Bad Breath (Halitosis)

 

Bad breath is a common problem that can affect anyone at any age.  About one in four people are thought to have bad breath (halitosis) on a regular basis

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Causes

There are a number of possible causes of bad breath (halitosis):

Poor oral hygiene

The most common cause of bad breath is poor oral hygiene. Bacteria that build up on your teeth – particularly between them – as well as your tongue and gums, can produce unpleasant-smelling gases. These bacteria are also responsible for gum disease and tooth decay

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Food and drink

Eating strongly flavoured foods, such as garlic, onions and spices, is likely to make your breath smell. Strong-smelling drinks, such as coffee and alcohol, can also cause bad breath.  Bad breath caused by food and drink is usually temporary. It can be avoided by not eating or drinking these types of food and drink too often. Good dental hygiene will also help

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Smoking

Smoking is another cause of bad breath. As well as making your breath smell, smoking stains your teeth, irritates your gums, and reduces your sense of taste.  It can also significantly affect the development of gum disease, another major cause of bad breath. Stopping smoking will lower your risk of gum disease and help prevent bad breath

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Crash dieting

Crash dieting, fasting, and low-carbohydrate diets are another possible cause of bad breath. They cause the body to break down fat, which produces chemicals called ketones that can be smelled on your breath

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Medication

Some types of medication can also cause bad breath. These include:

  • nitrates – these are sometimes used to treat angina, chest pain caused by a restriction in the blood supply to the heart
  • some chemotherapy medication
  • tranquillisers (phenothiazines)

Alternative medications may be recommended

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Medical conditions

In rare cases, bad breath can be caused by certain medical conditions. In dry mouth (xerostomia), the flow and composition of saliva may be affected

In some cases, gastrointestinal conditions can also cause bad breath. For example, a bacterial infection of the stomach lining and small intestine (H. pylori infection) and gastro-oesophageal reflux disease (GORD) have been linked to bad breath.  If a gastrointestinal condition is thought to be causing your bad breath, you may need to have an endoscopy

Other medical conditions that can cause bad breath include diabetes and lung, throat, or nose infections – for example, bronchiectasis, bronchitis, tonsillitis, and sinusitis

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Treatment and prevention

NOTE Treatment for bad breath (halitosis) will depend on its cause.  Usually, the most effective treatment is improving dental hygiene

Fresh breath tips

To help keep breath fresh, patients should:

  • give up smoking
  • eat a healthy, balanced diet and avoid eating strongly flavoured or spicy food
  • cut down on sugary food and drink as it can increase the amount of bacteria in your mouth
  • reduce your alcohol consumption
  • cut down on coffee
  • drink plenty of water to help prevent your mouth becoming dry
  • chew sugar-free gum after eating to stimulate the flow of saliva – this will help clean away any remaining food particles

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Gastrointestinal problems

Bad breath can be caused by a gastrointestinal problem, such as an H. pylori infection or gastro-oesophageal reflux disease (GORD).  A referral to a gastroenterologist may be required

The treatment recommended will depend on the type of gastrointestinal condition: a stomach ulcer may require a combination of two or three different antibiotics and a proton pump inhibitor (PPI) - eradication therapy

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Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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