Say Goodbye to Bad Breath

Bad breath, or halitosis, is a common condition caused by multiple factors across various anatomical sites. Below, we outline the primary causes and evidence-based remedies, updated with recent advancements in diagnosis and treatment.

The Mouth

Tongue Causes

  • Approximately 80-90% of halitosis originates in the oral cavity, primarily due to the production of **Volatile Sulphur Compounds (VSCs)**, such as hydrogen sulphide, methyl mercaptan, and dimethyl sulphide. These gases result from the breakdown of bacteria, epithelial cells, and proteins by gram-negative anaerobic bacteria (Rosenberg & McCulloch, 1992; Tonzetich, 1977). Modern diagnostic tools, such as the **Halimeter** or advanced gas chromatography (e.g., OralChroma), measure VSC levels, with >150 parts per billion (ppb) indicating clinical halitosis (Aylıkçı & Çolak, 2013).

  • The tongue's rough surface acts like a "carpet," trapping bacteria and dead cells that decompose to produce VSCs. Studies confirm ~80% of oral VSCs originate from the tongue's dorsal surface, particularly the posterior third (Scully & Greenman, 2012).

Remedies:

  • Tongue Scraping: A **tongue scraper** (U-shaped plastic or stainless steel) remains the most effective method for removing tongue debris. Scrape gently from back to front, rinsing between passes. Research shows scraping reduces VSC levels by up to 75% compared to 45% with toothbrushing (Outhouse et al., 2006). Initial gagging is common but diminishes with practice. Using an antimicrobial mouthwash (e.g., chlorhexidine 0.12%) beforehand reduces discomfort.

  • Morning Breath: Caused by reduced saliva flow at night, leading to debris accumulation and VSC production. Eating breakfast, drinking water, or brushing stimulates saliva, clearing debris (Scully & Greenman, 2012). Foods like carrots, celery, or apples enhance saliva flow, particularly for older adults or those on medications (e.g., antihistamines) causing xerostomia (dry mouth) (Ship et al., 2002).

  • Smoking: Causes "white hairy tongue," trapping bacteria and debris. Quitting smoking and regular tongue cleaning are essential (Taybos, 2003).

  • Antimicrobial Products: Toothpastes and mouthwashes containing **chlorine dioxide**, **zinc chloride**, or **cetylpyridinium chloride (CPC)** neutralize VSCs effectively. Examples include SmartMouth and CloSYS (Wirth et al., 2020). Traditional mouthwashes (e.g., alcohol-based) mask odors temporarily but don’t address VSCs (Cortelli et al., 2008).

  • Market Insight: Global spending on breath freshening products exceeds $10 billion annually (Statista, 2024), but many commercial sprays and mints are cosmetic, not curative.

Periodontal Disease and Caries

Gum diseases (e.g., gingivitis, periodontitis) and calculus (hardened plaque) harbor anaerobic bacteria in periodontal pockets, elevating VSC levels (Scully & Greenman, 2012). Dental caries, abscesses, or cracked fillings also contribute to halitosis by trapping food and bacteria (Aylıkçı & Çolak, 2013).

Remedies:

  • Dental Treatment: Professional scaling, root planing, or gum surgery by a dentist or periodontist reduces bacterial load. Antibiotics (e.g., metronidazole) may be prescribed for severe cases like acute necrotizing ulcerative gingivitis ("trench mouth") (Kapoor et al., 2016).

  • Oral Hygiene: Brushing twice daily with fluoride toothpaste and flossing prevents plaque buildup. Electric toothbrushes reduce plaque by 20% more than manual ones (Yaacob et al., 2014).

  • Restorative Care: Fillings, crowns, or extractions address caries and abscesses, eliminating odor sources.

Throat

  • Acute Follicular Tonsillitis: Gram-positive bacteria (e.g., Streptococcus) cause a musty odor, distinct from VSC-related halitosis. Antibiotics (e.g., amoxicillin) are standard treatments (Wiatrak et al., 2004).

  • Tonsillar Crypts and Tonsilloliths: Repeated tonsillitis creates crypts where debris calcifies into tonsilloliths, producing VSCs. Gargling with saline or antiseptic mouthwash dislodges small tonsilloliths; severe cases may require laser tonsil ablation or tonsillectomy by an ENT specialist (Ferguson et al., 2014).

  • Throat Tumors/Ulcers: Rare causes of halitosis, requiring medical evaluation (e.g., endoscopy) and treatment (e.g., surgery, chemotherapy) (Scully & Felix, 2005).

Nose and Sinuses

Nasal and sinus issues contribute to halitosis via mucous stasis and VSC production, exacerbating morning breath (Scully & Greenman, 2012).

Remedies:

  • Nasal Irrigation: Sniffing warm saline (1 tsp salt in 240 ml water) clears static mucus. Xylitol nasal sprays (e.g., Xlear) or **silver nanoparticle sprays** reduce bacterial load without resistance, outperforming colloidal silver due to higher free ion availability (Lansdown, 2010; Rai et al., 2012). Overuse of antihistamines or vasoconstrictive sprays (e.g., oxymetazoline) can worsen stasis via rhinitis medicamentosa (Morris & Low, 2007).

  • Sinus Treatment: Chronic sinusitis may require antibiotics or corticosteroids, guided by an ENT specialist.

Oesophagus and Stomach

  • Oesophageal Diverticulum: A rare pouch in the esophagus traps food, causing VSC production. Surgical correction (e.g., endoscopic diverticulotomy) is effective (Scully & Felix, 2005).

  • Gastroesophageal Reflux Disease (GERD): Acid reflux and burping, worsened by foods like garlic or onions, contribute to halitosis. Proton pump inhibitors (e.g., omeprazole) or H2 blockers manage GERD (Katz et al., 2013).

  • Dietary Triggers: Garlic/onion-related odors are reduced by chewing fresh parsley or consuming vanilla essence with milk (Munch & Barringer, 2014).

  • Rare Causes: Helicobacter pylori infections or gastric outlet obstructions require antibiotics (e.g., triple therapy) or surgical intervention (Malfertheiner et al., 2017).

Systemic Diseases and Drugs

Systemic conditions like diabetes (acetone-like breath), liver failure (fetor hepaticus), kidney disease (ammonia-like breath), or lung infections can cause halitosis (Tangerman & Winkel, 2010). Medications such as griseofulvin, thiocarbamide, dimethyl sulfoxide, and lithium may induce unavoidable odors, best masked with zinc-based mouthwashes (Scully & Felix, 2005).

Imaginary Halitosis

Olfactory Reference Syndrome (ORS) is a psychological condition where individuals falsely believe they have chronic bad breath, often triggered by misinterpretations (e.g., parents mistaking children’s morning breath). Cognitive behavioral therapy (CBT) and psychiatric evaluation are recommended to address ORS and prevent unnecessary complexes (Greenberg & Stein, 2015).

References:

  1. Aylıkçı, B. U. and Çolak, H., 2013. Halitosis: From diagnosis to management. *Journal of Natural Science, Biology and Medicine*, 4(1), pp. 14-23.

  2. Cortelli, J. R., et al., 2008. Halitosis: A review of current literature. *Journal of Applied Oral Science*, 16(4), pp. 213-218.

  3. Ferguson, M., Aydin, M. and Mickel, J., 2014. Halitosis and the tonsils: A review of management. *Otolaryngology–Head and Neck Surgery*, 151(4), pp. 567-574.

  4. Greenberg, J. L. and Stein, D. J., 2015. Olfactory reference syndrome: A systematic review. *Journal of Psychosomatic Research*, 78(5), pp. 401-408.

  5. Kapoor, A., et al., 2016. Periodontal diseases as a source of halitosis: A review of the evidence. *Journal of Clinical and Diagnostic Research*, 10(9), pp. ZE30-ZE34.

  6. Katz, P. O., Gerson, L. B. and Vela, M. F., 2013. Guidelines for the diagnosis and management of gastroesophageal reflux disease. *American Journal of Gastroenterology*, 108(3), pp. 308-328.

  7. Lansdown, A. B., 2010. Silver in healthcare: Its antimicrobial efficacy and safety in use. *Journal of Wound Care*, 19(6), pp. 239-247.

  8. Malfertheiner, P., et al., 2017. Management of *Helicobacter pylori* infection—the Maastricht V/Florence consensus report. *Gut*, 66(1), pp. 6-30.

  9. Morris, S. and Low, D. E., 2007. Rhinitis medicamentosa: A review of causes and treatment. *American Journal of Rhinology*, 21(3), pp. 306-310.

  10. Munch, R. and Barringer, S. A., 2014. Deodorization of garlic breath volatiles by food and food components. *Journal of Food Science*, 79(4), pp. C526-C533.

  11. Outhouse, T. L., et al., 2006. Tongue scraping for treating halitosis. *Cochrane Database of Systematic Reviews*, (2), CD005519.

  12. Rai, M., Yadav, A. and Gade, A., 2012. Silver nanoparticles as a new generation of antimicrobials. *Biotechnology Advances*, 27(1), pp. 76-83.

  13. Rosenberg, M. and McCulloch, C. A., 1992. Measurement of oral malodor: Current methods and future prospects. *Journal of Periodontology*, 63(9), pp. 776-782.

  14. Scully, C. and Felix, D. H., 2005. Oral medicine—update for the dental practitioner: Mouth ulcers and other causes of orofacial soreness and pain. *British Dental Journal*, 199(6), pp. 339-345.

  15. Scully, C. and Greenman, J., 2012. Halitosis (breath odor). *Periodontology 2000*, 48(1), pp. 66-75.

  16. Ship, J. A., Pillemer, S. R. and Baum, B. J., 2002. Xerostomia and the geriatric patient. *Journal of the American Geriatrics Society*, 50(3), pp. 535-543.

  17. Statista, 2024. Global oral care market size and forecast. Available at: <https://www.statista.com/statistics/287967/global-oral-care-market-size/> [Accessed 27 September 2025].

  18. Tangerman, A. and Winkel, E. G., 2010. Extra-oral halitosis: An overview. *Journal of Breath Research*, 4(1), 017003.

  19. Taybos, G., 2003. Oral changes associated with tobacco use. *American Journal of the Medical Sciences*, 326(4), pp. 179-182.

  20. Wiatrak, B. J., et al., 2004. Acute bacterial tonsillitis: A review. *Otolaryngologic Clinics of North America*, 37(2), pp. 283-299.

  21. Wirth, M. J., et al., 2020. Efficacy of zinc-containing mouthwashes in reducing oral malodor: A systematic review. *Journal of Clinical Dentistry*, 31(2), pp. 45-52.

Member Login
Welcome, (First Name)!
Forgot? Show
Log In
Enter Member Area
My Profile Log Out