Reasons for Bad Breath (Halitosis)

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When patients attend dental office, what is the most common reason they are worried about? It is not the ones that us dental professionals are worried about in people’s oral health. There are two most common worries people have and they are

  1. the appearance of the teeth
  2. bad breath

So today I’m going to write about the reasons for the bad breath because I have noticed that when I tell my patients the most common reasons for the bad breath, some of the reasons come as surprise for them. So read on to find out what it might be that is causing bad breath.

Who Told You That You Have Bad Breath?

Now, this is actually very important question. Normally no other than the very closest people to you have guts to tell you that your breath stinks. It is normally your spouse or your mother. And kids. Keep in mind, that kids are very frank and blatant in their statements. You will probably hear “Eeew, you’re smelly” just when you lean over to your kid at nursery to kiss her goodbye before you head off to an important meeting at work. Now, this if anything makes you slightly insecure and you rush to the off-licence to get mints to freshen your breath. Yet still at the meeting you try to inhale same time as you speak to the person next to you. Sound familiar?

Morning Breath

We all have bad breath in the morning. This is because the saliva flow at night decreases and there hasn’t been enough saliva to kill or rinse the bacteria away. The bad breath gets better when you brush your teeth and drink fluids. So if somebody tells you in the morning that you have bad breath, it is completely normal and most likely the person telling you this has a bad breath as well.


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I remember how bad my primary school teacher breath smelled when the teacher came to check my schoolwork after a break. You know that the teachers consume lots of coffee during the workday. My teacher drank lots of it on every break and I did not like the smell of his breath in the class. So nowadays I am very aware of my bad after-coffee-breath if I have had coffee and not had any breath freshener afterwards. Sometimes I forget it but when I see frowning at my kids face as I go close to them, I must apologise for my bad breath. So, remember, have sugar-free breath freshener after you have had coffee.


Coffee is also diuretic drink and if you consume lots of it during the day, you will get dehydrated if you don’t drink more water than normally. Dehydration will cause the saliva flow to decrease causing a dry mouth and the bacteria can grow more rapidly causing the bad breath. There are other diuretic drinks as well like tea, alcohol and coke.

Drinks are not the only reason for dehydration. Also working in a office that has strong air ventilation, will dehydrate you. So remember to drink plenty of water during the day (tap water preferably) and even more so if you also are a heavy coffee drinker.

Also certain medication can cause dehydration. These include e.g. diuretics.

Dry Mouth

Dehydration is the most common reason for dry mouth. And as I mentioned already in the previous chapter, the dry mouth can cause bad breath. Medication, stress and certain illnesses can cause dry mouth too. You can read more about it here.

Wrong Medication for the Bad Breath

Dental Revelations Blog-19It is tempting and easy way to try to get rid of the bad breath by using mouth washes. But using the mouth wash for bad breath can actually make the bad breath go from bad to worse. The mouth wash often contains alcohol and alcohol will dry your mouth even further. There are also other chemicals in the mouth washes that your mouth might not like and dry mouth could be a result of using even the non-alcohol mouth washes.

Poor Oral Hygiene Habits

The bacteria is the most common reason for bad breath. The bacteria is in your mouth and so it should be because it looks after the soft tissues. But if it can stay on the surface of the teeth for too long there will be really nasty bacteria attaching to the mass of dental plaque. These nasty bacteria are not only causing bad breath but also diseases like periodontitis.

So if you are not cleaning in between the teeth or only doing it occasionally, this can be the only reason for you bad breath. Cleaning between the teeth will also get rid of any food stuck there. I have sometimes found food debris from patients mouth that has been there for a long time and everyone can guess what happens to the food in long period of time – it rottens. And the rotting food smells.

A tip: You can test if there is smelly bacteria in between your teeth by flossing and then smelling the floss.

If it has been a long time since you had a teeth cleaning at the dentist, it might be a good time to book in an appointment. If you neglect cleaning between the teeth, the plaque build-up will very quickly harden to tartar. That is something you cannot remove yourself. Once it builds up below the gum, you will not get rid of the bad breath until you have had professional cleaning done. Once you have had it, listen to your dental hygienist and follow the instructions to prevent the build up of tartar in the future.



If you get a heartburn often, it can be a sign of gastroesophageal reflux disease (GERD) or more commonly known as acid reflux. In this medical condition, the content of the stomach flows backwards toward the mouth. This backflow can cause problems like dental erosion and bad breath.

The smell of a breath with acid reflux can be very pungent and can be relieved only by right medication for acid reflux. Another way to treat acid reflux is by diet but this will have slower effect on the bad breath. It is advisable that if you get heart burn on weekly basis, you should consult you doctor over a medication as sometimes over-the-counter medication are not effective enough. They might want send you to a gastroscopy to confirm the reason for the acid reflux.


This one probably everyone knows – smoking causes bad breath. No matter how you try to hide it with chewing gum, it will smell through. So quit smoking! Not only because of the bad breath but more so because of your health.

Tonsil Stones

Now this is probably the most unknown reason for the bad breath. Some people’s tonsils have such structure that harbours bacteria. The bacteria builds up in the crevices of the tonsils. It builds up until it a tiny white(ish) ball-shaped mass pops out. This is the tonsil stone. If you reach it with you finger before you swallow it, and smell the tiny ball, you understand the reason for your bad breath.

Sometimes the tonsils collect bacteria and the build up is stuck in the structure of the tonsils. This might cause sore throat and if you take a look at your tonsils (back of your mouth), you might see white spots there. By pressing the tissue around the white area, the tonsil stone might pop out and the area begins to heal. So to get rid of the bad breath that is caused by tonsil stones, you should try to get the tonsil stones out.

It might be useful to gargle with chlorhexidine mouthwash or salt water if you get sore throat from the tonsil stones. This will prevent the bacteria growth and help the inflammation in the tissue to heal.

Sometimes surgery might be needed to stop the tonsil stones forming.


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Of course we shouldn’t forget that some food can cause bad breath. The most common one is the garlic. This you can only hide away by using breath fresheners when socialising. Although some people say chewing parsley right after eating garlic helps to get rid of the garlic breath.

Word of Comfort

It is good for everyone to know that often when you think that you have a bad breath, it most often is actually just a bad taste in your mouth. It doesn’t necessary smell even if you have a bad taste. But to be sure, you can ask close friend/spouse to tell you if you have a bad breath.


Hands up Who Knew That Zinc in Toothpaste Can Cause Dry Mouth?

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I have noticed it is very easy for a health care professional to get annoyed about different things by just browsing through dental forums and discussion sections of dental news.

This time it was the toothpaste.

Especially the toothpastes of certain big brand that promise all sorts of things but have side effects the representatives sweep under the carpet by saying casually

It’s perfectly safe to use

It’s normal

Yeah, peeling off the mucosa in your mouth is normal. I wouldn’t be so sure. Especially with the patients who have a sensitive mouth.

The salesmen of the manufacturers of oral hygiene products would sell their granny to promote their products. They can tell a fib or even lie to your face without loosing a good night’s sleep. All they want to achieve is that you will start to recommend their products. This is enhanced by giving the practices boxes and boxes of free samples which I have written about in my previous post Can you trust the recommendations given to you by a dental professional?

Are We Fooled by the Representatives and Adverts?

I remember an occasion when a representative of this big company came to my practice to introduce new products. These new all-in-one toothpastes. There were many different toothpastes in the same product family. One for everyone even though the first all-in-one toothpaste introduced not so long before these new ones was supposed to be the one to deal with e-v-e-r-y problem one could have. Slightly confusing I think.

Anyway, the rep went through these new toothpastes and recommended the sensitive version also for the sufferers of dry mouth. Then on the next sentence she mentioned that this sensitive toothpaste contains zinc…

Rather boring session got my interest immediately. Dry mouth and zinc? You got to be kidding me?

We dental professionals know our business. Every detail of it. Well at least I hope most of us do. Despite this I have noticed that many dental professionals are fooled by these selling speeches representatives give and do not notice that the things coming out of their mouths are simply bogus.

So I looked around to see if anyone else was looking puzzled? If anyone was about to say something? No, not a chance. They were just leaning back on their chairs with empty eyes staring at the products. But I couldn’t keep quiet. I never really have learned to keep my thoughts to myself especially if somebody is talking nonsense.

So I raised my hand to get a say (and I swear I could see my colleague roll her eyes meaning here we go again). The rep looked surprised.

Me: Did you say this toothpaste is for people with dry mouth?
Rep: Yes I did.
Me: And it has zinc in it?
Rep: Yes it has.
Me: But the zinc associated with dry mouth, isn’t it? It can make the dry mouth worse.
Rep: Err, I must say I do not have an answer for you now. But let me get back to you on that. What’s your e-mail address? I’ll find out and send you an e-mail as soon as possible.

A typical diversion from the subject. About month later I received an e-mail which said:


I remember you asked something about the sensitive toothpaste. Care to clarify what was you specific question? All the toothpastes are well researched and tested. They are widely recommended by the dentists. Bla-bla-bla…

Yours truly,


Knowing Your Business in Depth

Now I must tell you that I did not know that zinc in toothpaste can be a culprit to dry mouth until another rep of another big oral hygiene product manufacturer (wouldn’t it be easier if I just told you which company?!) told me so couple of years ago.

I had recently tested their toothpaste for halitosis and got extremely dry mouth (honestly, I thought I will die of thirst between brushing my teeth and reaching the office in the morning). When I asked the rep about it she said that it could be due to the zinc in the toothpaste and asked me to file an adverse event report. She even gave me the document to fill in.

I was impressed. Not about the Sahara-Desert-in-mouth toothpaste but about the honest rep who could tell me something I didn’t know.

Since then it’s not been just once or twice that I have found out that my patient who is suffering from a dry mouth is using a toothpaste containing zinc.

The dentistry is constantly evolving. It is hard to keep up to it but we must. It is the only way we can give the correct advice to the patients.


It just occurred to me that I might be taking the visits of the representatives of oral hygiene products the wrong way. Perhaps it is accustomed way to let the reps babble away without questioning what they are saying. Am I considered to be rude to interrupt them when they are just trying to do their job? Should I just sit in silence when they are clearly not on the right path?

Perhaps, but I’m afraid it won’t happen in the near future. Or never. You see, isn’t it so that the annoying sides of one’s personality is only enhanced when one gets older?

Anyway. Be cautious of the advertising speeches of the reps. Read scientific studies about the ingredients and then make up your own mind if you will recommend certain products. Try them yourself and pay attention to how your mouth responds.

My advice for the patients is to use a toothpaste that feels good in their mouth. If the toothpaste burns, stings, makes your mouth numb or if you experience any other uncomfortable feeling STOP USING IT.

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