Reasons for Bad Breath (Halitosis)

labrador retriever dog
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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.


garlic in bucket
Photo by Artem Beliaikin on

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.


Today I Saw My One in a Thousand Patient


A-mazing. Simply amazing. That is what I thought when I took a look at one of my patient’s mouth today. It wasn’t something I expected to happen after interviewing the patient.

You see amongst many other things I always ask the patient if he uses fluoride toothpaste. This patient didn’t. And the reason for not using fluoride was a fear of the side effects and the fact that he has never had decay. He was 36 years old. I was sceptical of course. I was certain what I was going to find. If you have read my post Anti-Patients you know what it is. If you haven’t and you are about to click the link, do scroll down to the paragraph Anti-Fuoride when you get there.

So today I was certain that I was going to find decay. At least the early stages of it. Or dental erosion. And I was prepared to go through the routine of informing the patient about the consequences of not using the fluoride toothpaste.

But. A big but. The teeth were in immaculate condition. No plaque, only tiny amount of tartar and definitely no decay. No matter how hard I tried to find even the smallest evidence of it – of the patient being fool not to use fluoride. But he was no fool. Far from it. He had good eating and oral hygiene habits and he attended the dentist regularly. That made him very wise.

Both me and the patient had the same question in our minds. Why isn’t there a toothpaste which contains only calcium for the patients like this one. They don’t need fluoride. Would calcium be enough? But then again, do they need toothpaste at all?

And for those not using the fluoride toothpaste by choice, remember that it really is one in a thousand that will get away with it. Most people will get problems with decay or dental erosion.



Eeny Meeny Miny Moe – Which Type of Tooth Wear?

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There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. If there are also receding gums on the same teeth as where the tooth wear is, the dentist makes a wrong conclusion easily. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is. She’s afraid that the bleeding means her gums are receding.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

4. Check if the gums have receded on affected sites.

If you get positive answer to even one question the chances are great for the tooth wear to be an abfraction. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know that these fillings in the cervical area can be pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorise that


The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.

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