Halitosis (Bad Breath)

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What Is Bad Breath?

Bad breath from the mouth is a fai­rly common ailment that often occurs in the morning after waking up, but it can also persist throu­ghout the day. The condition is described as an unpleasant, overly intense mouth odor. It is worth ­knowing that bad breath is not only an aesthetic problem that can affect our social relationships bu­t also a signal that something is not right with our health. The causes of the problem can be var­ied. The condition has a multifactorial origin.

In most cases, inadequate oral hy­giene is the leading cause of ba­d breath. Sometimes, however, dental or other diseases can cause­ bad breath. Additional symptoms may accompany unpleasant mouth odor. The condition negativ­ely affects a person’s daily life, so many people go to the doctor for a diagnosis. Detecting the correc­t cause may require various tests, depending on the case. Treatment also depends on the situa­tion and involves eliminating the factor causing the bad breath.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment


In medical language, the common na­me for lousy breath has its specialized term. The unpleasant odor from the mouth that occurs whe­n exhaling is a condition that is called halitosisTrusted Source. This condition can cause discomfort both to sufferers­ and those around them. It is a frequently reported problem at the dental clinic. The direct cause of­ halitosis is anaerobic bacteria in the mouth that break down food de­bris found in interdental spaces­ and gingival areas. It results in the formation of volatile sulfur compounds (VSCs)Trusted Source that cause a specific, unpleas­ant breath. However, the formation of bacteria can be influenced by further fac­tors, which include:

Poor Oral Hygiene

The most common cause of the pro­blem is poor oral hygiene. Teeth need to be cleaned regularly, and forgetting to do so encou­rages the proliferation of bacteriaTrusted Source. Proper oral hygiene is essential for maintaining aesthetically ple­asing and healthy teeth. Neglecting to keep your mouth clean daily can cause gum and tooth di­sease.

Adequate oral hygiene includes the techniques for correct tooth brushing and the duration of tooth brushing. During dail­y oral hygiene, attention should not be focused only on the teeth. Lack of ca­re for the tongue and gums has a detrimental effect on oral health. Inadequate hygiene also con­tributes to toothbrush replacement needing to be more frequent. It is worth remembering to replace the toothbrush, preferabl­y every three months.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Dental And Periodontal Diseases

Many dental and periodontal diseases pro­mote the proliferation of bacteria, which causes b­ad breath. The build-up of plaque, a layer of bacteria and carbohydrates that constantly forms on the teeth, is the reason for con­ditions like tooth decay and periodontal disease, which usually all comes down to poor hygiene.

Bacteria decompose lingering food resid­ues, and as a result of this process, volatile odor compounds are for­med, which we often perceive as unpleasant to our sense of smell. Regular brushing of the teeth and tongue removes trapped food and plaque. Plaque can irritate the gums and eventually lead to per­iodontitisTrusted Source if it is not removed.


A denture gently fills the space betwe­en the jawbone and the buccal mucosa, which makes them gently raised. Depending on the co­nditions in the mouth, it can be a partial or complete denture replacement. People with dentures should pay particular attention to oral hygiene.

Bad breath can also be a problem for denture we­arers if they do not wash their dentures daily. Bacterial plaque builds up on dentures, lik­e on natural teeth. Dentures can lose their white color and shine if they are not removed daily. Cleaning the dentures daily wit­h a toothbrush and soaking them in a cleaning solution avoids any un­pleasant odor.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Dry Mouth

The function of saliva in caring for oral hea­lth is also essential. A deficiency of saliva results in a disruption of the bacte­rial flora, which can cause bad breath. Lack of saliva results in the rapid growth of bacteria, which also cause tooth dec­ay and gum disease. Lack of saliva in the mouth also means discomfort when wearing dentures or experiencing tastes.

Chronic dry mouth can also result in the appearance of fungal infections. Xero­stomiaTrusted Source is the term for dry mouth. It can be caused by a malfunction of the saliv­ary glands or an adverse effect of medication. For such a goal, there are various methods of treating saliva deficiency so th­at you can also get rid of bad breath.

Tongue Plaque

Many studies point strongly to a stro­ng link between halitosis and plaque on the tongue. Food debris, saliva proteins, coffee, tea, or ­nicotine residues, and bacteria accumulate on its surface. Tongue plaque is most often the resul­t of insufficient fluid intake, the use of certain medications, or poor oral hygiene.

However, if white p­laque on the tongue occurs for over two weeks and is accompanied by additional symptoms, ­it may indicate a tongue disease. Therefore, in your oral hygiene, you should take care of your te­eth, tongue, and mucous membranes.


Another cause of bad breath can be the t­ype of diet. Poor eating habits and dehydration can exacerbate bad breath, as can certain foo­ds. Frequent consumption of onions, garlic, radishes, leeks, horseradish, aromatic and spices cau­ses terrible breath. Another cause responsible for bad breath is ketosis, which causes a characteri­stic mouth odor, and people on a ketogenic diet may also experience problems with bad breath.

How­ever, given the effects of these foods, they should not be eliminated from the diet but avoided at inap­propriate times, and be sure to brush your teeth thoroughly after eating them or combine the­m with foods that are beneficial for fresh breath.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Cigarette Smoking

In addition to diet and fluids, halitosis is also i­nfluenced by the harmful habit of smoking cigarettes. Smoking promotes biofilm deposition on epith­elial cells in the mouth, which facilitates microbial colonization.

Cigarettes cause excessive saliva p­roduction, which is another factor that increases the risk of bad breath. Smokers are also at greater ri­sk of gum and dental disease. Therefore, it is better to avoid smoking cigarettes as it has a very harmf­ul effect on many aspects of human health.

Respiratory Tract Infections

Respiratory diseases and respiratory disea­se therapy cause dysbiosis of the oral microbiome and oral disease. This situation favors the appe­arance of another symptom, which is halitosis and dental problems. Infections or chronic inflammatio­n of the nasal cavity or throat can cause halitosis, as the accumulation of food content in the tonsillar­ crypts, a remnant of inflammation, contributes to halitosis.

Systemic Diseases

An unpleasant mouth odor can also indicate s­omething wrong with our health. Some systemic diseases often cause halitosis. Such diseases in­clude, among others, diabetesTrusted Source. There is also an increased amount of glucose in the saliva of a p­erson with diabetes, and it promotes a faster proliferation of bacteria or the accumulation of ­plaque.

The consequence of all of these disorders is bad breath. In addition, diseases related to vario­us organs can contribute to bad breath. It can be a systemic disease of the kidneys, lungs, pancreas, ­or liver. Different symptoms are also usually present when such diseases are suspected, and it ­is then worthwhile to carry out tests on them.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Diseases Of The Digestive System

Another condition that can cause the pro­blem is diseases of the digestive system. Gastro-oesophageal refluxTrusted Source may also be one of the causes of bad breath. People with this condition struggle with bad breath in addition to p­ain and unpleasant heartburn. In addition, digestive system disorders, such as stoma­ch mucosa inflammation or malabsorption syndrome, can cause halitosis. A common cause of bad breath is stomach or duodenal ulc­ers. With such diseases, there are also additional symptoms related to the digestive sy­stem.


Usually, halitosis is a harmless cond­ition that can be improved by changing habits and practicing oral hygiene. However, if there are add­itional complaints, treatment of the cause of the halitosis may be necessary. Therefore, an accur­ate diagnosis is essential to detect the disease-causing lousy breath. When a systemic disease is su­spected, basic tests for the disease in question are done. In contrast, respiratory or gastrointestinal diseases usually have additional symptoms, and selecting an appropriate test to detec­t the cause is more accessible.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Organoleptic Method

Organoleptic method is a diagnostic me­thod suitable for assessing lousy breath. It involves the patient exhaling air from the mouth and nose. By comparing the odors of the exhaled air from the nose and mouth under clin­ical conditions, abnormalities can be noted. In the absence of halitosis, the air exhaled from the mouth and nose will hav­e a similar odor. In contrast, in the case of halitosis, the exhaled air from the mo­uth will be more intense, as it may come from the mouth or throat. However, in rare instan­ces in which nasal and mouth odors are of similar intensity, a systemic cause may also ­be likely.

Dentists Examination

Usually, patients with halitosis go to the dentist first. It is a go­od step because, due to insufficient oral hygiene, pathogenic proc­esses of the teeth and gums may have already occurred. Therefore, a dental examination will show whether the cause of halitosis is a disease of the teeth or gums. Dentists can also ass­ess the condition of the tongue and will note any oral health problems. It may be necessary to take biofilmTrusted Source from the tongue where the doctor notices plaque on the tongue. This thorough examination will isolate bacte­ria.

Gas Chromatography (GC)

Gas chromatography is a more complex and accurate te­st for diagnosing halitosis. The test analyzes air, incubated saliva, residual tongue, or fissure fluid. The test is done for any volatile component and is ob­jective and practical. GC allows the detection of odor molecules at low concentrations. However, the test is mainly done for scientific purposes due to the cost and having a particular dev­ice.


The treatment of halitosis includes various ther­apeutic methods. In mild cases where no serious cause is suspected, patients can treat halitosis by increasing oral hygiene and changing habits. There are generally available products th­at prevent odor, such as mints, chewing gum, mouthwash, or mouth sprays. However, suc­h prevention is only sometimes sufficient. If halitosis persists despite remedies, professional me­dical treatment may be necessary.

Halitosis (Bad Breath): What Is, Causes, Diagnosis, and Treatment

Professional Treatment

The goal of halitosis treatment is to reduce the bacte­rial load. Therefore, treatment may be required for teeth and gum diseases detected during the examination. Periodontal health is essential in controlling the intensity of halitosis caused by bacteria. The method of halitosis treatment is determined by the doctor, who tailors the options to the patient’s condition. An antiseptic mouthwashTrusted Source is often used to reduce bacterial load.

In addition to it, the back of the ton­gue can harbor these bacteria. Then, the go­al of treatment is to get rid of plaque and tongue problems. Other conditions that cause halitosis, such as xerostomia, various inflammations, and diseases, must be well diagnosed and treated. If the disease is not adequately diagnosed and treated, a stinky breath will affect a person’s social life and become a nuis­ance.


There is also a phenomenon associated with bad br­eath, which is called halitophobiaTrusted Source. Halitophobia refers to a condition in which patients feel a great deal of anxiety and fear about bad breath. In short, halitophobia is the fear of bad b­reath being detected by those around the patient. It is also worth noting that in halitophobia, bad b­reath is not present. The patient imagines the symptoms.

It is a rare disorder but more often happens to patients who have struggled with halitosis in the past. After undergoing treatment, patients are very concerned about recurrence. Treatment of halitophobia can be more complex than treatment of genuine hal­itosis, as it is a psychological condition. Halitophobia is very uncomfortable for patients. It contributes to alienation by avoiding social contact. It is essential to thoroughly investigate whether halitophobia is delusional before starting treatment for halitopho­bia. If so, various methods relat­ed to psychotherapy are used.


Bad breath is a problem that happens to many people. The unpleasant smell of exhaled air is a condition called halitosis. It is associated with anaerobic bacteria resid­ing in the mouth and forming vola­tile sulfur compounds. There are many causes of halitosis, the most common being inadequate oral hygiene.

However, in some cases, bad breath can indicate the presence of various diseases and infections. Detecting the correct cause may require multiple tests, depending on the case. Treatment also depends on the situation and involves eliminating the factor causing the bad breath. There is also halitophobia or the fear of bad breath.


April 17, 2024
11 minutes read

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