Halitosis (bad breath)

The culprits for bad breath are what's known as aromatic chemicals. These are basically smelly compounds that are released either by the food itself or by bacteria. This can be your own mouth bacteria, helping to break down small particles of food as part of digestion, or bacteria from an underlying health condition.

To help understand the causes of bad breath further they can be split into three main categories: physiological, pathological and psychogenic.

Physiological halitosis

This is normal and means there is no underlying condition causing the bad breath. It tends to only last a short amount of time and can be improved with simple steps such as good oral hygiene. The causes of physiological halitosis are:

• Dry mouth: saliva plays a crucial role in wash food particles from your mouth down the digestive tract. It’s also got powerful antimicrobial properties against bacteria, in the form of hydrogen peroxide, lysozymes and lactoferrin. If you are not producing much saliva, more particles get left behind, and bacteria can grow unchecked, promoting the release of aromatic compounds in your breath. This is the cause of morning breath as you release less saliva overnight. It is also why dehydration, alcohol, and caffeine can cause bad breath, as they all lead to a dry mouth.

• Strong smelling foods: foods such as onion and garlic can cause short-term bad breath. They release strong-smelling aromatic compounds that can linger long after you have eaten them.

• Fasting or a diet low in carbohydrates: fasting or a low carbohydrate diet can cause bad breath due to the body producing a chemical called ketones which has a distinctive smell and is released when fat is broken down.

• Smoking: chemicals in cigarettes can stay on the surface of your mouth and gums. They are then released into your breath resulting in a distinctive smell. Smoking can also dry out your mouth and increase the chance of developing gum disease, which is another risk factor for bad breath.

Pathological halitosis

This is bad breath caused by an underlying condition. This can be something within the mouth. These tend to be dental issues such as cavities and gum disease. It can also be caused by conditions outside of the mouth. Digestive problems may cause an incomplete breakdown of food in the stomach, you may have an imbalance of your gut microbiome (friendly gut bacteria), and acid reflux (heartburn can also cause halitosis. Bacterial infections in the nose, sinuses or throat, such as tonsilitis or abscess, may release aromatic chemicals. Mouth and throat cancer are rare, and smoking puts you at particular risk, but this can be the cause of bad breath for some. Rarely some conditions cause a dry mouth, such as Sjogren’s syndrome, and some medications, such as antimuscarinics, antihistamines, tricyclic antidepressants like amitriptyline and some diuretics.

Psychogenic halitosis

Also known as subjective halitosis, this is when someone believes they have bad breath but it’s not detectable by anyone else.

Oral hygiene: The best way to prevent bad breath is through good oral hygiene. This sweeps away all food particles from the mouth to avoid the build-up of bacteria and remnants of your dinner. It also lowers the risk of plaque build-up, tooth decay and gum disease, which can all add to halitosis in the longer term.

You probably learnt early in life to brush your teeth morning and evening, but let’s go through the rules to ensure you’re doing everything to keep your mouth, teeth and gums healthy:

• brush your teeth morning and night with fluoride toothpaste for at least 2 minutes (as long as a song on the radio)
• invest in an electric toothbrush, as they remove plaque build-up more efficiently from your teeth than a normal toothbrush, giving you better oral hygiene and a lower risk of gum disease
• brush your tongue with a gentle toothbrush that has a specific tongue cleaner on the back
• use floss or interdental picks twice a day to get rid of any food stuck between your teeth
• clean any dentures thoroughly, to remove bacteria and food on them, in the same way you would look after your teeth

Chewing gum encourages the release of saliva to wash away food particles and fight unwanted bacteria. It can also help freshen your breath up with a minty scent. Make sure to choose the sugar-free type. Avoid things like sugary mints as they may help with bad breath in the short term but can cause longer-term issues, but stimulating saliva with ice cubes or sugar-free fruit pastilles will also help.

Hydration: Keeping well hydrated will also help maintain a good amount of saliva avoiding a dry mouth, and saliva can be stimulated with frequent sips of cold, unsweetened drinks.

Alcohol and caffeine: In a similar vein, avoiding alcohol and caffeine avoids the dry mouth that can lead to bad breath.

Stopping smoking will improve not only halitosis but also reduce the risk of serious mouth and gum problems, along with all the other health benefits your body can look forward to.

Treatments for bad breath aim to improve oral hygiene and to deodorise the mouth.

There are many flavoured toothpastes that can help to remove plaque and prevent tartar build-up on the teeth, which, in turn, prevent bad breath.

Gum disease, including gingivitis and periodonditis, can lead swollen and bleeding gums. This leaves growth pockets for bacteria to settle in to between the gums and around the teeth. These bacteria feed on remnants of food and debris around the teeth, growing in number and leading to infection, inflammation and bad breath.

Untreated gum disease can lead to avoidable problems like premature tooth loss and inflammation in the mouth and spreading to the body. Long-term consequences of this include cardiovascular disease and diabetes. For bleeding gums and gingivitis, a 30-day course of a chlorhexidine 0.2% based mouthwash such as Corsodyl mouthwash, rinsed twice a day, can help to reduce harmful mouth bacteria. If symptoms continue, you should book to see a dentist as soon as possible.

Most dentists and hygienists recommend twice daily cleaning with a good electric toothbrush for at least 2 minutes, and taking care not to put excessive pressure on the gumline. Particular importance should be on cleaning between the teeth with dental floss or interdental brushes. If this is tricky due the angle of the teeth, an electric water flosser or water pick can help to remove build-up of plaque and tartar between the teeth. Brushing your tongue with a more gentle setting on your electric toothbrush or with a specific tongue cleaner can also help improve oral hygiene. brushing your tongue with a gentle toothbrush that has a specific tongue cleaner on the back. If you wear dentures, make sure they're cleaned properly and regularly.

Other products such as CB12 mouthwash and CB12 chewing gum can be used to neutralise and deter substances that encourage bad breath. They are widely available from pharmacies and healthcare stores.

If you have tried these simple measure for at least 2 weeks and are still suffering from bad breath, or your symptoms are severe and causing you distress, then the best next step is to see your dentist. They will check your mouth or gums for any dental issues that could be causing symptoms.

If you think the bad breath is due to an underlying health issue, book an appointment to discuss this with your doctor. They will ask about any other symptoms and examine your mouth and other relevant areas. They may consider further investigations or refer you to a specialist team.