Bad breath is a common problem that can affect anyone at any age.
About one in four people are thought to have bad breath (halitosis) on a regular basis.
Do I have bad breath?
It's not always easy to tell if you have bad breath. Other people may notice it first, but they could feel uncomfortable telling you.
A simple test to find out whether you have bad breath is to lick the inside of your wrist with the back of your tongue and wait a few seconds until the saliva dries. If your wrist smells unpleasant, it's likely your breath does, too.
In rare cases, bad breath can be caused by certain medical conditions. In dry mouth (xerostomia), the flow and composition of saliva may be affected.
A lack of saliva can cause more bacteria than normal to build up in your mouth, as well as a change in the types of bacteria. A build-up of these in the mouth may lead to bad breath.
Dry mouth can sometimes be caused by a problem in the salivary glands or by breathing through your mouth instead of your nose.
In some cases, gastrointestinal conditions can also cause bad breath. For example, a bacterial infection of the stomach lining and small intestine (H. pylori infection) and gastro-oesophageal reflux disease (GORD) have been linked to bad breath.
If a gastrointestinal condition is thought to be causing your bad breath, you may need to have an endoscopy. This is a procedure where a piece of equipment called an endoscope is used to examine an area inside the body, such as your airways or abdomen.
Other medical conditions that can cause bad breath include diabetes and lung, throat, or nose infections – for example, bronchiectasis, bronchitis, tonsillitis, and sinusitis.
There are a number of possible causes of bad breath (halitosis) .
Poor Oral Hygiene
The most common cause of bad breath is poor oral hygiene. Bacteria that build up on your teeth – particularly between them – as well as your tongue and gums, can produce unpleasant-smelling gases. These bacteria are also responsible for gum disease and tooth decay.
If you don't floss and brush your teeth regularly, any food trapped between your teeth will be broken down by the bacteria and may be responsible for bad breath.
Bacteria can also live on the rough surface of your tongue. As well as brushing your teeth, cleaning your tongue can also help control bad breath.
You should have regular dental check-ups to ensure any oral hygiene problems are picked up and treated early. Your dentist will be able to advise you about how often you need a check-up.
Some types of medication can also cause bad breath. These include:
nitrates – these are sometimes used to treat angina, chest pain caused by a restriction in the blood supply to the heart
some chemotherapy medication
If the medication you're taking is causing bad breath, your GP may be able to recommend an alternative.
Food & Drink
Eating strongly flavoured foods, such as garlic, onions and spices, is likely to make your breath smell. Strong-smelling drinks, such as coffee and alcohol, can also cause bad breath.
Bad breath caused by food and drink is usually temporary. It can be avoided by not eating or drinking these types of food and drink too often. Good dental hygiene will also help.
Smoking is another cause of bad breath. As well as making your breath smell, smoking stains your teeth, irritates your gums, and reduces your sense of taste.
It can also significantly affect the development of gum disease, another major cause of bad breath. Stopping smoking will lower your risk of gum disease and help prevent bad breath.
Crash dieting, fasting, and low-carbohydrate diets are another possible cause of bad breath. They cause the body to break down fat, which produces chemicals called ketones that can be smelled on your breath.
Some people are convinced they have bad breath when they don't. This psychological condition is called halitophobia.
People with halitophobia are paranoid about the smell of their breath. They often misinterpret other people's behaviour and comments, thinking they're suggesting they have bad breath. They become fixated with cleaning their teeth, chewing gum, and using mouth fresheners.
Treatment for halitophobia involves talking therapies, such as cognitive behavioural therapy (CBT), to help the person overcome their paranoia and fixation on the smell of their breath.
Treatment & Prevention
Usually, the most effective treatment is improving your dental hygiene. As part of your daily routine, you should:
floss between your teeth
brush your teeth and gums
clean your tongue
You may want to consider investing in an electric toothbrush, which can make cleaning easier and more effective.
If you wear dentures, you should take them out at night to give your mouth a chance to rest. Clean your dentures thoroughly before putting them in the next morning:
don't use toothpaste to clean your dentures as it can scratch the surface and cause stains
clean your dentures thoroughly using soap and lukewarm water, denture cream, or a denture-cleaning tablet
use a separate toothbrush to clean your dentures
Your dentures should stay clean and fresh if you follow this routine. It will also help prevent the build-up of plaque, which can cause bad breath.
Cleaning Your Teath
Your dentist will probably recommend that you brush your teeth at least twice a day using fluoride toothpaste.
Below are some tips on how to brush your teeth and keep your mouth healthy. You should:
use dental floss to clean between your teeth and remove trapped food that could cause tooth decay – brushing on its own only cleans about 60% of the tooth's surface
choose a small or medium-sized toothbrush with soft, multi-tufted synthetic bristles
replace your toothbrush every three to four months
brush your teeth for at least two minutes – you could keep a toothbrush at work or school so you can brush your teeth after lunch
brush all areas of your teeth, paying particular attention to where your teeth and gums meet – your dentist or oral hygienist may recommend using a special single-tufted brush for specific problem areas of your mouth
use a separate toothbrush or a tongue scraper to lightly brush your tongue – some toothbrushes have a tongue cleaner on the back of the brush head
avoid brushing your teeth for 30 minutes after drinking an acidic drink, such as fruit juice, or eating acidic fruit, such as oranges, to help prevent tooth abrasion
Your dentist may recommend that you rinse your mouth daily using an antibacterial or anti-odour mouthwash. This shouldn't replace brushing, but can be included as part of your daily routine.
Fresh Breath Tips
To help keep your breath fresh, you should:
give up smoking
eat a healthy, balanced diet and avoid eating strongly flavoured or spicy food
cut down on sugary food and drink as it can increase the amount of bacteria in your mouth
reduce your alcohol consumption
cut down on coffee
drink plenty of water to help prevent your mouth becoming dry
chew sugar-free gum after eating to stimulate the flow of saliva – this will help clean away any remaining food particles
You should visit your dentist for regular check-ups. Having regular dental check-ups will ensure any plaque and calculus – previously known as tartar – is removed from your teeth, particularly in areas that are difficult to reach.
Your dentist can recommend the best way to clean your teeth and gums, and point out areas you might be missing. They can also identify any signs of gum disease and ensure early treatment.
Bad breath can be caused by a gastrointestinal problem, such as an H. pylori infection or gastro-oesophageal reflux disease (GORD). You may be referred to a gastroenterologist.
The treatment recommended will depend on the type of gastrointestinal condition you have.
For example, if you have a stomach ulcer, you may need a combination of two or three different antibiotics and a proton pump inhibitor (PPI). This is known as eradication therapy.