Halitosis (Bad Breath): Causes, Treatment, and Prevention

What is Halitosis?

Halitosis is an oral health problem that causes persistent bad breath. It’s different from the “morning breath” many people experience temporarily.

About 50% of adults have bad breath at some point.¹⁰ The odor typically resolves with oral health changes like brushing and using mouthwash after eating.

However, daily brushing, chewing gum, mints, and mouthwash typically won’t improve the odor halitosis causes. This condition can also indicate a more serious problem like cavities or gum disease. 

If you have bad breath, try improving your dental hygiene and the foods you eat. You may have halitosis if these lifestyle changes don’t help. Schedule an appointment with your dentist to determine the root cause.

How to Treat and Manage Halitosis

You can manage halitosis through professional treatments, home remedies, and preventing bad breath. Here’s an overview of them:

Professional Treatments

Professional treatment is the best way to manage halitosis. Below are four causes of halitosis and their treatments: 

1. Periodontal Disease

Advanced gum disease can be treated by your dentist or another oral specialist, like a periodontist. Periodontal cleanings remove tartar, plaque, and bacteria above and below the gum line. 

2. Poor Oral Hygiene

If poor dental care is causing halitosis, your dentist will also recommend ways to maintain good oral hygiene and reduce bad breath at home. 

3. Plaque Buildup

If you have extensive plaque buildup, your dentist or periodontist may suggest an antibacterial mouthwash. You should also brush your tongue daily to remove bacteria. 

4. Health Conditions

Some underlying medical conditions can cause halitosis. Diagnosis and treatment of these conditions may be the only cure for your bad breath. 

For example, a doctor treating gastroesophageal reflux disease (GERD) can stop oral malodor and clear up your halitosis.

Home Remedies

You can try several home remedies to get rid of bad breath. These include:

• Practicing good dental hygiene — This includes brushing your teeth twice a day with fluoride toothpaste, brushing your tongue, flossing daily, and rinsing with mouthwash that contains zinc and chlorhexidine.⁵
• Eating parsley — Chew on parsley leaves after a meal. Parsley, which contains chlorophyll, may mask the odor of bad breath temporarily.¹
• Drinking water — Dry mouth is one of the causes of halitosis, so staying hydrated can help eliminate bad breath by combatting a dry mouth.
• Eating yogurt — The healthy bacteria in yogurt, particularly Greek yogurt, can eliminate harmful bacteria in the mouth and reduce bad breath.⁶
• Drinking milk — Milk can reduce the “garlicky” smell of breath.³
• Drinking green tea — Green tea has disinfectant and deodorizing properties that can improve bad breath.⁷
• Taking zinc — Zinc salts (commonly found in mouthwash) help fight bad breath.⁵

These remedies are not proven to work for everyone. If bad breath persists, see your dentist.

Preventing Bad Breath

You can prevent bad breath odor by following these tips: 

Practice Good Oral Hygiene

This includes:

• Brushing your teeth twice daily (with fluoride) and flossing at least once daily. Dentists recommend flossing before you brush to loosen any debris between your teeth. 
• Brushing your whole mouth, tongue, cheeks, and the roof of the mouth. Also, gently brush or scrape your tongue. Your tongue harbors bacteria.
• Rinsing with mouthwash after you brush and floss your teeth (before bed). 
• If you have dentures, a retainer, or a mouth guard, brush it every night before placing it in your mouth.
• Quit smoking to lower your risk of gum disease and prevent dry mouth.

Eat a Healthy Diet

Eating healthy foods that stimulate saliva production is an effective way to prevent bad breath. Carrots and apples are two examples. They require intense chewing, which increases saliva content. This, in turn, can help prevent bad breath and dry mouth.

You can also chew sugarless gum or suck on hard candy to keep your saliva flowing. If you still have a dry mouth, talk to your dentist. They may give you artificial saliva.

Visit Your Dentist Regularly

Visit your dentist twice yearly for a professional teeth cleaning and dental exam. These visits are essential for preventing oral health conditions and treating any issues early.

Primary Causes of Halitosis

If nothing eliminates your bad breath, it may indicate something else happening in your body.

Mouth, Nose, and Throat Infections

Nose, sinus, and throat infections can lead to postnasal drip, causing bad breath. 

When you fight a sinus infection, your body may produce more mucus. Bacteria feed on mucus, making your mouth odor worse.

Oral Health Issues

Cavities, malocclusion, and periodontal disease (advanced gum disease) can contribute to bad breath. Holes in teeth and deep pockets between the gums give bad breath-causing bacteria a place to hide. 

Bacteria is challenging to remove from deep periodontal pockets. Normal toothbrushes and floss aren’t effective at removing plaque from these areas. 

Instead, you must visit a general dentist or periodontist for a professional deep cleaning. This treatment helps prevent gum disease from progressing.  

Dry Mouth

If you have a dry mouth, you don’t have enough saliva to maintain your dental health, potentially causing halitosis.

The following can cause dry mouth:

• Health conditions
• Medications
• Tobacco
• Alcohol
• Caffeine
• Mouth breathing 

Saliva is an integral part of your dental health. Saliva contains disease-fighting substances that protect against infections and cavities. It also helps break down food and rinse out any leftover food particles. 

Side Effects of Tobacco Products

Tobacco products significantly worsen bad breath. They have a strong odor that lingers in your mouth. Smokers are also more likely to develop dry mouth and gum disease than nonsmokers.

Poor Oral Hygiene

You are more vulnerable to bad breath if you don’t have good dental hygiene. Poor oral hygiene can lead to bacteria buildup, cavities, gum disease, and other infections.

Brushing your teeth twice daily and flossing daily helps remove bad breath-causing bacteria. Waterpiks can also improve oral health.

Other Chronic Conditions

Sometimes halitosis is a sign of another health problem. For example, the following conditions can contribute to chronic bad breath:

• Diabetes
• Liver disease
• Kidney disease
• Gastric reflux 

Other Possible Causes of Bad Breath 

Other causes of bad breath not necessarily linked to halitosis include: 

Certain Foods

Diet is a significant factor that contributes to breath and overall dental health. 

The foods you eat absorb into your bloodstream, and some can leave a bad odor in your mouth. Onions and garlic, for example, can lead to bad breath.

Odor-Causing Bacteria

Odor-causing bacteria on the tongue can react with amino acids to produce volatile sulfur compounds. These sulfur compounds can be particularly smelly, causing bad breath.

Ketoacidosis

Ketoacidosis occurs in people with diabetes. When the insulin levels are very low, bodies can no longer use sugar and start relying on stored fat for energy.

When fat is broken down, ketones are made and build up. Ketones can be poisonous in large numbers and create a distinctive and unpleasant breath smell.

Other Symptoms of Bad Breath

While bad breath is the main symptom of halitosis, it can also lead to a bad taste in the mouth. 

Symptoms vary depending on what is causing the halitosis:

• Poor hygiene ⁠— If you have poor dental hygiene, you might develop a toothache, indicating a cavity. 
• Infection ⁠— If a recent infection is causing your bad breath, additional symptoms may include a runny nose or other flu-like symptoms.

Breath smells can also differ depending on the cause of the problem. It is best to ask someone close to check your mouth odor as it can be challenging to assess it yourself.

How Is Halitosis Diagnosed?

A general dentist will often smell the breath of someone with suspected halitosis and rate it on a six-point intensity scale. 

The dentist may scrape the back of the tongue and check the scrapings for smell, as this area can typically be a source of the odor.

Several sophisticated detectors can rate the smell more accurately. They include:

• Halimeter ⁠— This picks up low levels of sulfur.
• Gas chromatography ⁠— This test assesses three sulfur compounds, which are hydrogen sulfide, methyl mercaptan, and dimethyl sulfide.
• BANA test ⁠— This measures levels of a certain enzyme created by halitosis-causing bacteria.
• Beta-galactosidase test ⁠— This test checks levels of the enzyme beta-galactosidase, which is linked to bad mouth odor.

If the dentist cannot determine the cause of the bad breath, they will refer you to a specialist.

Summary

• Halitosis is characterized by bad breath, but it’s different from morning breath, which vanishes with regular oral care.
• There are various possible causes of halitosis, and identifying its cause can help you receive the right treatment.
• Professional treatments, home remedies, and preventing bad breath will help you manage halitosis and its symptoms.
• Visit your dentist regularly to maintain oral health and prevent bad breath.