Symptoms & Causes
There are many causes of halitosis, the most well-known being tooth decay and gum disease, both the result of poor oral hygiene. However, there are numerous other causes for halitosis, many of which are often overlooked or contrary to popular belief. For example, a more common, but less known cause, is the coating on the tongue that creates an oxygen-free environment for anaerobic bacteria.
When the surface of the tongue becomes coated with mucous and/or a layer of bacteria, halitosis often ensues. It is not usually the coating itself that causes the problem, rather the oxygen-free environment it creates beneath on the surface of the tongue. This type of coating allows anaerobic bacteria to thrive and produce plenty of VSCs that diffuse up through the mucous layer and are noticed by others upon whom we exhale.
There are several factors that may contribute to a coating build-up. They, along with other significant sources for halitosis, are discussed below.
Xerostomia
Xerostomia, or dry mouth, is a major cause of halitosis. At least one third of adults in the United States suffers from this condition.
Xerostomia, or dry mouth, is a major cause of halitosis. At least one third of adults in the United States suffers from this condition.
While you may not realize it, saliva is a natural and effective mouthwash. It helps maintain pH levels, washes away debris, and introduces more oxygen to the tissue surfaces in your mouth, all of which help to control anaerobic bacteria. (A normal healthy mouth will produce 4 to 6 cups of saliva a day.) Less saliva means a drier mouth, ideal for halitosis to occur. Xerostomia is not unlike a stagnant beach at low tide -- with less water and greater exposed surface area, odors and VSCs become concentrated and evaporate more easily, to be exhaled into the air around us.
Xerostomia results from a number of factors, including many mouthwashes, medications (including diuretics, or water pills), dieting, dehydration, menses, age, and stress. Those who breathe through their mouths, such as public speakers, are often prone to dry mouth and halitosis. However, what we often call "morning breath" is not true halitosis, since it usually disappears once we brush our teeth and go about our daily lives. It's a result of decreased saliva flow from the salivary glands that occurs when we sleep, and can be worse in sleepers who breathe through their mouths.
Contrary to popular belief, overbrushing can contribute to temporary bad breath because it too dries out the mouth. Unfortunately, toothbrushes can't reach all the crevices where anaerobic bacteria nestle, and excessive brushing can wear away tooth enamel and irritate gum tissues.
The easiest preventive method for combating dry mouth is to drink plenty of water. This moistens your mouth and prevents overall dehydration.
Mouthwash
Despite the enormous mouthwash industry and OTC products available, most mouthwashes are not effective in treating halitosis. They simply mask the problem temporarily and can contain up to 30% alcohol. Alcohol is a drying agent, so frequent use only increases dry mouth. And that tingling feeling you experience? It's your cells in pain. Plus, the 99% of bacteria killed don't include the ones producing the smelly gases you're trying to target.
In addition, there is now medical concern that frequent, long-term use of alcohol-containing mouthwashes may actually lead to increased cases of oral cancer. Ask us about non-alcohol-based mouthwashes and rinses.
Medications
Some medications for high-blood pressure and depression, as well as antihistimines for allergies, also produce dry mouth. For example, diuretics dry out your system. Some people experience a dry, cottony feeling in their mouths, while others have a sour, bitter, or metallic taste. As with all medicines, speak with your physician before you make any changes to your medications.
Additionally, it is not a good idea to take antibiotic capsules, pills, or injections as a means of controlling halitosis. This has never been shown to be successful. However, in a situation where halitosis is wholly or in part caused by periodontal (gum) disease, the use of certain antibiotics designed to be specifically delivered into infected gum tissues may be part of an effective treatment regimen (as well as being an effective non-surgical option for treatment of gum disease).
Smoking and Tobacco
Besides the obvious damages cited by the Surgeon General that smoking and smokeless tobacco cause, these substances also contribute to halitosis. Smoking stains and deposits toxins on oral surfaces, dries out membranes, and changes the mouth's natural pH. Mixed with other oral odors, those from smoking can create a particularly potent and offensive combination.
Smokeless tobacco is also harmful, containing carcinogens that can lead to oral cancer. Like smoking, smokeless tobacco also stains the teeth and dries out the mouth. Plus, it contains a high sugar content, which helps feed odor-causing bacteria.
In addition, tobacco products damage the small blood vessels in the oral tissues, inhibiting healthy blood flow and nutrients going to the gums. Damaged gum tissue cannot repair itself effectively, and this can create a breeding ground for bacteria.
Allergies and Post-Nasal Drip
Allergies can bring about halitosis when the slow drip from the nasal sinus cavities leads to a build up of mucous in the back of the throat. This mucous contains large amounts of bacteria, living and dead, plus other proteins and substances. The living bacteria break down these proteins into amino acids, creating and releasing VSCs.
Many people are not even aware they have mild allergies, even though the steady sinus drainage causes frequent clearing of their throats. More obvious is the mucous and phlegm build up from colds and flus. In these instances, individuals who normally do not have chronic halitosis may experience a temporary onset during their illness.
Dental Appliances, Fillings, and other Prosthetics
Ill-fitting and poorly maintained restorations and dentures can contribute to halitosis. Just as poor oral hygiene means the presence of more gram negative bacteria, so does failure to clean dentures properly. Bacteria on dentures generate volatile organic compounds (VOCs), which are also offensive. Loose fittings can also result in abrasions, tissue swelling, and infections, all leading to increased bacterial growth.
Poor Oral Hygiene
Clearly, poor oral hygiene is often a major factor when it comes to halitosis. Failure to brush properly or floss means that food particles remain in the mouth and ferment, feeding and leading to the build up of bacteria. Plaque -- that soft whitish filmy debris that gathers on your teeth -- is 95% living bacteria. It's been cited that plaque-forming streptococci counts on the tongue have been shown to increase by as much as ten times after just a few days of not cleaning the tongue.
Poor oral hygiene can lead to dental decay and gum disease, increasing chances for halitosis from bacteria around teeth and hiding in unhealthy gums. Mechanical removal of debris and bacteria will significantly treat and prevent gingivitis and advanced periodontal disease, both significant contributors to bad breath.
You can test your gums by rubbing a finger against your gumline. If your finger smells, then you smell. The same goes for flossing (use unscented for more accurate detection). If the pasty substance on your dental floss smells bad, pay special attention to those areas of the teeth.
Hormones
Women may experience an increase in or greater chance of halitosis during their menstrual cycle or pregnancy. Hormonal changes cause tissue swelling throughout the body, which can lead to sloughing of tissue, including that in the mouth. Not only do swollen gums offer more hiding areas for bacteria, the extra tissue protein that comes off into the saliva means more material for bacteria to feed on. Hence, more VSCs.
Foods
Foods such as dairy products, coffee, wine, and other alcoholic beverages can exacerbate halitosis. While intaking them can immediately induce an unpleasant breath, this food odor is relatively transitory.
More significant is the fact that cheese and other dairy products increase or thicken mucous build-up, thereby creating a more anaerobic environment for gram negative bacteria. Plus, the amino acids in dairy -- even soy -- proteins is full of sulfur, the major component of VSCs.
Like alcohol, coffee and other caffeinated drinks are diuretics; they dry out the mouth and raise its acidity level. This lower pH environment promotes increased bacterial reproduction.
Coffee and other alcoholic beverages, including wine, also leave an odor-causing residue that adheres to the plaque in your mouth. Plus, the acid in these beverages can erode the enamel on your teeth, and long-term exposure can lead to possible tooth decay. One professional wine taster had nothing left in some of his teeth except posts after years of repeated exposure to the acids in wine.
Tonsilloliths
Although not a common source for halitosis, tonsils can generate evil-smelling substances called tonsilloliths, or tonsil stones.
The surface of the tonsil has little indentations that can trap food debris, dead cells and bacteria, and bodily secretions. In time, this matter can turn into a white, mushy, or even stone-like substance with a truly noxious odor. Usually we swallow these nodules without even knowing it. But sometimes these particles are dislodged and coughed up and we become aware of their awful taste and smell.
While disgusting, the stench from these particles is really only noticeable when placed close to the nose. However, there have been people who believed tonsilloliths were the cause of their halitosis and had their tonsils removed surgically. This is not recommended, and the procedure can be dangerous and unnecessary. In severe cases, an oral hydro-irrigator can flush out these particles from the crypts in the tonsils and help alleviate the problem.
Illness and Disease
In certain instances, bad breath is a symptom of a much more serious, non-oral medical disorder.
For example, a "sweet fruity smell" can be an indication of diabetes, while a fishy smell may be associated with kidney failure. In addition, breath odor can be a result of respiratory infection, sinusitis, liver disorder, or gastrointestinal imbalance. If these odors are not dental in origin, you should consult your doctor.
Genetics
It is not believed that a person inherits odor-causing bacteria. What is possible is that some people may have longer papillae (taste buds), those little fingers that form the surface of the tongue. In these cases, bacteria stand a better chance of hiding deep down and it may be more difficult to dislodge them. Using a tongue scraper more frequently, combined with rinsing and brushing, may help alleviate the problem by removing bacteria-laden mucous and allowing antibacterial mouthrinses to penetrate deeper.
Foreign Objects
Yes, there are reported cases whereby foreign objects lodged in the nasal cavity have caused odors to emanate from the nose and even from the pores. Usually these small objects -- a pea, a bead, toilet paper, etc. -- were introduced at an earlier age when the child liked to shove things up his/her nose.
If not removed, organic objects can absorb moisture and other substances, leading to bacterial proliferation and putrification. With a clogged nasal passage, trapped odors can be absorbed through the tissues and eventually released from other parts of the body. Non-organic objects that stay lodged may calcify over time and not make their presence known until years later.
In these cases, the odor that seemingly originates from the oral area is not true halitosis in nature and usually disappears once the object is removed.
