Causes of and solutions to bad breath

Halitosis, or bad breath, affects as much as 31.8% of the world’s population, but you don’t have to live with it. Dr Andrew Doig, Director and Lead Dentist at Skye Dental and Dr Arlena Lee, Prosthodontist and Medical Director of the Beverly Wilshire Dental Group explain the causes and treatments of halitosis, and put some myths to rest.

Myth 1: Halitosis comes from the stomach

Dr Doig: Only a fraction of halitosis stems from the stomach. When it does, the association is usually indirect. In 90% of cases, halitosis is caused by anaerobic bacteria breaking down food in the mouth, where they create smelly volatile sulphur compounds (VSCs).

These compounds can lodge in the tongue and gums, resulting in bad breath through:

  1. Tongue coating – the back of the tongue has a large irregular surface, making it ideal for anaerobic bacteria and VSCs. Unfortunately, the back of the tongue is not easily accessible for cleaning, making this condition difficult to treat at home.
  2. Gum disease and oral diseases – patients with gum disease often have bad breath because gum pockets are not only ideal for VSC production, but also because VSCs accelerate tissue breakdown, creating further foul odours. Gum disease patients are also more likely to have tongue coating than healthy patients. Oral diseases associated with halitosis include ulcerative gingivitis (painful gum infection due to bacterial overgrowth), dental abscesses, perioconitis (gum infection around the wisdom teeth) and oral candidiasis (yeast infection of the oral mucosa).
  3. Other reasons – dry mouth, dehydration and hunger, oral wounds and poor oral hygiene in patients with braces and dentures may also be causes.

Myth 2: Halitosis is caused by underlying conditions

Dr Lee: While this is true, only 10% of bad breath comes from extra-oral health issues. These include diabetics, asthmatics, and patients with kidney problems whose breath can smell citrusy, acidic and ammonia-like, respectively. Less than 0.5% of halitosis is associated with stomach disorders such as gastroesophageal reflux disease or the H. pylori infection.

Myth 3: It’s easy to tell if your own breath stinks

Dr Doig: Most people can’t tell they have bad breath as they’ve probably adapted to such odours over time. Plus, our noses and mouths communicate through an opening at the back of the mouth, making smelling our own breath difficult. In pandemic times however, people have become more aware of their breath when wearing masks, as dried oral moisture droplets leave an odour on the insides of masks.

To confirm the presence of bad breath, I recommend:

  1. Asking your dentist/someone you trust to smell your breath.
  2. Licking the back of your hand, letting it dry, and sniffing it. Otherwise, breathe through your mouth into a cupped hand; you should be able to smell your breath.

Myth 4: Bad breath is caused by eating pungent foods

Dr Lee: This is somewhat true, though odours from external factors are transient. When you eat foods with strong smells such as garlic, onion, or durian, these odours are absorbed into the bloodstream during digestion and breathed out through your lungs. Other habits associated with transient bad breath are smoking and alcohol consumption.

Myth 5: Brushing and scraping the tongue alone can keep bad breath away

Dr Doig: Since halitosis has several causes, brushing and scraping the tongue alone may not be enough to control foul odours. Nevertheless, brushing twice daily, using floss and interdental brushes, gargling with mouthwash and staying hydrated should be enough to control bad breath in most people.

Here are a few products for controlling halitosis:

  1. Tongue scrapers – these can be effective. You can also use a toothbrush to brush the entire tongue, focusing on the back of tongue as that’s where most VSC-producing bacteria is found.
  2. Mouthwash – those with ingredients such as chlorhexidine gluconate and cetylpyridine chloride are effective in eliminating VSC-producing bacteria, which are mostly available through prescription by your dentist.
  3. Toothpaste – choose toothpastes with chlorine dioxide, sodium chlorite and zinc compounds as these control VSC formation. Products that contain these ingredients include Colgate Plax, Crest Pro-Health and Breath Rx.

Myth 6: Mouthwashes, mints and gums can eliminate halitosis permanently

Dr Lee: Mouthwash, mints and gums freshen breath for only a brief moment. In cases of dry mouth, mouthwash reduces intra-oral bacteria, while mints and gum increase saliva production, temporarily improving halitosis. To eliminate halitosis permanently, I recommend visiting your dentist who can diagnose the cause of your bad breath and treat you accordingly.

Myth 7: There is no cure for halitosis

Dr Doig: This is definitely not true. Since 90% of halitosis is caused by poor oral hygiene, diligent home care alone should be sufficient in controlling bad breath. If halitosis persists, you should speak to your dentists about:

  1. Effective home care measures – consult your dentist about how you can improve your oral hygiene
  2. Potential intra-oral diseases – a thorough examination can determine the cause of your condition and whether you need treatment such as scaling, root planing, or dental decay and gum infection treatment to eliminate the source of your bad breath .
  3. Potential extra-oral causes – if intra-oral causes of bad breath have been eliminated, your dentist may refer you to a medical specialist as extra-oral halitosis may be a sign of an underlying medical condition.

[Left] Dr Andrew Doig, Director and Lead Dentist at Skye Dental and [Right] Dr Arlena Lee, Prosthodontist and Medical Director of the Beverly Wilshire Dental Group

Photos from Dreamstime.
Dr Andrew Doig photo courtesy of Dr Andrew Doig.
Dr Arlena Lee photo courtesy of Dr Arlena Lee.

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