Bad breath

Bad breath, sometimes known as halitosis, is a common problem. In most cases, it is caused by a build up of bacteria in the mouth, as a result of food debris, plaque, or gum disease.

It can be difficult to realise that you have bad breath. Bad breath tends to be noticed by other people first, and it may be difficult for them to tell you that you have it without embarrassing them or you. You may therefore have to rely on a close friend or family member to tell you that you have bad breath.

It is difficult to know just how common the problem of bad breath is, but it has been estimated that it affects up to 50% of us at some point during our lives. Bad breath often occurs after eating strongly flavoured foods, such as onions and garlic. Smoking and drinking a lot of alcohol can also cause your breath to smell unpleasant. However, using good dental hygiene practices can usually prevent bad breath.

There are a number of different causes of bad breath which are outlined below:

Poor dental hygiene

The most common cause of bad breath (90% of cases) is poor dental hygiene. Naturally occurring bacteria in your mouth breaks down food particles and proteins. As the bacteria breaks down the food and proteins, a smelly gas is released. Sometimes, food that is trapped between your teeth can rot and contain bacteria, causing bad breath. However, regular brushing and flossing will help prevent this.

Bad breath can also be caused if you have plaque on your teeth, or gum disease. Plaque is a soft, white deposit that forms on the surface of the teeth when bacteria combine with food and saliva. Gum disease varies in severity from mild to severe, and involves the tissues surrounding your teeth becoming inflamed or infected.

Occasionally, some people develop a bacterial coating on the back of their tongue, and this can cause bad breath.

Morning bad breath

Most people find that their breath smells bad after waking up in the morning. This is normal and occurs because the mouth dries up overnight, and the flow of saliva that washes away food particles slows down when we are asleep. Bacteria quickly break down any food residue, in the mouth, and an unpleasant, stale smell is released. However, the flow of saliva usually increases once you start eating.

Food and drink

Strongly flavoured foods, such as garlic, onion and spices often cause your breath to smell after you have eaten food containing them. Strong smelling drinks, such as alcohol and coffee, can also cause bad breath. However, this type of bad breath is usually temporary and can be easily avoided by not eating or drinking these foods or drinks.

Medicines

Sometimes, certain medications can cause bad breath. You should discuss possible alternatives with your GP.

Smoking

If you smoke, your breath is likely to smell of stale smoke. Smoking also increases your risk of getting gum disease which, is another cause of bad breath. Stopping smoking will lower this risk and prevent smoke-related bad breath.

Medical causes

Medical causes of bad breath are rare (about 10%), but they can occur. If you have a throat or tonsil infection, the catarrh that is produced can cause bad breath. Other conditions that may also cause bad breath include:

- dry mouth (xerostomia) - a condition that affects the flow of saliva and leads to a build up of bacteria in the mouth,
- infections of the throat, nose and lungs such as bronchitis or sinusitis,
- diabetes,
- liver or kidney problems,
- gastritis and food reflux, and
- low carbohydrate diets, such as the Atkins diet.

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The easiest way to find out if you have bad breath is to ask a close and trusted friend, or family member, for their honest opinion.

Bad breath is usually caused by a problem in the mouth, so you need to visit your dentist for a diagnosis. You should not try to mask the smell before visiting your dentist, as this will make it more difficult to find out what is causing the problem.

If bad breath is being caused by food decay in the mouth, your dentist will normally treat this straightaway. They will also give you advice about how to keep your teeth and gums healthy, and recommend regular dental check-ups to help spot signs of tooth and gum decay early on.

If bad breath is not caused by a problem in the mouth, you may be referred to a clinic specialising in breath odour, a dental hygienist, or your GP, for further investigation.

Treating bad breath will depend on what is causing it. The simplest and most effective treatment is usually to improve your dental hygiene. To avoid bad breath, you need to keep your mouth and teeth clean by regularly brushing and flossing.

Your dentist is likely to recommend that you brush your teeth at least twice a day using toothpaste containing fluoride. Choose a small to medium sized toothbrush, with soft, multi tufted, nylon bristles, and replace it every 3-4 months. You should spend a minimum of two minutes brushing your teeth, and should ensure that you cover all areas, paying particular attention to where the teeth meet the gum. Use a separate toothbrush, or tongue scraper, to lightly brush your tongue, and dental floss to clean between your teeth and remove any trapped food that could cause tooth decay.

Your dentist may also suggest daily rinsing with an anti-bacterial or anti-odour mouthwash. This should not replace brushing your teeth, but should be incorporated into your complete oral hygiene routine. Avoid brushing your teeth for 30 minutes after drinking an acidic drink, such as fruit juice, or eating acidic fruit, such as oranges. This will help to prevent tooth erosion.

If you wear dentures, take them out at night to give your mouth chance to rest. Avoid cleaning them with toothpaste, which will scratch the surface and cause stains to build up. Clean them thoroughly with soap and lukewarm water, a denture cream or a denture-cleaning tablet. Use a separate toothbrush to clean your dentures.

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As well as maintaining a high level of oral and dental hygiene, the following measures can also help prevent bad breath:

- eating a healthy, balanced diet, and cutting down on strongly flavoured or spicy food,
- reducing your alcohol intake,
- stopping smoking,
- using a tongue cleaner to clean right to the back of your tongue,
- using an anti-sceptic mouthwash (just before bedtime) as recommended by your dentist or pharmacist,
- drinking plenty of fluids, and cutting down on coffee,
- cleaning your mouth after eating milk products, fish and meat,
- chewing sugar-free gum after eating, and if your mouth feels dry,
- avoiding sugary snacks between meals which increase the number of bacteria in your mouth, and
- regularly visiting your dentist and having your teeth professionally cleaned, as required. NHSDEC07