Michael Hunter, MD on Medika Life

Here’s What You Should do to Dodge Bad Breath (Halitosis)

HALITOSIS (BAD BREATH) CAN BE EMBARRASSING and anxiety-producing. Today we explore ways you can dodge bad breath (halitosis).

Go to your local store, and you will likely find the shelves chock full of products aiming to fight bad breath. Mints, gum, mouthwashes, and more. But each of these approaches to halitosis is temporary and doesn’t address the root cause.

Here are the American statistics for gum:

And here are mouthwash numbers from Scotland:

The prevalence of mouthwash use declined with age. Women used mouthwash more than men, and never-smokers appeared less likely to use mouthwash (40 versus 53 percent). Daily alcohol consumers tended to use mouthwash daily more than abstainers (42 versus 37 percent).

Halitosis is common, affecting nearly one in three individuals around the globe. A research study that combined the results of 13 medical journal articles reported that halitosis affects about 32 percent of the population.

Halitosis (bad breath) causes

A primary cause of halitosis is the buildup of volatile sulfuric compounds in the mouth. Anaerobic bacteria, feeding on the food we leave behind, produce these odor-producing substances.

Potential causes of halitosis include the following:

  • Poor dental hygiene. Skip the proper, regular brushing and flossing (and dental cleanings), and you leave food in your mouth. This detritus creates a breeding ground for bacteria. Moreover, the food around your tongue, teeth, and gums can rot. The result? An unpleasant odor in the mouth.
  • Certain foods. Diet is associated with our oral health. In addition, our bodies absorb garlic, onions, and other consumed food. Until the food leaves the body, it can affect breath.
  • Tongue bacteria. Certain bacteria interact with food’s amino acids, producing smelly sulfur compounds.
  • Dry mouth (xerostomia). With decreases in saliva, the mouth cannot optimally cleanse itself. Food debris is left behind. Xerostomia can be the product of some medicines, radiation therapy that hits salivary glands, a primary salivary gland disorder, or always mouth breathing.
The radiograph shows bone loss between a tooth’s roots (black region). The spongy bone has receded due to an infection under the tooth. https://en.wikipedia.org/wiki/Periodontal_disease
  • Periodontal disease. A primary symptom of periodontal disease is bad breath. Please seek immediate care from an oral health professional.
  • Tobacco products. Consume cigarettes, cigars, smokeless tobacco, or snuff, and you stain your teeth while putting yourself at risk of numerous diseases. In addition, tobacco products cause bad breath, periodontal disease, irritated gums, taste loss, and more.
  • Certain health conditions. The problems that can cause bad breath include nose, windpipe, or lung infections. Chronic bronchitis, postnatal drip, chronic sinusitis, diabetes, a gastrointestinal disorder, or a liver or kidney disorder can cause halitosis. Please see your healthcare provider for an evaluation.

The main halitosis symptom is a foul odor from the mouth that is considered beyond socially acceptable. This odor may worsen in the morning or after drinking coffee, smoking, or eating foods such as garlic.

Diagnosing halitosis begins with a history and physical examination. A clinician checks the mouth to see if a cause (such as infection) is present. Diagnosing halitosis begins with a history and physical examination. The mouth is checked to see if a cause (such as infection) is present.

Halitosis (bad breath) conventional treatment

The Mayo Clinic (USA) has some recommendations about reducing the chances you will suffer from halitosis (bad breath):

  • Brush your teeth after you eat. In addition to my home toothbrushes, I have a toothbrush at the office to use after eating. Toothpaste with antibacterial properties can reduce bad breath odors.
  • Floss at least once a day. Get those tiny food particles and plaque out from beneath your teeth.
  • Brush your tongue. Your tongue has bacteria, so carefully brushing it may reduce odors. Some benefit from a tooth scraper, while others use a toothbrush with a built-in tongue cleaner.
  • Clean dentures or dental appliances. If you wear a denture or bridge, clean it thoroughly at least once daily (or as directed by your dentist). If you have a mouth guard or dental retainer, clean it each time before you put it in your mouth. Your dentist can recommend the optimal cleaning product.
  • Avoid dry mouth. Consume lots of water (not coffee, alcohol, or soft drinks). Try chewing gum or sucking on candy (ideally sugarless) to stimulate saliva. For chronic dry mouth, your physician or dentist may recommend an artificial saliva preparation or an oral medication that stimulates saliva flow.
  • Adjust your diet. Avoid foods such as garlic and onions that can cause bad breath. Eating a lot of sugary foods is also linked with bad breath.
  • Regularly get a new toothbrush. Change your toothbrush every three or four months, and choose a soft-bristled toothbrush when it becomes frayed.
  • Schedule regular dental checkups. See your dentist regularly — typically twice annually — to have your teeth or dentures cleaned and examined. Your care provider may also suggest that you use an antimicrobial mouth rinse.
Photo by Nastya Dulhiier on Unsplash

Halitosis (bad breath) and probiotics

A new meta-analysis discovered that consuming four probiotics can reduce bad breath-causing compounds, at least in the short term.

The beneficial probiotics (for the nerds amongst us) include Lactobacillus salivariusLactobacillus reuteriStreptococcus salivarius, and Weissella cibaria. These substances, present in fermented foods, may benefit gut health. Probiotics may work magic by eliminating smelly volatile sulfur compounds (VSCs) buildup for up to four weeks.

Researchers recently published the study results in BMJ Open. For the research investigation, they analyzed seven randomized controlled trials. You might be surprised at how scientists detected halitosis levels. They had subjects close their mouths for one minute before exhaling into an evaluator’s nose from 10 centimeters away.

They then measured volatile sulphuric compounds using a halimeter, an instrument designed to measure gases.

Compared to control groups, subjective halitosis scores dropped by 58 percent. The volatile sulfuric compound scores dropped by about one-quarter (26 percent).

The probiotic-related improvements in volatile sulfuric compound scores did not last more than four weeks. However, the subjective improvements continued beyond four weeks.

One analyzed study showed probiotics led to less plaque buildup at 12 weeks. The meta-analysis authors appropriately note that the studies have varying methods, data reported, and bias risks.

There were significant differences between the studies regarding methodology, data reported, and risk of bias in their assessments.

Halitosis (bad breath) and food

Many individuals try to improve bad breath with gum chewing, but there may be more effective long-term strategies. Chewing gum without food may increase the chance of developing gastroesophageal reflux (GERD; heartburn).

Probiotic supplements may help reduce halitosis (bad breath), but what about consuming probiotic-containing foods?

Some sources of the probiotics Lactobacillus salivarius, Lactobacillus reuteri, and Streptococcus salivarius include fermented foods such as kefir, yogurt, kimchi, or pickled beetroot.

Photo by Ryutaro Uozumi on Unsplash

Other good food sources of probiotics include miso, real sauerkraut, sourdough bread, and fermented cheeses. How about kombucha? It is a type of sweetened black tea that uses fermentation to promote the growth of good bacteria. Consume any of these goods, and you are on your way to favorably changing your gut microbiome. Weissella cibariais bacteria in these foods allow them to ferment.

Certain health conditions and foods can cause bad breath, and many can improve their breath with proper dental hygiene. If simple self-care approaches daily to solve the problem, please see your dentist or other healthcare providers to ensure a more serious condition is not causing the halitosis.


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Michael Hunter, MD
Michael Hunter, MD
I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

Michael Hunter, MD

I received an undergraduate degree from Harvard, a medical degree from Yale, and trained in radiation oncology at the University of Pennsylvania. I practice radiation oncology in the Seattle area.

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