Written By Sharon Boyd, RDH, BS. | Reviewed by Lara T. Coseo, DDS
Definition Of Halitosis
Causes of HalitosisWhat causes halitosis? Bad breath can have numerous causes:
- Unbalanced oral flora
- Gum disease
- Medications [1.]
- Food such as garlic and dairy
- Dry mouth
- Tobacco use
- Poor oral hygiene
- Gum disease
Bad breath is typically due to poor oral hygiene, but if halitosis persists then it may be due to other factors. Drainage in the back of the throat from allergies or sinus infections can cause bad breath. If active gum disease is present, halitosis will most likely persist until the condition has been reversed.
Signs And Symptoms of Halitosis
Sometimes bad breath can be difficult to notice yourself. You may need to ask a friend or family member to help with your self-diagnosis.
The following signs and symptoms may be associated with bad breath:
- Black or white hairy tongue
- Visible tartar buildup on the teeth
- Swollen, red or bleeding gums
- Filmy buildup on the tongue
- Accompanying systemic infection
- Swollen lymph nodes
Some other symptoms you may notice during bout of bad breath are saliva that is thick or stringy; sores or split skin at the corners of the mouth; cracked lips; altered sense of taste; or increased plaque, tooth decay and gum disease.
Progression of Halitosis
|A bad taste in the mouth may develop first.||Then the odor may be more easily noticed by others than by yourself.||By this point, social and professional embarrassment may occur.|
Bad breath can progress from a temporary problem to a chronic condition that is difficult to reverse. Many people believe they can simply treat the condition topically with the use of mints or gums, but treating only the symptoms will allow the underlying condition to progress until the cause is identified.
If bad breath is due to the development of gum disease, not treating the condition properly can result in severe bone destruction and the loss of teeth.
Dangers And Health Risks from Halitosis
Halitosis is typically associated with periodontal disease infections. In some cases it may be due to other underlying conditions. If gum disease is the cause of your halitosis, then it is important to know that gum disease is linked with numerous health conditions that should not be ignored.
Examples of diseases linked with periodontal infections include: cardiovascular disease, including heart attack, stroke and elevated blood pressure; diabetes; obesity; erectile dysfunction; and premature labor Treatment for these conditions should be correlated with treatments for gum disease, as the severity of each can affect the response of the other conditions.
Steps To Prevent Bad Breath/Halitosis
Treatments for Halitosis
Gum and mints are other options as well, but generally mask breath instead of treating the actual cause of it. If you do go that route, be sure to use sugar-free products, as ones with sugar will only feed that germs that you need to eliminate.
Alcohol In Mouthwash
While some studies indicate a link between oral cancer and mouthwashes containing alcohol, other studies have found no connection. The American Dental Association states that people at risk for oral cancer, including those who smoke, have a family history of the disease, or have an intolerance for alcohol, should avoid mouthwashes containing alcohol.
There are also concerns that mouthwashes with alcohol may worsen the condition called dry mouth. Here’s why.
What Alcohol In Mouthwash Does
Most mouthwashes you see in drug stores contain an alcohol (specifically ethanol) which cause that initial burning sensation, and also bring an unpleasant taste and dryness to the mouth. The ethanol in alcohol mouthwashes can kill almost all the good and bad germs in your mouth, which can cause an imbalance that can lead to bad breath and other problems.
So unless you’re consistently using mouthwash every day, there are a lot of opportunities for bad breath to actually build up and cause this imbalance of germs. Also, since alcohol does not reach harmful germs deep beneath the gum line it may not be cleaning your teeth as well as you think.
Some mouthwashes also contain phenols, which are a type of alcohol, and have widely been considered toxic due to their susceptibility of being absorbed by lungs and skin, potentially resulting in caustic burns, kidney and liver damage and hyperactivity.
“Some mouthwashes contain such high levels of alcohol in their formulas, they surpass both red and white wine,” says Dr. Jonathan Levine, DMD. “High levels of alcohol dry out the mouth’s soft tissue, and can cause burning sensations in teeth, gums and cheeks, a condition called mucosal irritation. The higher the level of alcohol in a rinse, the more sloughing – or shedding of dead surface cells from the skin - that occurs. More sloughing brings about more food for germs, which increases germs levels, which increases the sulfur levels of bad breath. It also destroys any resin technology that's been performed on the teeth, like bonding or veneers.”
Why Natural Mouthwash Is A Good Alternative
Saliva is critical to oral health. Its primary job is to flush out potentially harmful germs and make it difficult to stick to your teeth and gums. Without adequate saliva, bad breath will result, while the risk for developing gum disease and cavities increases significantly.
A big downside of alcohol-based mouthwashes is that they actually are highly ineffective or counterproductive when it comes to long-term treatment of bad breath. While alcohol-based mouthwash products may kill germs in the short term, the high alcohol content reduces the amount of saliva in your mouth, which ultimately makes bad breath worse.
Alcohol-free mouthwashes are typically alcohol-and-sugar-free and help to maintain the natural balance of saliva. This balance is critical not only for breaking down starches and flushing out germs, but also for assisting in the body’s natural digestive process.
If you experience dry mouth due to certain medicinal side effects, radiation therapies or systemic diseases such as Sjogren's syndrome or diabetes, you can benefit from using alcohol-free mouthwashes. Studies by the peer-reviewed journal BioMed Research International, suggest alcohol-free mouthwashes have a better effect on the gloss, color, hardness and wear of tooth composite restorations compared to mouthwashes that contain alcohol.
Essential oils are recommended for their therapeutic benefits in dental care because they help prevent infection, bad breath, and gum disease without the harmful side effects that are associated with commercial mouthwashes. Natural mouth rinses containing essential oils and herbal extracts can provide antimicrobial and connective tissue rebuilding properties, which can substantially strengthen your healing abilities and overall oral health.
Your Questions About Bad Breath Answered
How do I know if I have bad breath?
There is no concrete way to perform a halitosis test. Rather, a family member or close friend will usually tell you. It may be embarrassing to bring the topic up with your dentist, but they are there to help you if you fear you have a problem with bad breath.
Why do I have bad breath?
Bad breath is typically due to inappropriate oral hygiene, or dental disease such as gingivitis, gum disease or severe decay.
What’s the quickest way to get rid of bad breath?
In order to reduce bad breath you must eliminate the germs in your mouth, which are causing the malodor. Knowing how to control oral germs is how to control bad breath.
How do I get rid of morning breath?
Cleanse your mouth thoroughly before bed and drink plenty of water. Be sure you take any medications for allergies or acid reflux. Upon waking, cleanse your mouth thoroughly or rinse with a bit of non-alcoholic mouthwash such as water mixed with a few drops of essential oils.
What’s the best mouthwash for bad breath?
The best mouthwash for bad breath is one that does not contain alcohol or act to cover-up the halitosis, instead of treating it. Keeping oral flora in balance is important, so using natural products such as a few drops of essential oils in water can be beneficial.
What’s the best toothpaste for bad breath?
The best toothpaste for bad breath is one that is used properly, with an efficient brushing method that removes all oral germs. Most over-the-counter toothpastes contain a mild mint flavor that provides a short duration of a fresh scent in the mouth. Adding a few drops of essential oils to your toothbrush can provide hours of relief to your bad breath.
Do I need to see a dentist about my bad breath?
If you are experiencing bleeding gums, broken teeth, or sensitivity to sweet, hot or cold, you are most likely suffering from active decay or other disease that may need to be addressed by a dentist.
My bad breath seems to also be associated with a bad taste. Why is this?
Areas in your mouth that have food pack between teeth, active gum disease, or dental abscesses may also taste bad. This is due to disease germs in the mouth.
Can’t I tell by myself if I have bad breath?
Most people are unaware of scents or odors that they give off themselves. Other times, they simply become accustomed to it to the point where they no longer notice it, even if it is very obvious to others. Just because you can’t tell you have bad breath doesn’t mean that others don’t.
Where does bad breath come from?
Most dentists will tell you that 90% of bad breath germs (the germs that cause malodor) originate on the tongue. But halitosis also comes from things like gum disease and post-nasal drips/drainage and sinus infections.
What does it say about your health?
The way your breath smells can sometimes be a warning sign of medical problems like acid reflux or lung disease. But usually, bad breath just says that you’re not taking good care of your teeth and gums.
Is it a gum disease?
Halitosis is closely linked with gum disease (periodontitis). The smell originates deep under the gums, where there are high levels of germs and necrotic (dying) tissues.
What causes bad breath even after brushing?
It could be that the bad breath smell is scattered across your tongue, still resides under your gumlines, or is due to sinus drainage in the back of your throat.
Does bad breath come from your stomach?
Sometimes, but rarely. If you have a gastrointestinal problem or eat something known for causing bad breath, it can cause you to have halitosis for several hours thereafter.
Does acid reflux cause it?
People who have acid reflux disease do tend to occasionally experience bad breath. But if you have chronic halitosis, there’s likely something else going on. It’s best to talk to your dentist and/or doctor.
Does it come from the teeth or tongue?
Both. Your tongue is covered with hundreds of tiny papillae, which can trap odorous germs and food debris. But if you have active gum disease, there may be large amounts of smelly germs across the surfaces of your tooth roots.
Do cavities cause bad breath?
Normally, no. But large cavities – which are obviously visible due to their size – may harbor odorous germs. Additionally, if a tooth is abscessed and starting to drain, that pus can cause a bad taste or smell.
Can braces cause them?
No. The only reason someone would experience bad breath linked with orthodontic treatment is if they aren’t cleaning around their braces properly. Keep in mind that if you are a mouth breather because of the appliances, it could raise your chances of having bad breath.
Can plaque cause it?
Yes. Plaque is made up of various types of germs, all of which can produce bad odors. But most notably is calculus – which is calcified plaque – and how it’s closely linked to gum disease.
Can candida cause it?
Yes. Any time the natural flora inside of your mouth is altered, there can be an overgrowth of good or bad germs. As such, candida (yeast) infections may lead to bad breath.
What about gingivitis?
Minor gingivitis is usually associated with bad breath, but it doesn’t cause it. On the other hand, untreated gingivitis that evolves into gum disease (periodontitis) does cause bad breath.
Can veneers cause them?
No. Veneers are tightly bonded to your teeth, so there’s not space around or underneath the edges for odorous germs to accumulate. That being said, if you do not brush or floss them regularly, areas of leakage can develop.
Can a tooth extraction cause it?
Yes. It’s fairly common for someone who recently had a tooth pulled/removed/extracted to experience bad breath. The halitosis tends to last for a few days, while the extraction site heals. Cleaning your mouth thoroughly can limit the extent of the odor.
Can wisdom teeth removal cause it?
Yes. Since multiple extraction sites are present following wisdom tooth surgery, it’s common for those patients to experience bad breath while their incision areas are healing. If you develop a dry socket, the halitosis can last up to a couple of weeks or more.
Can constipation cause it?
No. Gastrointestinal problems may occasionally contribute to bad breath, but constipation is not one of them.
Can it come from your lungs?
Yes. People with respiratory diseases, sinus drainage, congestion, or other types of airway-related infections are likely to experience bad breath to some extent.
What causes bad breath in cats and dogs?
If your pet gets bad breath, it could be from something they ate (such as a dead animal, waste byproduct, or digging in the neighbor’s trash). But it can also be caused by gum disease, respiratory infection, or gastrointestinal disorder.
Which foods cause bad breath?
Some of the most common foods that cause bad breath include onions, garlic, fish, eggs, and milk. If you know you’re going to be out and around other people, you might want to save those ingredients or meals for another time.
Do eggs cause it?
Eggs do contribute to bad breath, because of the sulfuric compounds in them. Sometimes the halitosis symptoms don’t appear until hours after you’ve eaten them.
Can it be caused by tonsils?
If you tend to experience chronic tonsillitis, tonsil stones, or a sore throat, chances are that there’s an increased level of germs surrounding your tonsils. And since your tonsils are practically impossible to clean, bad breath is fairly common.
Do ulcers cause it?
Minor to moderate ulcers shouldn’t affect what your breath smells like. However, if you have a serious ulcer outbreak or cold sores, it could be painful to clean your mouth. As a result, it could cause your breath to stink.
What about tonsils?
Tonsils don’t cause bad breath, but if you have infected tonsils or tonsil stones, you likely have bad breath germs tucked in and around them. As such, you could see halitosis symptoms get worse whenever you experience tonsil flare-ups.
Do crowns cause it?
Sometimes odorous germs will collect around crowns or other dental work if you do not floss them regularly. Chances are, there is germs or food debris lodged somewhere around the tooth. Left unaddressed, your crown could fall off.
Is it caused because I am diabetic?
People with diabetes are at an increased risk of developing gum disease. Although periodontitis is known for causing bad breath, diabetes is not. The only time most diabetics see a change in the smell of their breath is if they’re going into some type of glycemic shock.
Is it because I’m on a keto diet?
Going into ketosis can change the way your breath and body smell. But being on a ketogenic (keto) diet usually isn’t enough to cause any significant issues when it comes to halitosis.
Is it a sign of illness?
It definitely can be. Bad breath is linked with periodontal disease, respiratory diseases (including pneumonia), gastrointestinal illnesses, and sometimes organ failure or cancer (although those are less common).
Sign of dehydration?
Being dehydrated can lead to an electrolyte imbalance, which in turn is linked with ketosis. Although bad breath isn’t the biggest concern when that happens, it could be a sign that something is wrong.
Is it a sign of mono?
If you or your child has mono, it’s common to see white patches at the back of your throat. Symptoms like swollen lymph nodes are also common. As such, there’s sometimes an excess of germs inside of your mouth, which can change the way your breath normally smells.
Does it mean I have a sinus infection?
Active sinus infections do cause bad breath. So, if you struggle with frequent nasal drainage, allergies, or upper respiratory/sinus infections, chances are you’ll also have halitosis.
What does bad breath mean?
Having bad breath usually means that you’re not putting as much into your oral hygiene routine as you ought to. In most cases, it’s rooted with biofilm buildup or gum disease. But there are always instances where halitosis has nothing to do with your brushing and flossing habits.
Which medications cause bad breath?
Any medication that alters your normal oral flora (such as antibiotics) or dries up your natural saliva flow (such as decongestants, allergy meds, or anxiety/depression prescriptions) could potentially set you up for developing bad breath.
What helps bad breath?
Drinking plenty of water, cleaning your tongue, daily flossing, brushing, and an alcohol-free mouthwash are helpful. However, if your halitosis is due to gum disease, you will need to schedule a professional dental cleaning to remove the germs deep under your gums.
Will flossing help?
Yes. Since odorous germs tend to get trapped between teeth and below the gumlines, flossing is the only way to thoroughly clean it out.
Can it be cured?
Fortunately, yes. But it might take the help of your dentist and dental hygienist! It’s best to treat halitosis at the source, rather than attempt to cover it up with gums, mints, or rinses.
Do breath testers work?
That depends. Breath tests are made to pick up on sulfuric compounds, which are a primary source of bad breath. But they’re not guaranteed 100% if your bad breath is caused by something else.
Do bad breath pills work?
If your halitosis is because of changes in your oral flora, then supplementing with something like a probiotic could be helpful. But in most cases, physical removal of the germs is necessary. That’s not something that a pill can fix.
Is there a tea that helps bad breath?
Green tea is a natural antioxidant, meaning that it can potentially help with the source of your bad breath. Keep in mind, if you’re adding any type of sweetener (whether it’s sugar or a sugar substitute) to your tea, you’re giving the germs something to feed on and your breath could get worse.
A toothpaste that helps?
Any toothpaste that has the ADA seal of approval is appropriate for what it’s packaging states that it’s formulated for. Finding a toothpaste that contains essential oils – such as mint or peppermint – can help freshen your breath for a longer period of time between brushing sessions.
Will scaling stop bad breath?
If your bad breath is because of gum disease, then a scaling (deep cleaning) is the first step to getting your halitosis back in check. However, after those germs deposits are cleaned off of your teeth, you’ll need to keep flossing and brushing to see permanent results.
Do probiotics help?
Probiotics can be helpful for some types of bad breath. Especially if it’s due to antibiotic use. But ultimately the best treatment is physically removing the germs responsible for the odor.
What kills bad breath?
Physically removing dental plaque through daily brushing and flossing is the first step. Next, supplement your oral hygiene routine with an essential oil-based mouthwash (alcohol-free). Finally, schedule regular cleanings with your dental hygienist to remove buildup that accumulates between checkups.
Will peroxide kill it?
Peroxide can kill some types of germs, but it will also alter the natural flora inside of your mouth. Used too often, rinsing or brushing with peroxide might actually cause bad breath instead of helping it.
Will a Waterpik help get rid of it?
Waterpiks are a popular brand of water flosser (oral irrigator). They’re ideal for cleaning hard-to-reach areas such as between teeth, under dental bridges, and under the gums. If you have difficulty flossing, a water flosser could help with your bad breath woes.
Will chlorophyll help?
Looking for a holistic option for treating bad breath? Chlorophyll is the compound that gives plants their bright green color. It’s also a natural deodorizer. Some people find that taking chlorophyll supplements can help with their bad breath.
Do you get bad breath when you’re pregnant?
When you’re expecting, things like brushing or flossing your teeth could trigger your sensitive gag reflex. If it’s difficult to clean your mouth or you’re struggling with bouts of morning sickness, you might start to experience some trouble with bad breath. Fortunately, this is usually temporary. As your hygiene routine improves, your halitosis will too.
Is it a sign of pregnancy?
No. Aside from your normal symptoms of morning sickness or fatigue, it’s not natural to experience issues such as halitosis or bad breath during early pregnancy.
Why does my baby or child have bad breath?
Children tend to exhibit signs of bad breath when they breath through their mouth or have problems with allergies/sinus drainage. But if neither exists, ask your dentist to evaluate your child for signs of an oral infection or tooth decay.
Do babies get it from teething?
No. The only time babies might have bad breath is if they have an issue going on such as thrush or a similar oral infection. Teething might make their gums sore – which makes it more difficult to clean their mouth – but it shouldn’t be the source of breath malodor.
Can you get bad breath when fasting or dieting?
Changes in your diet can lead to a number of side-effects, including the way your breath smells, body odor, or even the color of your urine.
Why did I get bad breath on my low-carb diet?
A low-carb or keto diet usually doesn’t cause bad breath, but if your body reaches the point where it goes into clinical ketosis, then yes, you are likely to experience changes in your breath.
Do vegans get bad breath?
Some types of foods have heavier sulfuric compounds than others. If you eat certain vegetables – such as Brussels sprouts – it can lead to bad breath. As such, vegans and vegetarians are encouraged to rotate different foods through their diet to keep nutrition in balance without unwanted side-effects.
Why do I get bad breath when I’m sick?
When we’re ill, we tend to get swollen lymph nodes, increased mucus in the back of our throat (depending on why you’re sick) and are less likely to keep our mouth clean because we just don’t feel well. As a result, bad breath tends to flare up whenever we come down with a bug.
Why do I get it when I’m hungry?
Being hungry doesn’t cause bad breath, but it can increase saliva production! And if you have an oral infection or gum disease, the extra germs inside of your saliva may be more noticeable just before meals.
Why do I wake up with bad breath?
Morning breath is fairly common. Since our mouths dry out at night while our saliva glands shut down, it can make them feel sticky and gross when we wake up. The lack of saliva flow also means that there are probably more germs inside of your mouth when you wake up in the morning than the night before. Snoring or mouth breathing can make morning breath worse.
Is bad breath a sign of cancer?
Although rare, it is possible for bad breath to be linked with certain types of cancers - especially those related to your stomach, liver, esophagus, lungs, or other respiratory and gastrointestinal tissues.
Is it a sign of liver problems?
It can be. A condition known as “fetor hepaticus” can cause you to have bad breath when your liver is shutting down or diseased. It’s caused by unfiltered sulfur particles finding their way back into your bloodstream and airway.
Is bad breath contagious?
Not really, but sort of (how do you like that answer?) Since bad breath is usually because of a person’s oral hygiene habits or medical condition, it’s rare for those health issues to be transferred to someone else. However, oral germs can be spread through kissing or sharing food, so be sure to brush and floss routinely to prevent them from settling around your teeth and gums.
Is it genetic?
Sometimes issues such as allergies or poor oral hygiene habits tend to run in families. As a result, there could be multiple family members who struggle with bad breath. But halitosis itself isn’t something that’s genetic or inherited.
Is bad breath a sulfur gas?
Some types of bad breath are due to sulfur gas, while others are because of necrotic (dying) tissues or infection inside of your mouth. Sulfur gas, however, comes from foods that we eat. So, if you have a meal with eggs or Brussels sprouts, you’re more likely to experience some type of sulfur gas odor later on in the day.
Is it a sign of gluten intolerance?
Individuals with gluten allergies or a wheat intolerance (such as Celiac disease) commonly experience issues such as odorous gas. They may also develop odd tastes inside of their mouth. Bad breath, however, isn’t uncommon.
Is it a symptom of strep throat?
Technically, bad breath isn’t a warning sign of strep throat. But when you have an oral infection, it’s only natural to develop halitosis as a side effect. And if your doctor puts you on antibiotics to treat your strep throat, the medication could also contribute to your bad breath due to changes in your normal oral flora.
Can it be a sign of HIV?
Individuals with HIV/AIDS tend to be extremely high risk for developing periodontal disease. And it just so happens that periodontitis (aka “gum disease”) is one of the most common causes of moderate to severe bad breath.
Is there a bad breath quiz?
Some people say that they can test their bad breath by scraping their tongue with a spoon, wiping the residue on their hand, then smelling it a short time later. Unfortunately, that doesn’t always work (and most of us tend to be immune to picking up on our own body odor).
Why did I get bad breath after my appendectomy?
Appendectomies themselves don’t cause bad breath. But anytime someone is hospitalized or undergoes emergency surgery, there’s a likely chance that they go a few days without keeping up with their normal oral care routine. As a side-effect, they could experience temporary bad breath.
Why did I get it after my tonsillectomy?
Having your tonsils removed usually requires several days or up to a week of recovery after your surgery. In the meantime, your mouth is sore and your diet is restricted to softer foods. Changes in your diet, increased germs from not brushing and flossing, and the scarred tissues at the back of your throat all create the perfect recipe for bad breath.
- 1 Murata T, Fujiyama Y, Yamaga T, Miyazaki H.; Breath Malodor In An Asthmatic Patient Caused By Side-Effects Of Medication: A Case Report And Review Of The Literature.; Oral Dis. 2003 Sep;9(5):273-6.
- 2Tornout, V., Dadamio, J., Coucke, W., Quirynen, M.; Tongue Coating: Related Factors; Clin Periodontology; 2013 Feb;40(2):180-5.
Article Written By Sharon Boyd
Sharon has been a Registered Dental Hygienist since 2001. She also holds a Bachelor of Science degree in Human Relations and Business. In 2011, she began implementing her dental knowledge into freelance writing services that aided dentists, product designers, continuing education providers and web marketing firms for their online and distribution purposes. She has since bridged her services into the medical and cosmetic surgery fields.
Article Reviewed by Dr. Lara Coseo
Lara T. Coseo, DDS, is a 2004 graduate of Baylor College of Dentistry. She has 13 years of experience practicing general dentistry. She currently serves as a part-time faculty instructor at Texas A&M College of Dentistry and writes dental website content and blog material.