Oral health considerations

Halitosis: Causes and treatment for bad breath

Halitosis or bad breath is an unpleasant condition that generates shame and social problems. The causes and treatments of this problem can be diverse.

Halitosis, bad breath or oral odor are all synonymous with the same condition, a common oral problem that affects 25% of the general population. Halitosis has a great social repercussion since it causes embarrassment to most patients and affects their daily life. The causes of this problem can vary, as can its treatments.

1) What is halitosis?

Halitosis is an unpleasant odor coming from a person's breath, a problem that has a great social impact. In addition, it can be an indication of some major ailment either in the mouth or in another part of the body. One of the added complications of halitosis is that it may not be perceived by those who suffer from it, making it difficult to find a solution. The causes and treatment of this problem can vary.

2) What causes bad breath?

Halitosis is a frequent symptom of multiple diseases, with those of intraoral origin being the most common. The problem is found in the mouth in about 90% of all cases of halitosis, being the direct cause of bacteria located on the back of the tongue. This has a greater amount of bacterial load than any oral tissue and makes the largest contribution to the total number of bacteria present in saliva. Food, bacteria, white blood cells and desquamated epithelial cells are impacted there and in their degradation volatile sulfur compounds are formed causing the aforementioned bad smell.
Most of these microorganisms present in halitosis are related to periodontitis, so gum disease is closely related to this problem. People with a healthy mouth can also suffer from halitosis, although, contrary to what many people believe, less than 2% of patients with bad breath originate from a stomach problem.

3) Most common causes of halitosis

What are the specific elements that can generate this oral problem? It is important to distinguish between pathological halitosis (caused by some disease) and physiological halitosis (whose origin is not pathological).

a) Causes of physiological halitosis

We speak of physiological halitosis when bad breath is not caused by any disease. Within this category we find:

Morning bad breath

The flow of saliva is reduced at night and, with it, its detergent effect, which facilitates the growth of anaerobic bacteria. The problem disappears as soon as routine hygiene measures are carried out.


Breath worsens over the years; it begins after adolescence and reaches its maximum expression during old age. The salivary glands are less efficient during old age, even with an adequate level of oral hygiene.

Smoking causes halitosis

Tobacco causes bad breath, reduces tissue oxygenation and irritates them, stains teeth and is harmful to health in general, even in passive smokers. In addition to all this, smokers are more likely to suffer from periodontitis or gum disease and have a higher risk of developing oral cancer.


What we eat affects the air we exhale, especially foods like garlic, onions, or alcoholic beverages. Also, if you don't brush and floss your teeth daily, food debris can remain in your mouth, accumulating bacteria that promote halitosis.

Hunger can also cause bad breath

Not only can certain types of food cause bad breath, but fasting can have similar consequences. In fact, dieters can develop foul breath if they eat infrequently.

Dental prosthetics

Dentures, bridges, and orthodontic devices are especially prone to food debris buildup, requiring an extra level of hygiene. The prosthesis must be removed and thoroughly cleaned daily or by a qualified professional from time to time.

b) Oral causes of pathological halitosis

It is recommended to visit your periodontist for check ups and eventual treatment.

In our clinic we have a specialized department in Halitosis with which we can solve your bad breath problems.

Periodontal disease, the main cause of halitosis

Persistent bad breath or a bad taste in your mouth can also be one of the signs of gum disease, caused by bacteria that build up in plaque. This is the most common cause, but a percentage of patients with periodontal disease do not have halitosis.

Inadequate oral hygiene

Poor oral hygiene will end up developing a presence of plaque, cavities, accumulation and putrefaction of food debris that contribute to this microbial degradation and therefore bad breath. The tongue is the place where most of these bacteria are located, being the most frequent origin of halitosis in people who do not suffer from periodontal disease.

Xerostomia or dry mouth and bad breath

One of the possible causes of halitosis is xerostomia or dry mouth, caused when the flow of saliva decreases. Food remains are not eliminated without enough saliva, which usually generates a greater volume of plaque on the teeth and on the tongue and its consequent bad smell. Xerostomia can be caused by excessive talking, lack of hydration, continuous breathing through the mouth, consumption of a certain type of medication, or it can be the consequence of a systemic disease such as Sjögren's Syndrome, diabetes or some other problem. in the salivary glands.

Parotid gland problems

The parotid glands are responsible for producing much of the saliva, so any condition that affects them can be closely related to bad breath. Here we include mumps (mumps), sialolithiasis, saliodenitis or parotid tumors, among others.

Stomatitis and glossitis

The bad smell is caused by fissures or devitalized tissues and decreased salivary flow in those patients affected by this condition.

Tonsil problems

The tonsils can harbor traces of food and pathogens that can calcify forming the so-called tonsilloliths. These produce a characteristic foul odor.

Other oral problems causing halitosis

Dental abscess or phlegmon, peri-implantitis (infection of an implant), pericoronaritis (typical infection around a wisdom tooth), recurrent oral ulcerations, herpetic gingivitis, pharyngitis and oral candidiasis are other diseases whose relationship with halitosis has been demonstrated

Some drugs can cause bad breath

There is also a close relationship between the consumption of a certain type of medication and bad breath. Among the side effects of some drugs, there is xerostomia, candidiasis or thrush, bleeding gums, oral ulcers or hairy tongue, conditions that can cause bad breath problems.

c) Extraoral causes of pathological halitosis

Only 10% of the causes of halitosis are extraoral, but they should not be overlooked because they can be the sign of a systemic disease:

Halitosis caused by nasal and perioral reasons

If the smell that comes out of the nose is worse than that of the mouth, it may be indicative of infections, such as sinusitis, or problems that affect exhaled air or mucous secretions, such as polyps or also due to rhinitis.

Halitosis from digestive diseases

This type of halitosis is not so common, although it has always been thought that it could be one of its main triggers. Digestive diseases that can affect breath include Zenker's diverticulum, dyspepsia, gastroesophageal reflux, hiatus hernia, weakened esophageal sphincter, gastrointestinal bleeding, bezoar, Helicobacter Pylori infection, gastric cancer or gallbladder disease, among others.

Respiratory diseases

Some diseases that affect the respiratory system such as bronchitis, pneumonia, or tuberculosis can affect the smell of the breath.

Bad breath caused by systemic diseases

Other systemic diseases that also have a negative influence, such as diabetes, kidney failure, severe liver dysfunction, some types of carcinoma and some autoimmune diseases such as the aforementioned Sjörgren's Syndrome and rheumatoid arthritis.

Halitosis caused by anatomical problems

Craniofacial abnormalities such as cleft palate or cleft lip can cause bad breath.

Halitosis caused by vitamin deficiencies

The lack of certain vitamins such as A and B1 2, or minerals such as iron or zinc can cause xerostomia, with the consequences described above.

Misperception of halitosis or pseudohalitosis

Certain neurological diseases can alter the perception of odors. There may also be psychological alterations with which you can perceive a bad smell on your breath that other people are not able to detect and that is not diagnosable.


It is an excessive fear of suffering from halitosis. In these cases, the patient believes that bad breath persists despite having received the appropriate treatment. May require psychological treatment.

4) How is halitosis diagnosed?

The first thing that is done is a complete medical history to rule out systemic diseases, medications, etc. In addition, a complete oral examination is carried out, which includes soft tissues, detection of possible cavities or tartar, periodontal probing to detect possible gum diseases such as gingivitis or periodontitis, X-rays, etc. If any possible dental cause is detected, treatment will proceed.
Once possible dental causes have been eliminated, the patient is reassessed. If bad breath persists, then a test will be carried out with a device called a gas chromatograph, which detects volatile compounds in the breath that may be the cause of bad breath, such as sulfur compounds. This device detects various types of gasses, which can come from the accumulation of bacterial flora in teeth, gums and mucous membranes, characteristic of cases with poor oral hygiene; of periodontal pockets associated with germs responsible for periodontitis; or extraoral causes such as upper respiratory tract, digestive system, hormonal disorders, etc. Depending on the result, the possible origins will be investigated, which may include consultation with other medical professionals such as internists and otolaryngologists.

5) Treatment for halitosis

Halitosis can be treated by maintaining proper dental and tongue hygiene in most cases. Some recommendations:

a) Proper dental hygiene to combat bad breath

Halitosis can be treated by maintaining proper dental and tongue hygiene in most cases. Some recommendations:

  1. You will need to brush your teeth after every meal.
  2. You should also brush the cheeks and the tongue with the brush without toothpaste, trying to reach as far back as possible. This operation can be carried out more easily by using a tongue cleaner or scraper instead of the brush (available at any pharmacy).
  3. It is also advisable to floss once a day to remove food debris and plaque that may have remained between the teeth.
  4. The professional may tell you to use antiseptic mouthwashes such as chlorhexidine in some cases for a certain time. Chlorhexidine is the most effective product against plaque, although toothpastes, which contain fluorides, zinc or triclosan, also seem to have a beneficial effect in reducing oral malodour for a limited period of time.
  5. If you eat away from home, you must clean as indicated as soon as you have the opportunity to do so. If there is no other remedy, it is possible, exceptionally, to dispense with the midday cleaning, but in no way should they stop practicing the morning and night cleaning.
  6. It is also convenient to have a professional oral cleaning every six months approximately, depending on the needs of each patient.
  7. If you wear removable dentures, be sure to remove them at night and clean them thoroughly before replacing them the next morning.

Do you suffer from periodontal disease or any other problem in the mouth? Put a remedy

Periodontal disease is one of the main causes of bad breath, but other oral diseases such as pericoronitis, deep caries or dental abscess can lead to it. Therefore, visiting the dentist is essential to know the state of oral health and solve any problem. Keep in mind that periodontal disease can have very serious consequences on oral health and even on the rest of the body, therefore there are many reasons to prevent it and prevent it from developing.

c) Diet, a great ally against bad breath

Having a proper diet can help us combat this problem in addition to dental hygiene. An eminently vegetarian diet, low in fat and meat, favoring the consumption of fruits and vegetables is recommended. It also recommends limiting those foods that cause bad breath such as garlic, onion, dairy products and, of course, avoiding alcohol and tobacco.

d) Don't let your mouth dry out

The lack of saliva is closely related to bad breath as we have already mentioned. If you suffer from this problem, it is important to avoid very sweet or salty foods and caffeinated drinks and it is recommended to drink plenty of water. You can promote the production of saliva by consuming sugar-free gum or candies. If you are taking any medication that produces xerostomia, you should try to find an alternative. For very extreme cases, the use of artificial saliva may be prescribed.

e) What if the halitosis does not come from the mouth?

We have already seen that halitosis is usually related to oral problems, but not always. If your bad breath is caused by an extraoral disease, it should be studied by your family doctor or referred to the corresponding specialist to determine the appropriate treatment for your case.

f) Specialized treatment against halitosis in A Coruña

In our clinic we have a department specialized in halitosis with which we can solve your bad breath problems. For the treatment of halitosis it is important to make a correct diagnosis of the origin of bad breath. Based on these results, the specialist will prepare a treatment plan that may include the use of different drugs, and where necessary, dental treatment or complementary surgery (rhinosinusal, tonsillar, gastric, etc.). It is recommended to visit your periodontist for check-ups and eventual treatment.

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