Halitosis, also known as bad breath, affects approximately one in four people,1 and this widespread issue isn't only caused by consuming onions and garlic.
Everybody can have bad breath from time to time, but most of us wouldn't even realize it. However, consistent mouth odor can mean that something more serious is going on. Halitosis is a condition that can have multiple causes, so knowing and understanding the root cause is paramount for treatment and prevention.
With research linking oral health to more serious health conditions such as cardiovascular disease, pregnancy complications, and cognitive decline, proper oral care has never been more important.
The causes of bad breath are split into two categories: intraoral (inside the mouth) and extraoral (outside the mouth), with intraoral being the most common. Studies have shown that approximately 90% of all halitosis cases are caused by intraoral issues2, and around 10% of halitosis cases are extraoral.
Intraoral (inside the mouth) causes of bad breath
Most bad breath is due to a build-up of odorous volatile sulfur compounds (VSCs).3 There are many different reasons VSCs may be overproducing. These are the top three.
Imbalance of intraoral bacteria: Our mouths are full of a community of bacteria, fungi, and viruses, which are collectively known as our oral microbiome. Most of these organisms are critical for our health, aiding with absorbing vitamins from our food and protecting us from infection. However, when the oral microbiome becomes unbalanced (dysbiosis), harmful species can grow in number and start wreaking havoc. This can lead to conditions such as gum disease, cavities, and bad breath. The types of microbes that cause bad breath range from inflammatory gum pathogens to tongue coaters and fungal species, so traditional hygiene routines of brushing and flossing will not be sufficient to address all the causes.
Xerostomia (dry mouth): People who suffer from hyposalivation (decreased saliva production) can often have higher levels of VSCs compared to the general population. One of saliva's many jobs is to attach to the bacteria in our mouths and act as a natural rinse when we swallow. People who don’t produce enough saliva can have bacteria multiplying in their mouths, causing bad breath. This is a key reason for "morning breath" as our saliva production slows while we sleep.
Gum disease: Good oral hygiene is essential for many reasons—one being that it reduces your chance of developing periodontal (gum) disease. Gum disease is a common problem in the US that affects 46%4 of adults over the age of 30. A study has shown that gum disease can cause more VSCs due to patients suffering from deeper periodontal pockets (openings under the gum line), allowing for a build-up of pathogenic bacterial species.5
Extraoral and other reasons
Diet is a main cause of extraoral halitosis.6 People who tend to have bad breath should avoid eating excessive amounts of high-sulfur foods, such as the classic offenders onions and garlic, and overdosing on coffee to neutralize mouth odor.
Acid reflux or GERD. This is due to the build-up of postnasal drip on the back of the tongue, releasing an odor caused by irritated throat walls.
Illnesses. Sustained halitosis can be symptomatic of some more serious oral and extraoral illnesses. For example, those who suffer from gum disease are often more likely to suffer from cardiovascular issues due to bacteria penetrating through the gums and into blood vessels. So halitosis may be an early warning sign for conditions like heart disease or endocarditis7.
Ways to improve your health and avoid halitosis
It may seem like just about anything can cause halitosis. But don't despair; there are several ways to reduce the risk.
Everyone's oral microbiome is different, so a one-size-fits-all approach to oral hygiene just won't work. Understanding all the different aspects of your oral hygiene is a great way to start improving it, and leveraging new technology can help you with this.
Oral microbiome testing companies, such as Bristle and MicroGenDX, can test your saliva and give you a complete breakdown of your personal oral health. They can provide you with a detailed report that includes a breakdown of all the bacteria found in your mouth and how they relate to conditions like halitosis. Companies like Bristle can also provide results that include recommended products, diets, and lifestyle interventions to improve your overall health.
Although halitosis can have several underlying issues, upping your oral hygiene game is a good first step. By regularly brushing your teeth (don't forget about your tongue) and flossing, plus your recommended professional cleanings, you should help to keep your mouth's bacteria under control. Investing in an electric toothbrush is also an effortless way to help give your mouth a better clean. Plus, since many have built-in timers, you can ensure you're giving your mouth the full two minutes it needs.
Mouthwash is another handy tool to use regularly as its active ingredients can reduce VSCs. The best way to use mouthwash to decrease halitosis is after a saliva test. This is because once you know which oral bacteria are causing your bad breath, you can choose a suitable mouthwash with the recommended ingredients for your personal oral microbiome. Just be careful not to overuse mouthwash as it can stain your teeth and reduce your taste sensation.8
Another simple yet effective way to reduce your chances of halitosis is by adjusting your diet. Eating foods high in fiber is not only beneficial for your overall health, but foods like raw fruit and vegetables can reduce disease-causing bacteria. Probiotics can also be particularly advantageous: You can increase your dosage by taking supplements or by consuming them naturally with high nitrate foods like spinach, lettuce, and radishes.
Our bodies are designed like well-oiled machines, but when one part starts to fail, it can affect every other part of the design. Our overall health is connected to every part of our body. So, we need give our oral health the care and attention it deserves.
- Newman T. Everything you need to know about bad breath.https://www.medicalnewstoday.com/articles/166636
- Renvert S, Noack M J, Lequart C, Roldán C, Laine M J. The Underestimated Problem of Intra-Oral Halitosis in Dental Practice: An Expert Consensus Review.https://pubmed.ncbi.nlm.nih.gov/32753975/
- Krepsi Y P, MD, Shrime M J, MD, Kacker A, MD. The relationship between oral malodor and volatile sulfur compound–producing bacteria.https://journals.sagepub.com/doi/abs/10.1016/j.otohns.2005.09.036?journalCode=otoj
- Centers for Disease Control and Prevention. https://www.cdc.gov/oralhealth/fast-facts/gum-disease/index.html#:~:text=Nearly%20half%20(46%25)%20of,affects%20about%209%25%20of%20adults
- Ehizele A O, Ojehanon P I. Relationship between the concentration of volatile sulphur compound and periodontal disease severity in Nigerian young adults.
- Harvey-Woodworth, C N. Dimethylsulphidemia: the significance of dimethyl sulphide in extra-oral, blood borne halitosis. https://www.nature.com/articles/sj.bdj.2013.329#:~:text=About%2010%25%20of%20all%20genuine,origin%20of%20extra%2Doral%20halitosis
- Mayo Clinic Staff. Oral health:A window to your overall health.https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475
- Renvert S, et al. The Underestimated Problem of Intra-Oral Halitosis in Dental Practice: An Expert Consensus Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342603/#:~:text=1601%2D5037.2012.00546.x%20%5B-,PubMed,-%5D%20%5BCrossRef%5D%20%5BGoogle%20Scholar