Have you ever felt a moment of hesitation during a conversation, wondering if your breath might not be as fresh as you’d like? I think we all have! Bad breath, or chronic halitosis, can affect our social interactions and self-confidence. Fortunately, while the causes can vary, it’s usually treatable with the right approach.
Why do we get chronic bad breath?
Our mouth is a fascinating ecosystem teeming with hundreds of different bacterial species living on your tongue, teeth and gums. Most of these bacteria are beneficial and contribute to a healthy oral microbiome. However, the story takes a turn when food particles become trapped between teeth, gums and on the tongue’s surface. These trapped particles become feeding grounds for certain bacteria.
Food debris can get lodged in the crevices of our teeth, gumline and the rough texture of our tongue as we eat. When these trapped particles aren’t removed by an excellent oral hygiene routine, they become a delicious feast for bacteria. As these bacteria break down the food, they release various byproducts, which could almost be considered ‘bacteria farts.’ Unfortunately, volatile sulphur compounds (VSCs) abound in these byproducts and they have a very unpleasant odour. Rotten eggs or sulphurous gases have basically the same compounds in them. So, as unpleasant as it is, you could imagine the trapped food debris feeding tiny factories in your mouth which churn out smelly VSCs – the culprits behind bad breath!
The tongue plays a particularly serious role in this process. With its rough texture, it provides a prime breeding ground for bacteria. Tiny bumps on the tongue’s surface, called papillae, offer a perfect haven for bacteria to accumulate. These bacteria can form a biofilm, a sticky layer that’s difficult to remove with just brushing. Bacteria in this biofilm are particularly adept at breaking down proteins. The breakdown products of proteins often contain sulphur, which significantly contributes to the formation of VSCs and bad breath.
Who might experience chronic bad breath?
Chronic halitosis can affect anyone, regardless of age, gender, or overall health. However, certain factors can significantly increase your risk. Here’s a breakdown of the most common contributors:
- Oral hygiene habits: This is the leading cause. Inconsistent brushing, flossing, and tongue cleaning allow food particles and bacteria to accumulate, leading to the production of VSCs with unpleasant odours.
- Dry mouth (Xerostomia): Saliva plays a vital role in washing away food debris and bacteria, keeping your mouth moist, and aiding digestion. Conditions like Sjögren’s syndrome, certain medications, or even dehydration can cause dry mouth, creating an environment conducive to bad breath.
- Underlying medical conditions: Several medical conditions can contribute to chronic halitosis. These include:
- Sinus problems: Chronic sinusitis or postnasal drip can drain mucus into the back of the throat, harbouring bacteria and causing a bad odour.
- Acid reflux (GERD): Stomach acid backing up into the oesophagus can irritate the throat and contribute to bad breath.
- Diabetes: Uncontrolled diabetes can alter the body’s metabolism, leading to the production of ketones – a byproduct of fat breakdown that can be exhaled through the lungs and cause a fruity odour.
- Liver or kidney problems: These can alter the body’s ability to process waste products, potentially leading to a metallic taste or bad breath.
- Tonsillitis: Chronic inflammation of the tonsils can trap food debris and bacteria, contributing to bad breath.
- Dietary choices: Strong-smelling foods like garlic and onions can temporarily alter your breath due to the breakdown of certain compounds in your digestive system. Additionally, sugary or acidic foods can create an environment where odour-producing bacteria thrive.
- Smoking and tobacco use: Smoking not only dries out the mouth but also contributes to gum disease, both of which can worsen halitosis. Tobacco products can also leave behind a lingering unpleasant odour.
How to combat chronic bad breath
Chronic bad breath requires a comprehensive approach to effectively target the root cause and achieve lasting results. Here’s a breakdown of how each strategy tackles the issue:
Tongue cleaning: The tongue harbours a large population of bacteria, especially on the back where taste buds are located. These bacteria can contribute to bad breath by breaking down food particles and releasing odorous compounds. Using a tongue scraper or gently brushing your tongue with your toothbrush helps remove bacteria and freshen your breath.
Stay hydrated: Saliva plays a vital role in maintaining oral health. It washes away food particles and bacteria, neutralises acids produced by bacteria, and lubricates the mouth. When you’re dehydrated, saliva production decreases, allowing bacteria to thrive and exacerbate bad breath. Drinking plenty of water throughout the day keeps your mouth moist and flushes away food particles that could contribute to bad breath.
Dietary adjustments: Strong-smelling foods like garlic and onions contain volatile compounds that can be absorbed into the bloodstream and released through your breath. Limiting your intake of these foods can help reduce bad breath. Sugary and acidic foods can also contribute to bad breath by creating an environment conducive to bacterial growth. Incorporating fruits and vegetables rich in fibre into your diet can help stimulate saliva production, which can help combat bad breath.
Mouthwash (consult your dentist): While not a replacement for proper oral hygiene, mouthwash containing chlorhexidine can provide a temporary boost of freshness and help kill odour-causing bacteria. However, it’s important to consult with your dentist before using any medicated mouthwash for extended periods. Some mouthwashes can have side effects like staining teeth or disrupting the natural balance of bacteria in your mouth.
When to see your dentist
While the strategies outlined above can effectively combat most cases of chronic bad breath, there may be situations where professional intervention is necessary. If you’ve diligently followed these steps for a reasonable amount of time and your bad breath persists, it’s advisable to schedule an appointment with your dentist.
During your appointment, your dentist will likely discuss your medical history, current medications, and lifestyle habits. They will also perform a thorough oral examination to assess your oral health and identify any potential causes for your bad breath. Based on their findings, they can develop a personalised treatment plan, which might include:
Specialist referral: In some instances, chronic bad breath might be a symptom of an underlying medical condition, such as diabetes, sinus issues, or digestive problems. If your dentist suspects this, they might refer you to a specialist for further evaluation and treatment of the underlying condition. Addressing the root cause can often resolve the bad breath issue.
Gum treatment: If gum disease (periodontitis) is suspected as a culprit, your dentist will recommend appropriate treatment. This may involve scaling and root planing, a deep cleaning procedure that removes plaque and tartar buildup from below the gum line, where traditional brushing and flossing might not reach. In some cases, depending on the severity of gum disease, additional periodontal therapy might be necessary. Healthy gums are essential for fresh breath, and treating gum disease can significantly improve the situation.
Tailored oral hygiene routine: Your dentist might recommend adjustments to your existing oral hygiene routine to optimise its effectiveness in combating bad breath. This could involve using a toothpaste formulated specifically for plaque and bacteria control, incorporating a chlorhexidine mouthwash into your oral care routine for a temporary boost of freshness and additional bacterial control, or even recommending specific techniques for brushing and flossing to ensure you’re reaching all surfaces of your teeth and tongue.
Breathe easy, live confidently
Dealing with chronic bad breath can be frustrating, but you don’t need to put up with it! Your dentist is well positioned to recommend personalised approaches that will likely incorporate some of the strategies outlined above, so you can achieve fresher breath and regain your confidence. Including regular dental checkups in your oral hygiene routine will help you to address any underlying health issues and modify unhealthy lifestyle choices. If bad breath continues to be a problem, be sure to chat about it at your next dental checkup. Keeping your dentist informed about your concerns can be very helpful – they are more than willing to partner with you in achieving fresh breath and a smile you’ll be proud of.
