Bad Breath - Halitosis 

Introduction
Everyone experiences bad breath (halitosis) at one time or another, but how do you know if you need more than just a breath mint?  Poor oral hygiene or something that you eat or drink are common causes of bad breath.  It is usually remedied with good oral care or dietary changes.  However, persistent bad breath can be the sign of an underlying dental or medical condition.  You should consult your dentist or doctor if your bad breath continues despite your best efforts.

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Anatomy
Healthy teeth and gums are free of decay and infections.  Healthy tissues lining your sinuses, nose, mouth, and throat are naturally moist and do not over or under produce secretions. 

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Causes
There are many temporary or persistent causes of bad breath.  Bad breath most frequently results from poor tooth brushing and oral care.  Temporary bad breath may simply occur because of the food or beverages that you consumed, such as spicy foods, garlic, coffee, or alcohol.  However, bad breath can be the sign or symptom of a medical or dental condition.
 
Mouth, Nose, Throat Conditions
Sinusitis, tonsillitis, strep throat, mononucleosis, bronchitis, and canker sores are all caused by infections that can cause nasal discharge, sputum, and bad breath.  Zenker’s diverticulum is a throat condition that causes a pouch to form in the lower throat.  Food that becomes trapped in the pouch can cause bad breath.  In young children, foreign objects in the nose can cause both nasal drainage and bad breath.
 
Cigarettes and Chewing Tobacco
Smoking cigarettes and using chewing tobacco dry out your mouth and can contribute to gum disease and bad breath.
 
Medical Conditions and Diseases
There are a variety of medical conditions and diseases that can cause bad breath, some with distinct odors.  For example, diabetes or severe dieting can cause fruity smelling breath, liver failure can cause fishy smelling breath, and kidney failure can cause urine-smelling breath.  Lung infections produce a very bad odor, and breath that smells like feces can be caused by vomiting or bowel obstruction.  Other causes of bad breath include dehydration, certain cancers, certain prescription medications, zinc deficiency, and stomach or digestive tract disorders.
 
Dental Conditions
Untreated dental conditions, such as impacted  or infected teeth, and poor oral care can cause bad breath. An overgrowth of plaque on the teeth or gums is a main cause of gum disease (periodontal disease) and tooth decay that can lead to bad breath.  The sugar or starch in foods that you eat increase plaque formation. Smoking, chewing tobacco, teeth grinding, and poor fitting dentures can make the condition even worse.  Fortunately, good tooth brushing, flossing, and oral care can help prevent plaque buildup.
 
Dry Mouth
Saliva helps to keep your mouth moist and clean.  People that smoke, take certain medications, breathe through their mouth while sleeping, or have salivary gland disorders may be vulnerable to bacteria build up on the tongue or in the mouth.  This causes what is commonly referred to as “morning breath.”

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Symptoms
You may notice bad breath yourself or someone may point it out to you.  Certain medical conditions can cause breath to smell distinctively like fruit, urine, fish, or feces.

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Diagnosis
You should contact your doctor or dentist if you experience ongoing bad breath that is not resolvable with home treatments, such as good tooth brushing, gum care, changes in diet, or smoking cessation.  Your doctor or dentist will review your medical history, examine you, and conduct some tests to determine if you have an underlying medical condition.

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Treatment
Bad breath that is caused by poor oral hygiene may be corrected with regular tooth brushing, flossing, and mouth rinsing.  Regular dental visits may help prevent tooth decay.  Avoiding certain foods, beverages, and tobacco products may help improve your breath as well. 

If you are diagnosed with an underlying medical condition that causes bad breath, your doctor will provide you with specific treatment for your condition or refer you to an appropriate specialist.

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Prevention
You may prevent bad breath by brushing your teeth and flossing regularly.  Attend regular preventative dental appointments.  Eliminate tobacco and alcohol use.  Avoid foods or beverages that make your breath smell bad.  Breath mints or mouth rinses may temporarily resolve breath problems, but you should contact your doctor if you experience an ongoing problem with bad breath.

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Am I at Risk
Everyone is at risk for bad breath.  People at greater risk practice poor oral hygiene or have one of the causative factors listed above.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.