Halitosis: What to Know About Bad Breath

Bad breath, or halitosis, is a common symptom of poor oral hygiene. Sinus infections, certain foods, tobacco products, and dry mouth can also lead to bad breath. The medical term for chronic bad breath is halitosis. Bad breath can result from sulfur compounds released by bacteria in the mouth, food odors, or salivary gland dysfunction. 

Bad breath alone is rarely due to a serious problem. However, it can be a symptom of an underlying health condition, such as a digestive issue, a respiratory condition, or diabetes.

Treatment starts with practicing good oral hygiene. If bad breath persists, a dentist can help you get to the root of the problem or suggest when to see a primary care physician.

This article goes over the symptoms that come with bad breath, some common causes, and how to get rid of halitosis.

Breath can have a bad odor when you first wake up. This can also occur after eating certain foods. However, chronic bad breath can be different. Halitosis can indicate a health condition or a problem with oral hygiene.

Most cases of bad breath originate in the mouth and airway passages. Poor oral hygiene is a common cause of chronic bad breath. Without brushing and flossing daily, food particles remain in the mouth, on the tongue, and between the teeth. These food particles collect bacteria, causing bad breath.

Infections of the gums (gingivitis) and salivary glands can both result in bad breath. Other common causes include dry mouth and smoking or chewing tobacco.

Certain medical conditions — such as postnasal drip, tonsillitis, sinusitis, and bronchitis — can also cause bad breath. Digestive disorders, including gastroesophageal reflux disease (GERD) and bowel obstruction, may result in breath that smells.

Breath with a fruity odor may be a symptom of diabetic ketoacidosis, which is a life threatening complication of diabetes. Liver disease may be to blame if breath has an ammonia-like odor.

Bad breath may accompany other symptoms, which vary depending on the underlying disease, disorder, or condition.

Bad breath may accompany other symptoms affecting the mouth, including:

• bleeding, tender, swollen, or receding gums
• a bright red or red-purple appearance to gums
• dry mouth
• mouth or facial pain, especially when eating
• mouth sores or sores that contain pus
• flushing over the side of the face or the upper neck
• a sore throat
• swollen tonsils

Bad breath may accompany symptoms related to the respiratory system and other body systems. Such symptoms may include:

• fatigue
• fever
• headaches
• pain, tenderness, swelling, and pressure around the eyes, cheeks, nose, or forehead
• postnasal drip
• a sore throat
• a stuffy nose or nasal congestion

Bad breath may accompany symptoms related to diabetic ketoacidosis, including:

• confusion
• frequent urination
• difficulty breathing
• dry or flushed skin
• nausea with or without vomiting
• thirst or a very dry mouth

Bad breath may accompany symptoms related to the digestive system. Such symptoms may include:

• abdominal gas or bloating
• abdominal pain 
• indigestion
• heartburn or GERD
• nausea with or without vomiting

Bad breath may accompany symptoms related to liver disease, including:

• abdominal swelling
• confusion
• dark urine
• easy bruising or bleeding
• fatigue and weakness
• a loss of appetite
• nausea with or without vomiting
• persistent itching
• swelling of the feet and ankles

In some cases, bad breath may be a symptom of a serious condition, such as bowel obstruction. Seek immediate medical care (call 911) for any of these serious symptoms:

• breath that smells like feces
• difficulty thinking clearly
• high fever (higher than 101ºF or 38ºC)
• prolonged vomiting
• rapid breathing or shortness of breath

Bad breath often results from bacteria releasing sulfur during the breakdown of food particles in your mouth. Eating foods such as onions and garlic is a common cause of bad breath. Your body absorbs chemicals from these foods into the bloodstream, carries them to your lungs, and exhales them.

Infections of the mouth and gums can also cause bad breath. This is often the result of poor oral hygiene. If you do not clean the mouth and teeth daily, plaque forms on the teeth, irritates your gums, and may result in tooth decay.

Dry mouth is another common cause of bad breath. Saliva cleanses the mouth and removes foreign particles. Dry mouth can occur during sleep from mouth breathing and decreased saliva production. This can result in bad breath upon waking. Medication and tobacco use, both of which cause dry mouth, may also lead to bad breath.

Other cases of bad breath are due to underlying conditions. Some metabolic disorders and cancers can cause a distinctive breath odor as a result of the chemicals they produce.

Infections in the upper respiratory tract — including sinusitis, pharyngitis, laryngitis, and postnasal drip — can also cause bad breath.

Diabetic ketoacidosis and liver failure can lead to unusual and unique changes in breath.

Chronic GERD is another source of bad breath.

Bad breath may be due to certain foods and substances, including:

• garlic
• onions
• spices
• tobacco

Bad breath can also result from certain dental conditions, such as:

• gingivitis, which is an infection of the gums
• periodontitis, which is an infection of the gum line involving the teeth and bones
• poor dental hygiene
• reduced saliva
• tooth decay
• unclean or poorly fitting retainers or dentures

Some diseases and conditions may be associated with bad breath, such as:

• bronchitis
• GERD
• salivary gland infections
• sinus infections

In some cases, bad breath may be a symptom of a serious or life threatening condition. These may include:

• bowel obstruction
• diabetic ketoacidosis
• liver failure
• pneumonia

To diagnose halitosis, your dentist will examine your mouth for odor and see if there is an obvious cause of the bad breath. Causes range from poor dental hygiene to tooth decay to gum disease.  

In addition, your dentist will ask you several questions related to your bad breath. These may include:

• How long have you had bad breath?
• Is your bad breath sporadic or more constant? 
• Do you have any other symptoms?
• Do you have diabetes?
• What medications are you taking?
• What foods make up your diet?
• How often do you brush and floss your teeth?
• Do you snore or breathe through your mouth? 
• Do you have any allergies? 

If your dentist is unable to pinpoint a cause, you may need to visit your primary care doctor for further evaluation. They can perform tests to see if your bad breath is due to a certain medical disorder or an existing medical condition.

To address halitosis itself, it is necessary to treat the underlying cause of the condition. 

If your bad breath is due to poor oral hygiene, your dentist may first treat any plaque buildup or tooth decay. Then, they may recommend a toothpaste or mouth rinse that can help prevent poor oral hygiene going forward. 

If your bad breath is due to gum disease, your dentist may perform a periodontal cleaning procedure to remove bacteria or plaque that is irritating the gums. If it is extremely serious, your dentist may refer you to a periodontist for more specialized care. 

If your bad breath is due to a medical condition, your primary care doctor can offer treatments that may, in turn, alleviate the halitosis. 

There are a number of home remedies and lifestyle changes that you can try to help prevent or treat bad breath. They include the following.

Brush and floss your teeth at least twice per day. Be sure to brush your tongue, the interiors of your cheeks, and the roof of your mouth.

Use a soft-bristled toothbrush, and get a new toothbrush every 3­–4 months. It may be best to use an electric toothbrush paired with fluoride toothpaste. Also, consider using a water flosser. This device can help remove food particles left behind after brushing.

What you eat and drink can affect saliva production. Maintaining regular saliva production is important to avoid dry mouth, cleanse the mouth, and aid digestion. 

Replace coffee, soda, and alcohol with water. Increase your intake of healthy foods that require a lot of chewing to spur saliva production. Examples of these foods include apples, cucumbers, celery, and carrots. 

Chewing sugar-free gum or sucking on sugar-free candy can also help increase saliva production.

You may be able to prevent bad breath by avoiding certain foods, including onions, garlic, spices, and sugary foods. 

Visit your dentist for your twice-yearly cleanings and exams. Doing so enables your dentist to identify and treat any problems that could result in bad breath, such as gum disease or tooth decay. 

Remove your dentures before going to sleep, and thoroughly clean them before putting them back in your mouth when you wake up. 

Ask your doctor about recommendations for any deodorizing tablets or sprays, as many may not have long lasting effects.

Without proper treatment, some infections and diseases that cause bad breath can lead to serious complications. Such complications may include:

• bowel obstruction
• diabetic ketoacidosis
• kidney failure
• liver failure
• severe respiratory distress

Bad breath is a problem that most people have at one time or another. Most of the time, it is a simple matter of managing dry mouth, practicing good oral health, or changing what you eat or drink.

It is important to contact your dentist regularly and when bad breath persists. Bad breath can indicate dental problems or gum disease. In some cases, bad breath is a warning sign of an underlying medical condition.