More on bad breath (halitosis)

Dear Alice,

Like many people, I often have an embarrassing bad breath. Listerine and other mouthwashes won't be of any help for this chronic problem. There are lots of products available to get rid of "volatile sulfur compounds (VSC)" - that supposedly cause this — and I just don't know which one I should try. Also, what's your opinion on tongue-brushing?


Evil Breath

Dear Evil Breath, 

As you’ve surmised, you’re in the same boat as millions of Americans who deal with bad breath, which is also called halitosis. For this common problem, countless breath freshening products exist, such as mouthwash, toothbrushes, dental floss, and tongue scrapers. However, some of these may only temporarily mask odors instead of resolving the true cause of chronic bad breath. So, aside from mouthwash, what are other effective alternatives? The solution to your situation may depend on the source of your bad breath. Potential causes could include: 

  • General dental hygiene affects the mouth's environment. The mouth offers a moist, dark, and warm place for bacteria to thrive. Some of these mouth-residing bacteria react with sulfur-containing proteins in the mouth. In turn, these proteins help generate the release of volatile sulfur compounds (VSCs), which are gases that smell like rotten eggs. A thorough dental hygiene routine may help get rid of these odor-causing bacteria. 
  • Various foods, such as garlic and onions, are absorbed into the bloodstream after digestion and can enter the lungs from there, which may result in smelly breath odors when exhaling. This is different from odors from burps, which come from the stomach and are usually fleeting. If this sounds like it rings true for you, you might consider experimenting with avoiding these foods to determine whether they’re the culprits behind your bad breath. 
  • Tobacco use may result in short-term, foul mouth odors. Smoking or chewing tobacco not only causes your mouth to smell of tobacco, but it also can dry out the oral lining, causing stinky breath. If you’re a current smoker or tobacco user, quitting may improve your breath and overall health. 
  • Dry mouth (xerostomia) may also contribute to the development of bad breath. Dry mouth can be caused by certain medications, breathing predominantly through the mouth, salivary gland problems, or not drinking enough fluids. 
  • Various dental conditions, such as advanced periodontal disease, gum disease, and cavities, may cause persistent bad breath. If any of these are an issue for you, your dentist may have more information about potential treatment options.  
  • Certain medical conditions, such as liver and kidney disease, diabetes mellitus, postnasal drip, and respiratory and sinus infections may cause bad breath. If you think these could be a contributor to your situation, you might want to chat with a health care provider. 

If you'd like to stick with mouthwash, it may be worthwhile to try gargling a few more types to see if any of them help. Aside from antibacterial and antiseptic mouthwashes, there are other options such as fluoride rinses or breath-freshening rinses. These don’t contain as much alcohol as classic antiseptic mouthwashes and may be gentler for your mouth. 

Additionally, there is emerging research about the effects of the oral microbiome — the colonies of friendly bacteria, viruses, and fungi that live inside your mouth and contribute to your body’s healthy functioning — on oral health and bad breath. A healthy microbiome is comprised of many different types of microbes, all keeping each other in check so no one species can grow too much and start causing problems. One theory posits that bad breath may be caused by a disturbance in the oral microbiome, when the “good” bacteria get killed off and the “bad” bacteria that cause smelly breath overgrow. Researchers are currently investigating whether treatments to improve the balance of the oral microbiome, such as the use of probiotics or discontinuing use of harsh antibacterial mouthwashes (which kill both the “good” and “bad” microbes), could improve bad breath; there’s no conclusive answer yet, but early research looks promising. Until then, following the official guidance from dental professionals and keeping an eye out for emerging research can help you on your way to fresh breath.  

Hopefully these tips can help you to stop holding your breath and breathe a little easier. However, if a new mouthwash or any of these tips don’t tame the oral odor, consulting with a dental care provider may be your best bet. For more, check out the American Dental Association's Mouth Healthy information on bad breath and the National Institutes of Health's Dental Health resources. 

Here's to staying fresh, 

Last updated Sep 17, 2021
Originally published May 23, 1997

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