Topic Resources
Bad breath is a frequent or persistent unpleasant odor to the breath.
Other breath odors
Certain diseases produce substances that are detectable on the
breath, but these odors are typically mild and not considered bad
breath. For example,
-
Liver failure gives the breath a mousy or sometimes faintly rotten egg-like (sulfurous) odor.
-
Kidney failure makes the breath smell like urine or ammonia.
-
Severe, uncontrolled diabetes makes the breath smell like nail polish remover (acetone).
Causes
Most bad breath is caused by problems in the mouth. Causes that contribute to bad breath are listed in table Some Causes and Features of Bad Breath.
Common causes
The most common causes of bad breath are
-
Odor-causing bacteria on the tongue
-
Certain foods and alcoholic beverages
-
Tobacco use
Bad breath is most often caused by the action of certain mouth
bacteria on food particles in the mouth. These bacteria break down
(ferment) the food particles into foul-smelling substances. These
bacteria are more common among people with periodontal diseases (such as
gingivitis and periodontitis) and poor oral hygiene.
Periodontal diseases inflame and destroy the structures
surrounding and supporting the teeth, such as the gums and the outer
layer of the tooth root, and are caused mainly by an accumulation of
certain bacteria. These bacteria grow in deep pockets that surround the
teeth. Such bacteria can also grow on the back of the tongue, even in
people who do not have periodontal disease. These bacteria can also
overgrow due to a decrease in the flow of saliva (caused by some
diseases or the use of certain drugs—see Dry Mouth) or a decrease in the acidity of saliva.
After digestion, odors caused by certain foods or spices, such as
onions or garlic, pass from the bloodstream into the lungs. The odors
are then exhaled and may be unpleasant to others. For example, the odor
of garlic can be smelled on the breath by others 2 or 3 hours after it
is eaten, long after it is gone from the mouth and stomach. Oral hygiene
cannot remove these odors.
Bad breath is more common among smokers than nonsmokers.
Less common causes
Less common causes of bad breath include
-
Infections in the sinuses (sinusitis) or lungs
-
Foreign object in the nose (typically in children)
-
Imagined halitosis (psychogenic halitosis)
Although people commonly think that gastrointestinal (GI)
disorders cause bad breath, they rarely do because the muscular channel
that connects the throat with the stomach (esophagus) is normally
collapsed. Bad breath is not caused by poor digestion, nor does it
indicate how a person’s digestive system or bowels are functioning.
However, rarely, a pouch in the esophagus (Zenker diverticulum), present at birth in some people, can collect food particles. The food particles can decompose and create a foul odor.
Bad breath that is imagined is called psychogenic halitosis
(pseudo-halitosis). People believe that their breath smells bad when it
actually does not. This problem may occur in people who tend to
exaggerate normal body sensations or in people who have a serious mental
disorder, such as schizophrenia. Some people with obsessive thoughts have an overwhelming sense of feeling dirty and believe that their breath smells bad.
Evaluation
Bad breath rarely requires an immediate evaluation by a doctor or
dentist. The following information can help people decide whether an
evaluation is needed and help them know what to expect during the
evaluation.
Warning signs
Certain symptoms and characteristics are cause for concern. They include
-
Fever
-
Pus-filled (purulent) sputum or discharge from the nose
-
Visible or touchable abnormal spots in the mouth
When to see a doctor
People who have fever or purulent sputum or nasal discharge or
who may have inhaled a foreign object should see a doctor right away.
People who discover an abnormal spot in their mouth should see a dentist
within several days.
People with bad breath but no warning signs and who otherwise feel well should see a dentist when they are able.
What the doctor does
Dentists and doctors first ask questions about the person's
symptoms and medical history. They then do a physical examination. What
they find during the history and physical examination often suggests a
cause of the bad breath and the tests that may need to be done (see
table Some Causes and Features of Bad Breath).
The sniff test is a helpful part of the examination that
can help tell whether the bad odor is coming from a nose or sinus
disorder versus a mouth or lung disorder. The person exhales about 4
inches (about 10 centimeters) away from the doctor’s nose, first through
the mouth with the nose pinched shut and then through the nose with the
mouth closed. If the odor is worse through the mouth, the cause most
likely originates in the mouth. If the odor is worse through the nose,
the cause most likely originates in the nose or sinuses. If the odor is
similar from both the nose and the mouth, the cause most likely
originates from another part of the body or the lungs. If the examiner
is unable to tell where the cause originates, the back of the tongue is
scraped with a plastic spoon. After 5 seconds, the spoon is sniffed. A
bad odor on the spoon shows that the likely problem is bacteria on the
tongue.
Testing
The need for testing depends on what the doctor finds during the history and physical examination, particularly whether warning signs
are present. Some specialists who focus on bad breath have unusual
testing equipment, such as portable sulfur monitors, gas chromatography,
and chemical tests for tongue scrapings. Such testing is rarely needed
except for medical research.
The doctor may suggest that people whose symptoms seem to be
related to ingested or inhaled substances avoid the suspected substances
for a period of time to see whether the symptoms go away (trial of
avoidance).
Treatment
-
Treatment of the cause
-
Regular oral hygiene and dental care
Once diagnosed, any causes of bad breath are treated.
Physical causes can be removed or corrected. For example, people
can stop eating garlic, onions, and other odor-producing food and stop
smoking. If the cause is oral, people should see a dentist for
professional cleaning and treatment of periodontal diseases and
cavities. At home, people should improve their daily oral hygiene
routine, including thorough flossing, toothbrushing, and brushing the
top and back of the tongue with the toothbrush or a tongue scraper. Many
deodorant mouthwashes and sprays are available, but these are of
limited benefit. The effects of most of these products do not last more
than 20 minutes. Recovering alcoholics should use alcohol-free
mouthwashes.
People with psychogenic halitosis may need to have a psychiatric evaluation.
Essentials for Older People
Older people are more likely to take drugs that cause dry mouth, which leads to difficulties with oral hygiene and hence to bad breath. Oral cancers, another cause of bad breath, also are more common with aging. Older people are otherwise not more likely to have halitosis.
Key Points
-
Most bad breath is caused by fermentation of food particles by bacteria in the mouth.
-
Disorders outside the mouth may cause bad breath but are often recognizable based on findings during a doctor's or dentist's examination.
-
Bad breath is not caused by poor digestion, nor does it indicate how a person's digestive system or bowels are functioning.
-
The effects of mouthwashes do not last very long.
Posts
0 Comments