Bad Breath
In this section, we will cover:
- What are the causes of bad breath?
- What can I do to prevent or cure bad breath?
- Should I see a dentist?
What are the causes of bad breath?
Bad breath, also known as "halitosis", affects about 25-50% of the population. It is caused by a build up of "bad bacteria" in the mouth which produce chemicals called "volatile sulphur compounds". Not all bacteria in the mouth are bad bacteria.
Potential causes of bad breath include:
- Tongue coating
This is the most common cause of bad breath. The surface of the tongue is rough so is the ideal reservoir for bad bacteria, food and the shedding layer of cells on the tongue. - Poor oral or denture hygiene
This causes a build up of bacteria or fungus on/between the teeth/denture, gums and tongue. It is also the cause of gum disease. - Gum disease
This is the second most common cause of bad breath. The bacteria which cause gum disease are the same bacteria which cause bad breath. - Untreated tooth decay
- Pericoronitis or infected wisdom teeth
- Dry mouth
One of the functions of saliva is to wash away food particles and bacteria. When there is little or no saliva, there is a build up of these particles which can cause bad breath.
As there is less saliva produced when you are sleeping, it is common to suffer from bad breath when you wake up - this tends to affect women more than men, although the reasons are unknown.
Lifestyle causes of bad breath include:
- Low carb diets
- Eating strong-smelling foods such as onions and garlic
- Smoking
Some common medical causes of bad breath include:
- Tonsillitis
- Sinusitis
- Constipation
- Certain medications can cause dry mouth, resulting in bad breath
Less common causes include:
- Kidney failure
- Liver disease
The liver plays an important role in eliminating waste products from the body. If the liver is not functioning properly, these products are eliminated from the lungs instead causing bad breath. - Diabetes
- Trimethylaminuria
This is a condition affecting the bowels and results in a fishy odour in the urine, sweat and breath.
What can I do to prevent or cure bad breath?
It is important to attend regular dental check ups so your dentist can identify and treat any signs of tooth decay or gum disease early.
Maintaining a good daily oral hygiene routine will help to remove any bacteria which has built up throughout the day on your teeth, gums and tongue.
- Brush your teeth and/or denture twice a day
- Clean in between your teeth (with floss or interdental brushes) at least once a day
- Use a tongue scraper or tooth brush to clean your tongue once a day. Do not brush your tongue with too much force as this can make the surface rougher which harbours more bacteria!
- Don't wear your denture at night/when you are sleeping
Certain toothpastes and mouthwashes contain chemicals which can help to reduce halitosis on a long term basis. I've listed some products below which contain chemicals proven to help treat bad breath:
- Chlorhexidine (CHX)
Chlorhexidine is an antiseptic which kills bacteria and prevents further growth of bacteria. Studies have shown 0.2% CHX mouthwash is effective at reducing bad breath. The side effects include: brown staining on the teeth (which can be removed), altered taste and irritation of the lining of the mouth.
Product examples: Corsodyl mouthwash - Chlorhexidine and cetylpyridinium chloride (CPC)
CPC is another antiseptic agent which kills bacteria. Studies have shown 0.12% CHX + 0.05% CPC is effective at reducing bad breath. There are also fewer side effects due to the lower concentration of CHX.
Product examples: Perio-aid mouthwash - Chlorhexidine + cetylpyridinium chloride + zinc
Zinc inhibits the growth of "bad bacteria" and neutralises bad odours. Studies have shown 0.05% CHX + 0.05% CPC + Zinc is effective at reducing bad breath. Again, there are fewer side effects due to the lower concentration of CHX.
Product examples: Halita mouthwash - Zinc
Zinc can also be found as an ingredient in some toothpastes
Product examples: Colgate Total Advanced Pure Breath
Probiotics are "good bacteria" which can be found in food and supplements. They encourage the growth of good bacteria and limit the growth of bad bacteria. Studies show some probiotics can help fight bad breath, as well as reduce the risk of gum disease (along with good oral hygiene). These probiotics include: Streptococcus salivarius (K12 and M18) and lactobacillus salivarius. You should not use probiotics if you have a weakened immune system.
Avoid strong smelling foods. Or after eating strong smelling foods, use sugar-free chewing gum to help mask the odour. Chewing gum will also increase the salivary flow helping to remove any bad smells.
If you believe you may suffer from a medical condition causing bad breath, you should see your GP who can prescribe you medication to control this or refer you to a specialist.
Should I see a dentist?
Your dentist should be your first port of call for persistent bad breath.
If you have toothache, bleeding gums or wobbly teeth, this may be the cause of your bad breath. Your dentist will be able to provide treatment for these conditions after which you should see an improvement in your breath. They may also recommend you use an antimicrobial mouthwash such as chlorhexidine to help eliminate the bad bacteria.
If you think you may have a medical condition causing bad breath, or your dentist has ruled out a dental cause, you can book an appointment with your GP. They may be able to diagnose and help you manage an underlying health condition causing these symptoms.