The Harvard Medical School Family Health Guide
Teeth, Mouth, and Gums
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Common Dental Problems and Procedures

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Bad Breath: Causes and Treatments

While it’s not a life-or-death problem, bad breath (halitosis) causes embarrassment and self-consciousness for many people. When certain bacteria in the mouth eat, they release airborne compounds that cause bad breath. The bacteria prefer anaerobic, or oxygen-free, conditions. One reason most of us wake up with bad breath is that our mouths have been closed and sealed off from a fresh supply of oxygen. For the same reason, you may have bad breath if you haven't talked or eaten in a while.

Low salivary flow — like that in people with Xerostomia, or dry mouth — can also be a factor. Sluggish saliva gives bacteria a chance to feed on peptides and proteins. One thing that can help prevent bad breath is acidic saliva, because the bacteria responsible for bad breath prefer alkaline saliva. So, while eating sweets is bad for your teeth, it might be good for bad breath because glucose makes saliva acidic.

About 90% of bad breath comes from oral bacteria, but there are other causes. Tonsillitis and sinusitis are occasional culprits. On rare occasions, respiratory tract tumors can be a source. Just how often gastrointestinal problems cause bad breath is up for question. Some experts say that the thin, tube-like esophagus that carries food from the mouth to the stomach is normally collapsed, so smelly gas from a “bad stomach” couldn't escape. That doesn't preclude foul-smelling belches, however. Fetor hepaticus, or liver breath, is the term for bad breath peculiar to people with cirrhosis, a kind of liver disease.

If bad breath persists, the culprit may be certain foods (garlic or curry, for example), tobacco, a sinus infection, or gum disease. If you think your problem may be a sinus infection, see a doctor. And if it’s gum disease, a periodontist can help recommend a course of action. Diuretics, antihistamines, and some antidepressants can cause bad breath. If you take these drugs, keep breath mints on hand.

Rinsing, flossing, and brushing your teeth, gums, inside cheeks, and hard palate (the front part of the roof of your mouth) can eliminate morning breath. Use a soft-bristle toothbrush and fine, unwaxed floss.

October 2002 Update

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