What’s the deal with my bad breath?

1) Dear Alice,

I often have a bad taste in my mouth, and bad breath as well, I assume. This doesn't stem from poor hygiene: I brush my teeth at least three times a day, and usually more. I'm wondering if there is anything I can do about this. Could this be a symptom of some sort of nutritional deficiency? I think my diet is pretty bad, although I'm working pretty hard on getting more protein and eating less fat. I've also been nauseous a lot lately, and vomiting some. Could that be related?

Stinky Breath

2) 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 Stinky Breath and Evil Breath, 

Bad breath, or halitosis, is usually defined by an unpleasant odor that comes out of someone’s mouth, one that might be socially unacceptable or cause embarrassment. But you’re not alone—it’s estimated that about half of the adult population experiences bad breath. It’s also a common reason that people look for dental services. Keeping up with oral hygiene practices like proper teeth brushing or using tongue scrapers can be helpful in reducing bad breath. Other conditions such as tooth or gum concerns, oral ulcers, or teeth modifying devices (to name just a few) could be related to your bad breath, too. Read on to learn more! 

Halitosis can be rooted in a number of causes. Proper or real halitosis is caused by poor oral hygiene or compounds that form inside or outside of the mouth. Some of the factors that could affect your breath include poor oral health and hygiene, tongue coating (a film of bacteria or other compounds on your tongue), tooth decay and gum disease (periodontitis, gingivitis, or cavities). Additionally, oral ulcers or cancers, saliva with low flow or high viscosity, or use of dentures and orthodontic devices that aren't cleaned properly may also be contributing factors. Evil Breath, you mentioned volatile sulfur compounds (VSCs)—these produce the ‘morning breath’ people may have when waking up. VSCs are associated with tooth decay, gum disease, and leftover food or debris in the mouth and may contribute to bad breath. 

However, not all factors that cause halitosis occur inside the mouth. Some of the external factors include inflammatory bowel disease, allergic rhinitis (runny nose), peptic ulcers or Helicobacter pylori infections, hepatitis B infection, kidney problems, and gastroesophageal reflux disease (GERD). It can also be caused by consuming smelly foods or smoking tobacco. On the other hand, volatile organic compounds (VOCs) also cause bad breath, but they're caused by other conditions like chronic infections. The main distinction here is that external factors for halitosis are due to other symptoms that produce VOCs, such as feeling nauseous due to inflamed bowels which leads to vomiting and bad breath. In these cases, taking care of your teeth and mouth wouldn’t do anything to fix your halitosis since oral hygiene isn’t the reason for the smell. 

In addition to proper or real halitosis, some people may experience pseudohalitosis or halitophobia. These are mental health situations in which a person is convinced that their bad breath is real, that treatment didn't work, or that it's worse than it actually is. For those who are experiencing pseudohalitosis or halitophobia, they may find that working with a mental health professional is helpful in easing some of their stress.  

So, what can be done about bad breath? For halitosis causes that are inside of the mouth, you may consider: 

  • Maintaining good oral hygiene practices like brushing your teeth and flossing daily to prevent cavities, gum disease, and tooth decay 
  • Using mouthwash, brushing or scraping your tongue, or doing a combination of the two to get rid of tongue coating or compounds in your mouth 
  • Consuming foods with probiotics in them to build up some “good” bacteria, which might reduce the amount of VSCs produced 

And of course, it may be helpful to speak with a health care or dental care provider if halitosis is causing you distress or impacting your daily life. If trying to maintain good oral health isn’t working, it could be possible that another condition or extra-oral factor is the culprit. Figuring out the root causes or symptoms that are leading to bad breath might require some trial-and-error. Talking through various treatment options or speaking to professionals about your concerns will hopefully help.

Best of luck on the path towards fresh breath! 

Last updated Dec 08, 2023
Originally published Nov 30, 1994

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