Bad Breath: What Causes and How To Manage Halitosis

What is halitosis

This is a medical condition in which an individual finds his or her mouth constantly having a bad odour. This is common with people who have poor oral hygiene. However, there are some people who despite having or practicing good oral hygiene still suffer halitosis.

The causes of halitosis are divided into four main points:

  • Habits (eg: Poor oral hygiene)
  • Medical conditions
  • Certain foods or chemicals taken into the body
  • Genetics

What are the causes of bad breath (halitosis)?

What are the causes of bad breath – Halitosis

1. Not brushing regularly

The commonest cause of bad breath or halitosis is not brushing your teeth regularly or not keeping a good oral hygiene. Brushing of teeth helps you remove debris or food particles trapped in between your teeth.

This means that when you don’t brush your teeth these debris will linger in between your teeth. Bacteria therefore act on these food particles leading to decay and production of foul odour that exudes from your mouth.

2. Gum disease and cavities in the teeth

The bacteria that feed on food particles left in your mouth thus causing bad breath, also create cavities in the teeth where they lodge. In other words, cavities will serve as a hiding place or a breeding ground for these bacteria. 

These bacteria also cause gum diseases which create deep pockets in the gum where they lodge and cause more damage to the gum.

3. Drinking or eating strong-smelling foods and drinks

Foods like onions, garlic and others with very strong odors can be a cause of bad breath. Your stomach absorbs oils from such foods during the digestion process and these oils come along with peculiar scents. These oils with peculiar scents circulate through your blood, get to your lungs and become a part of your breath where they can freely escape through your mouth. 

Garlic and onions also contain sulfur compounds which are very stinky especially when metabolised by bacteria in the mouth. This can leave the mouth smelling bad for several hours.

4. Smoking or Chewing tobacco

The presence of tobacco smoke lingering in your mouth can cause bad odour. Tobacco is also able to cause dry mouth which predisposes you to getting various gum diseases. 

Thus for smoking, you may get bad odour from the smell of it or from developing gum diseases.

5. Some medications

Some medicines that you are using may contribute to bad breath by causing dry mouth. Some other medicines too may have a bad odour from the chemical molecules which can also be carried through the bloodstream and eventually find their way in your lungs. Once in the lungs the odour will be present in your breath.

6. Fasting and low carbohydrates diets

During fasting, your body won’t be receiving energy from outside sources so it will generate energy from carbohydrate stores. Unfortunately, these are quickly depleted and the body starts using fats stores.

Also, when you keep taking in low carbohydrate diets, the body tends to make use of fats for energy production. The use of fats for such processes lead to the build up of chemical substances called ketones.These ketones are known to have very strong aroma and may present with halitosis in some people.

What medical conditions can cause halitosis?

  • Sinus, mouth or throat infections (sinus infection, tonsillitis, thronic bronchitis, postnasal drainage)
  • Dry mouth disorder (xerostomia)
  • Gastro-esophageal Reflux Disease
  • Some cancers and metabolic disorders like diabetes 
  • Liver failure
  • Bronchiectasis

Can halitosis be genetic or hereditary?

Although the majority of halitosis cases are temporary and may have identifiable causes, recent research has shown that a very small percentage of people suffer chronic halitosis.

This has been attributed to a genetic mutation in a particular gene that has been found to lead to excess production of the volatile compounds dimethyl sulfide and methanethiol. These volatile substances have been implicated in most cases of halitosis.

It can therefore be concluded that some people’s bad breath may be hereditary or genetic. A simple way to help with diagnosis of a genetic form of halitosis is to rule out all possible causes of halitosis as stated above and then find out if any other family member suffers the same problem without any of the possible causes.

Meaning, your bad breath is likely to be genetic if you keep a good oral hygiene, have no oral infections or no other identifiable cause and at the same time some family members of yours also suffer the same problem.

Is halitosis a symptom of another condition?

Halitosis may present as a symptom of another condition in some instances. In most of those instances, there are characteristic odors or aroma that are produced depending on the chemicals implicated.

Some of the conditions that may present with characteristic breath odor include: Diabetes, Liver failure, some cancers etc.

Which organisms cause halitosis?

Bacteria have been implicated in the majority of the causes of halitosis. According to an article published on NCBI, gram negative bacteria are the usual culprits when it comes to bacteria causing bad breath.

Examples of gram negative bacteria noted to cause halitosis include:

  • Prevotella (Bacteroides) melaninogenica 
  • Treponema denticola 
  • Porphyromonas gingivalis 
  • Porphyromonas endodontalis 
  • Prevotella intermedia 
  • Bacteroides loescheii 
  • Enterobacteriaceae 
  • Tannerella forsythensis (Bacteroides forsythus
  • Centipeda periodontii 
  • Eikenella corrodens 
  • Fusobacterium nucleatum vincentii 
  • Fusobacterium nucleatum nucleatum 
  • Fusobacterium nucleatum polymorphum 
  • Fusobacterium periodonticum

How to treat halitosis

Treating halitosis basically looks at eliminating the cause of the bad breath. Therefore,  it generally involves keeping a good oral hygiene, getting rid of any food or chemical substance that may be causing it or treating any condition that is causing the bad breath.

How to keep a good oral hygiene

  • Brush your teeth regularly (at least twice a day)
  • Do clean your tongue as well during brushing
  • Make use of a toothpaste containing fluoride
  • Do well to clean the in between of your teeth with interdental brushes or with a floss
  • You can chew or use sugar free mints or gum after taking in a strong-smelling drink or food.
  • You can also make use of mouthwashes
  • Avoid brushing your teeth and tongue so hard to prevent bruising or bleeding of your gums
Keep good oral hygiene

Other specific ways to treat halitosis

  • Avoid dry mouth: You have to stay constantly hydrated and avoid certain medications or chemical substances that may result in dry mouth. Since tobacco is known to cause dry mouth, you should avoid it, drink more water (not alcohol, soft drinks or coffee). You can also chew gums or sugar-free candies to stimulate salivation and prevent dry mouth.
  • Avoid high amounts of strong-smelling foods like garlic or onions
  • You can also see a dentist, or an ENT specialist if you have an oral, nasal or sinus infection which is causing the bad breath.

Can halitosis be transmitted?

Fortunately, halitosis is not contagious and therefore not transmitted from one person to another through sharing of a drink or kissing.

The bacteria implicated in halitosis are not usually transferred from one person to the other. 

However,  you can have multiple people in a family having the same condition. 

This will usually be because of a genetic transmission and not an oral to oral transmission. It may also be because the family members suffering from it are all not keeping a good oral hygiene or eating the same kinds of foods causing the problem.

Can halitosis be permanently cured?

Halitosis or bad breath can be treated permanently if the underlying cause of the bad breath is identified and treated accordingly. It is in only a few cases where it has been found to be genetic and permanent treatment hasn’t really been established for such cases. 

But even with that, treatment with, and maintenance of good oral hygiene can go a long way to help the person.

WRITTEN AND EDITED RESPECTIVELY BY:

Dr. Ehoneah Obed is a registered pharmacist and a member of the Pharmaceutical Society of Ghana. He has a Doctor of Pharmacy degree from Kwame Nkrumah University of Science and Technology and has experience working in a Tertiary hospital as well as various community pharmacies. He is also a software engineer interested in healthcare technologies.

His love for helping others motivates him to create content on an array of topics mostly relating to the health of people and also software engineering content.

He is knowledgeable in digital marketing, content marketing, and a host of other skills that make him versatile enough to uplift any team he joins.

Chief Editor at Wapomu.com

MPSGH, MRPharmS, MPhil.

Isaiah Amoo is a practicing community pharmacist in good standing with the Pharmacy Council of Ghana who has meaningful experience in academia and industrial pharmacy. He is a member of the Royal Pharmaceutical Society, England, UK and currently pursuing his overseas pharmacy assessment programme (MSc) at Aston University, UK. He had his MPhil degree in Pharmaceutical Chemistry at Kwame Nkrumah University of Science and Technology. He has about 5 years’ experience as a community Pharmacist and has also taught in academic institutions like KNUST, Kumasi Technical University, Royal Ann College of Health, and G-Health Consult. He likes to spend time reading medical research articles and loves sharing his knowledge with others.

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