacteria. It can be, for example, tartar, leaky fillings, infected wounds or other infections in the mouth.

Exhaled air is measured

Bad smell from the mouth can come from many different gases. The dentist uses different methods to tell if and in what concentration the odorants are.

The most common instruments suck in exhaled air through a suction pipe. The proportion of sulfur-containing compounds in the air is stated directly. The straw can be held in the mouth or in the nostril and gives an idea of ​​where the smell comes from.

It is also possible to check if the smell mainly comes from tongue or tonsils. Such an investigation does not hurt.

Treatment of bad breath

You may need the help of your dentist or dental hygienist to scrape off the coatings. It can be difficult to access yourself, especially on the back of the tongue where the coating is usually thickest.

If you have had a coating on your tongue for a long time, it may have been packed and formed a hard cake that cannot be removed on your own by tongue scraping. Then a dentist or dental hygienist can help dissolve the hard coating and remove it.

After such treatment of bad breath, you will be allowed to continue to thoroughly clean your teeth and heavy morning and evening for a couple of weeks. The goal is to get rid of the bacteria that cause bad odor so much that the smell is not noticed.

Several treatments may be required

The treatment of bad breath may require several visits if you have problems or diseases of the teeth and gums at the same time. For example, you may have tooth decay, caries, or tooth decay. Then infections of the teeth or gums must be treated simultaneously. You may also be recommended to use special mouthwashes.

You will get a referral to a doctor if the dentist suspects that the causes of bad breath are in the nose or sinuses. Also, for infections of the ears, throat, lungs, esophagus, and stomach, you are referred to a doctor for examination and treatment. This also applies if you have dry mouth.

Revisit

When you have been examined and treated for bad breath and any dental problems, you will have a period of return after four to eight weeks. Then you and your dentist will have the opportunity to talk about the questions you have and you can assess how effective the treatment has been. Sometimes it may take longer to get rid of bad breath.

Bad breath can affect life

It is important that you contact a dentist or dental hygienist if you think you have a breath that affects how you feel and your relationships with others.

After an examination and treatment, you can get rid of the worry you feel about smelling badly out of your mouth. Your social situation can be better so that you do not avoid the company of others.

Halitofobi

You may find that the breath is much worse than it is.

To think that you have bad breath even though you do not have it is called halitophobia. For you who have halitophobia, the problem can be as great as for a person who has bad breath.

It is important that you are taken seriously and examined by a dentist or dental hygienist. You may need help to rule out that you have bad breath. If needed, you can get a referral from your dentist for help from a psychologist or doctor, for example.

Ehtisham Nadeem

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