While bad breath is not a common topic of conversation around the dining table, if you’ve ever been to a dinner party in close quarters you’ll know that it can be an unwelcome guest. It goes by several names, including halitosis, foetor oris, and oral malodor. The American Dental Association estimates that about half of all Americans experience halitosis at some point in their lives, but for some, bad breath can be a more chronic problem than just spreading a whiff of your last tuna sandwich.

What is Halitosis?

Put simply, halitosis is exhaled air from the nose or mouth that just doesn’t smell so good. At a molecular level, bad mouth odors are caused by volatile compounds in the breath that are interpreted by the nose as a smell it wishes it hadn’t smelled.

Halitosis can make for an embarrassing social encounter although many people with bad breath don’t realize they have it. Conversely, there are people who are overly anxious about the thought but who have no detectable malodor, a situation known as halitophobia.

What Causes Halitosis?

Though bad breath can originate from either the mouth or elsewhere, 90% of halitosis cases are due to a problem in the mouth. Around 9% arises from elsewhere in the body and the remaining 1% is due to the diet or drugs. When we inspect it more closely, there are a multitude of specific reasons why your breath may be carrying a less than pleasant odor:

Poor dental hygiene – The American Dental Association doesn’t advise twice-daily brushing and regular flossing just for fun. Food particles trapped in the various spaces of the mouth are broken down by bacteria, which then release sulfur compounds, one of those volatile molecular compounds that offend the nose. Dental cavities, plaque, and gum disease provide extra hiding places for food and bacteria, further contributing to bad breath.

• Certain foods – apart from foods getting stuck between your teeth and causing a bad smell, certain foods with a strong odor contribute to halitosis by passing their oils through the bloodstream to the lungs during digestion, which are then exhaled on the breath. These foods include onions, garlic, and beverages such as coffee
• Dry mouth – also known as xerostomia, a dry mouth means there’s an underproduction of saliva. Saliva plays several important roles, including digesting food, cleansing the mouth, and helping to prevent tooth decay and mouth infections. As a dry mouth can be caused by several underlying reasons, including certain systemic illnesses and prescription medications, if you’re experiencing bad breath, it may be worthwhile considering xerostomia as a factor
• Other mouth, nose, and throat problems – these include tonsil stones, which accumulate bacteria, sinus infections, postnasal drip, or chronic bronchitis
• Smoking – the smell of tobacco on someone’s breath is not pleasant at the best of times. Add to that the fact that smoking is linked with an increased likelihood of a dry mouth and gum disease and you have a recipe for halitosis
• Other diseases – the rare 9% of halitosis cases originating from a source other than the mouth may be traced back to conditions such as disease of the respiratory system, gastrointestinal system, liver or kidney. Diabetes is also known to affect the smell of the breath, as can foreign particles lodged in the nose
• Deviated Septum – a deviated septum can reduce airflow, create more difficulty breathing, and can cause bad breath and tooth decay.

Treatments for Halitosis

Halitosis can be detected with a simple sniff. If it smells like garlic it’s reasonably straightforward what the culprit is but if it just smells generally bad all the time, it may be worth a visit to the dentist or physician to figure out what the underlying cause may be. Particularly unusual breath odors may be a sign of something unexpected; for example, poorly controlled diabetes can result in the breath smelling fruity, while liver or kidney failure can cause the breath to smell fishy.

Many of the causes of halitosis can be easily dealt with or prevented. Consider not eating that tuna sandwich just before you go on a date. According to the American Dental Association, brush and floss your teeth regularly to weed out those bacteria-attracting food particles and reduce plaque build-up. If you are a habitual or occasional smoker, fresher breath will be only one of the many benefits of quitting. Other steps you can take to improve bad breath include:

• Regularly clean your dental appliances, such as mouthguards, retainers, or dentures, as recommended by your dentist
• Schedule regular dental checkups to guard against plaque build-up and gum disease
• Investigate chronic dry mouth with your dentist or physician. Solutions may involve using mouthwashes to promote saliva production, modifying the diet, or reassessing your prescription medications
• Drink plenty of water to help rinse out the mouth and keep it moist
• Reduce your caffeine intake to avoid coffee breath and drying out your mouth

Persistent bad breath should not be ignored, and not just for the sake of your social life. After checking in with your dentist to rule out any oral-related factors, the next stop may need to be a visit to your family physician or even an ENT specialist to ensure that there aren’t any serious underlying conditions causing your halitosis.