Bad breath - What is it?
In this section
Bad breath is an unpleasant smell on your breath. Other people may notice it when you speak or breathe out. You might not be aware of it yourself.
Everyone gets bad breath occasionally, but some medical problems can mean you have it most of the time or even all of the time. Bad breath is sometimes called halitosis.
Temporary bad breath
Lots of people have bad breath first thing in the morning. That's because saliva usually keeps your mouth clean, and it dries up while you sleep.[1]
'Morning breath' is probably worse in people who tend to breathe through their mouths rather than their noses.[2] But the problem is easily put right. It will go away as soon as you have something to eat, brush your teeth or rinse your mouth.
You can also have temporary bad breath after:[2]
- Eating spicy or strong-smelling foods, like garlic, raw onions or curry
- Smoking
- Drinking alcohol.
Most people put up with bad breath for a little while if they enjoy these things. But steering clear of alcohol, cigarettes or spicy food can help you avoid bad breath.
Long-lasting bad breath
Bad breath that lasts through the day is usually caused by a problem in your mouth.[3] For 9 in 10 people, bad breath is caused by either gum disease or bacteria that grow on your tongue.[1] [3]
However, bad breath is occasionally caused by a medical problem somewhere else in your body. Conditions that can cause bad breath include sinusitis, tonsillitis, and some lung problems or stomach problems.
Here are the different types of bad breath.[4]
Bad breath caused by bacteria
Bacteria can grow on the coating on the back part of your tongue. As they grow, bacteria give off gasses. These gasses can make your breath smell bad.
You may be more likely to have this kind of bad breath if you:[5]
- Smoke
- Don't brush your teeth every day
- Don't produce enough saliva.
Not producing enough saliva can be a problem because saliva helps to keep your mouth clean. You might produce less saliva than usual if you:
- Are taking some medicines, such as antihistamines, antidepressants or tablets for high blood pressure
- Have problems with the glands in your mouth that make saliva
- Don't drink enough water
- Don't eat regularly enough
- Breathe through your mouth too much.
Bad breath caused by gum disease
The most common problem which causes bad breath is gum disease. You get gum disease because of plaque. Plaque is a coating on your teeth. It's mainly made up of bacteria. These bacteria can sometimes infect your gums and make them inflamed.
There are two main stages of gum disease.[6]
- Gingivitis. This is when your gums become red and swollen. They may bleed easily when you brush your teeth. You can get rid of gingivitis by brushing your teeth at least twice a day. Flossing can also help, by getting rid of plaque from between your teeth. Or you can get your teeth thoroughly cleaned by a dentist or dental hygienist.
- Periodontitis. This is a later stage of gum disease. Your gums start to pull away from your teeth and form pockets that are infected. If you don't get treatment, the bones, gums and other tissue that support the teeth can be destroyed. If this happens, teeth may eventually become loose and have to be removed.
Other problems in your mouth that can cause bad breath are:[2]
- An infection in the tooth socket after a tooth has been taken out
- Mouth ulcers
- Bits of food that collect under something in your mouth, such as braces or a bridge.
Bad breath caused by another medical condition
Bad breath can be caused by a condition that affects your throat, lungs or somewhere else in your body. Conditions that can cause bad breath include:[1] [2] [5]
- Sinusitis (an infection of the air spaces behind your nose)
- Bronchitis (an infection in your airways)
- Tonsillitis (a type of throat infection)
- Catarrh that lasts a long time
- An object that's trapped in your nose. Children sometimes put small objects in their noses
- Problems with your digestive system (for example, heartburn can make stomach acid and gas travel back up into your throat)
- Liver or kidney problems
- Diabetes. If you have diabetes, your body may burn fat for energy instead of glucose. This is called diabetic ketoacidosis. It can make your breath smell fruity or sweet. Diabetic ketoacidosis is very serious. Anyone who has it should see a doctor straight away
- A condition called trimethylaminuria. This happens when a chemical called trimethylamine can't be broken down by your body. Instead, you get rid of it in sweat and saliva. This causes bad breath and body odour.
Thinking you have bad breath when you don't
Some people worry that they have bad breath when they actually don't. This is called pseudo-halitosis. People with pseudo-halitosis tend to look for signs in other people's behaviour to prove to themselves that their breath is bad.[2]
Some people with pseudo-halitosis continue to worry that they have bad breath even after they've been examined and reassured. This is sometimes called halitophobia. A phobia is when you're very afraid of something.
Thinking you have bad breath can be very upsetting.[7] It's even been known for people with halitophobia to commit suicide.
Seeing a doctor or dentist
A doctor or dentist can help you with bad breath. If your problem is caused by bacteria or a problem in your mouth, your dentist will be able to suggest treatment. Your dentist will also be able to offer advice if you think you have bad breath but it turns out you don't.[4]
If your bad breath is caused by a medical condition somewhere else in your body, you'll need to see a doctor. If you have halitophobia, and you feel bad about your breath even though nothing is wrong, your doctor may arrange for you to see a therapist or counsellor who can help you.
References
- Sanz M, Roldan S, Herrera D. Fundamentals of breath malodour. Journal of Contemporary Dental Practice. 2001; 4: 1-17.
- Scully C, Rosenberg M. Halitosis. Dental Update. 2003; 30: 205-210.
- Bollen CM, Rompen EH, Demanez JP. Halitosis: a multidisciplinary problem. [in French] Revue Medicale de Liege. 1999; 54: 32-36.
- Yaegaki K, Coil JM. Examination, classification and treatment of halitosis: clinical perspectives. Journal of the Canadian Dental Association. 2000; 66: 257-261.
- U.S. National Library of Medicine. Medline Plus: breath odor. January 2007. Available at http://www.nlm.nih.gov/medlineplus/ency/article/003058.htm (accessed on 24 August 2007).
- National Institute of Dental and Craniofacial Research. Periodontal (gum) disease: causes, symptoms and treatments. September 2006. NIH publication 02-1142. Available at http://www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions (accessed on 23 August 2007).
- Yaegaki K. Oral malodor and periodontal disease. In: Rosenberg M (editor). Bad breath: research perspectives. 2nd edition. Ramot Publishing, Tel Aviv, Israel; 1995.
Glossary
- sinusitis
- If you have sinusitis, you have irritation in the spaces formed by the bones around your nose (your sinuses). Sinusitis can cause a feeling of tightness or pain. You may also have a fever. You can get these symptoms when you have a cold or an allergic reaction or when you fly in a plane.
- tonsillitis
- Tonsilitis is when your tonsils become inflamed. It happens when your tonsils get infected with viruses or bacteria. Tonsilitis causes a number of symptoms, including a sore throat, pain when you swallow and a high temperature.
- bacteria
- Bacteria are tiny organisms. There are lots of different types. Some are harmful and can cause disease. But some bacteria live in your body without causing any harm.
- antidepressant
- Antidepressants are medicines used to treat and sometimes other conditions. They work by changing the levels of chemicals in your brain called neurotransmitters. There are three main types of antidepressants, which work in different ways: selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs).
- high blood pressure
- Your is considered to be high when it is above the accepted normal range. The usual limit for normal blood pressure is 140/90. If either the first (systolic) number is above 140 or the lower (diastolic) number is above 90, a person is considered to have high blood pressure. Doctors sometimes call high blood pressure 'hypertension'.
- gland
- A gland is any group of cells in the body that makes and releases something for use by another part of the body. For example, the thyroid gland makes a hormone called thyroxine. This acts on receptors within cells. By acting on the receptors it gives the cells a message to speed up their metabolism and work harder.
- inflammation
- Inflammation is when your skin or some other part of your body becomes red, swollen, hot and sore. Inflammation happens because your body is trying to protect you from germs, from something that's in your body and could harm you (like a splinter) or from things that cause allergies (these things are called allergens). Inflammation is one of the ways in which your body heals an infection or an injury.
- infection
- You get an infection when an , such as a or , gets into a part of your body where it shouldn't be. These organisms are so tiny that you can't see them without a microscope. An infection in your nose and airways causes the common cold. An infection in your skin can cause rashes such as athlete's foot.
- phobia
- If you have a phobia of something, you are much more afraid of it than would be expected. You could have a phobia about things (such as dogs) or activities (such as going out in public). Phobias can make you feel panicky. They can also make your heart race or give you an upset stomach.
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
