Home Symptoms Bad breath (halitosis): causes and help

Bad breath (halitosis): causes and help

by Josephine Andrews
Published: Last Updated on 365 views

Bad breath (med.: halitosis, foetor ex ore ) rarely indicates a serious health problem, but it is extremely unpleasant for those affected. Other people often avoid their proximity, which can go as far as social isolation. Initially incomprehensible to many of those affected, as they often do not even notice the bad smell themselves. Bad breath is usually caused by poor oral hygiene. Then the bacteria responsible for bad breath multiply. Read here how bad breath develops, what causes it and what you can do about it.

quick overview

  • Description : Unpleasant smelling odor of exhaled air
  • Causes : Mostly insufficient oral hygiene and its various consequences (food residues between the teeth, dental plaque, tongue coating, tooth decay , gingivitis, periodontitis , etc.). Other causes are, for example, reduced salivation (e.g. when snoring, fasting or in old age), inflammation of the oral mucosa and tonsillitis, nasal polyps , chronic inflammation of the paranasal sinuses (sinusitis), heartburn or reflux disease, esophageal diseases, bronchitis, pneumonia, tumors in the mouth or throat, uncontrolled diabetes (diabetic coma ), hormonal fluctuations (in women), kidney failure, poisoning, medication.
  • When to the doctor? If the bad breath persists for a long time and cannot be eliminated by thorough brushing of teeth or mouthwash.
  • Tips : e.g. brush your teeth thoroughly and regularly , scrape your tongue, have dental problems (bad fillings, tooth decay, etc.) treated by the dentist, chew coffee beans (if you have bad breath caused by your stomach), chew aniseed or fennel seeds, chew parsley (if you smell garlic), lemon juice (with reduced salivation).

Bad breath: description

Unpleasantly smelling breath from the oral cavity is commonly referred to as bad breath. It rarely has serious causes. There are often social problems associated with it. Because the bad breath sufferer usually has no idea that he is forcing his fellow human beings at a distance as soon as he opens his mouth in the truest sense of the word. In addition, many do not dare to talk to those affected about their bad breath. Most of the causes can be eliminated quickly.

Bad breath is not the same as bad breath

Strictly speaking, medicine distinguishes between halitosis and foetor ex ore.

  • Foetor ex ore is the bad odor when exhaling, which is only perceptible when speaking or with the mouth open . The cause of bad breath lies in adjacent areas such as the oral cavity or the tonsils.
  • Halitosis differs in that the foul odor can also be smelled through the nose when exhaling . Only about ten percent of all those affected suffer from this form. The causes are not only to be found in the oral cavity, but especially in the nose and throat area.

formation of bad breath

Foetor is mainly caused by bacteria. And there are many of them in our oral cavity – around 800 to 1000 different types of bacteria are at home there. Food components and cell debris offer them optimal living conditions. As so-called plaque, the microorganisms sit noticeably on the tooth surfaces, where they usually fall victim to the toothbrush. They thrive particularly well in places that are easily overlooked in daily oral care: the spaces between the teeth and especially the tongue with its large, deep surface offer the bacteria perfect places of refuge.

Some types of bacteria release volatile sulfur compounds, fatty acids and polyamines when they digest food. These substances cause bad breath. The volatile sulfur compounds in particular are odour-active. They are produced by microorganisms that occur more often in diseases of the oral cavity such as periodontitis. Diseases of the periodontium are often accompanied by unpleasant bad breath.

Our saliva works against bad breath . It washes around the teeth and dissolves leftover food along with bacteria, fungal spores and viruses , which are then swallowed. In addition, the saliva contains antibacterial substances and thus protects the tooth enamel.

Too little saliva also explains the typical bad breath after waking up in the morning. When we sleep, we produce less saliva and swallow less often. Strict dieting and snoring also dry out the mouth and make it easier for bacteria to grow.

frequency of bad breath

Many people avoid foods containing onions and garlic because they cause bad breath that can last up to 72 hours. But the bad breath after eating certain foods is usually only temporary. 

This is different with permanent bad breath. It is estimated that around 25 percent of the population suffer from it. With increasing age, the number of those affected increases again. The reason for this lies in the teeth: many older people have cleaned teeth or wear dentures . Both offer the bacteria a larger surface to attack. For example, every second person over the age of 60 suffers from bad breath.

Imaginary bad breath

In a quarter of all patients who are convinced they suffer from bad breath, this cannot be detected. This mostly psychological phenomenon is called pseudohalitosis or halitophobia .

Bad breath: causes and triggers

Around 95 percent of all causes of bad breath are local to the mouth or throat and are the result of inadequate oral hygiene:

Foetor ex ore: causes

  • Plaque : Bacteria that can cause bad breath collect in hard-to-reach places or between teeth.
  • Tongue Coating : Most bacteria live on the tongue. Cleaning them is a good remedy for bad breath.
  • Poor denture cleaning: Even removable dentures should be cleaned thoroughly every day to prevent bad odors.
  • Food and stimulants : Onion , garlic , alcohol, smoking and coffee cause bad breath.
  • Food debris in the mouth : Often undetected and small, food debris can get caught between teeth or even on the tonsils or down the throat and cause bad breath.
  • Reduced salivation : The mouth dries out as a result of snoring, breathing with the mouth open, but also with increasing age or when fasting. Diseases of the salivary glands such as Sjögren’s syndrome also reduce saliva production. In addition to an uncomfortably dry mouth and problems eating or speaking, bad breath often develops.
  • Inflammation of the oral mucosa : Especially in children, a herpes infection occasionally spreads to the mouth and causes the so-called herpetic gingivostomatitis (mouth rot).
  • Changes in the oral mucosa : STDs such as syphilis also show up as sores in the oral mucosa, which are ideal places for bacteria to cling.
  • Tonsillitis : Especially with chronic tonsillitis, deposits form that cause an unpleasant odor.
  • Tumors in the mouth and throat ( squamous cell carcinoma ) can also be the reason for bad breath.
  • Fungal infection : Infection with Candida albicans leads to bad breath plaque.
  • Caries (tooth decay): Holes in the teeth and in the enamel of the teeth provide ideal places for bacteria to nest. Bad breath usually comes back again and again, even a few hours after brushing your teeth.
  • Gingivitis : A slight inflammation of the gums can still be reversed with regular oral hygiene.
  • Periodontitis: The periodontium can become inflamed as a result of a predisposition, careless brushing of teeth or diseases such as diabetes. Bacteria then accumulate in the enlarged gum pockets, which can cause bad breath.
  • Abscesses and fistulas: Teeth with inflamed root canals often cause pain and accumulation of pus, which in turn can lead to bad breath.


If the breath from the nose also smells unpleasant, the cause of bad breath is often in the paranasal sinuses or in the throat. Sometimes the reason is also a serious physical illness (systemic illness). Common causes include:

  • diets and fasting cures
  • nasal polyps
  • Foreign bodies in the nose – you should think about this, especially with small children
  • chronic sinusitis
  • chronic runny nose , for example as a result of nose surgery, frequent drug use or radiation treatment for cancer in the face
  • Tumors in the nasopharynx
  • Respiratory diseases : bronchitis, pneumonia, bronchiectasis (saclike enlargement of the bronchi), lung abscess
  • Poisoning : With phosphorus or selenium the breath smells of garlic, with hydrocyanic acid of bitter almonds.
  • Medicines : Certain medicines promote the colonization of the oral mucosa with fungi or bacteria or dry out the mouth.

Far less often than previously assumed, bad breath comes from the stomach:

  • Heartburn, reflux disease : A sour bad breath is more typical here.
  • Esophageal diseases : In the rare case of Zenker’s diverticula (bulging of the esophageal mucosa), leftover food can spread bad breath. However, such symptoms can also be caused by tumours, inflammation and movement disorders of the esophagus (achalasia).

Rare causes of bad breath are systemic diseases:

  • liver cirrhosis
  • kidney failure
  • uncontrolled diabetes mellitus: diabetic coma with breath smelling of acetone (smell of rotting fruit)
  • acute rheumatic fever

In women , hormones can also affect breathing – for example during menstruation, pregnancy or menopause.

What helps against bad breath?

  • Prevention instead of fighting : Don’t let bad breath develop in the first place – brushing your teeth daily eliminates leftover food and odour-active bacteria.
  • Off to the dentist: Halitosis is usually based on superficial causes in the area of ​​the teeth. Caries, old fillings, leaking crowns or bridges are ideal breeding grounds for bacteria. Since these areas cannot be reached with a toothbrush, the bad breath is permanent, but can be remedied with new restorations.
  • Tongue scraping : Deep folds in the tongue are the mouth’s reservoir of bacteria. Special tongue scrapers gently remove the tongue coating. But brushing the tongue with an ordinary toothbrush also gives good results.
  • Chewing coffee beans : Chewing coffee beans can help with bad breath caused by the stomach.
  • Nature between your teeth : Chewing aniseed or fennel seeds also cleans your breath. Fresh parsley is said to help against the smell of garlic.
  • Lemon against dry mouth : If you suffer from dry mouth and bad breath due to reduced salivation, lemon juice stimulates the salivary glands in most cases.
  • Mouthwash : Especially antibacterial mouthwashes with chlorhexidine can prevent the growth of microorganisms and freshen breath for a short time. But even simple sage tea has a disinfecting effect as a mouthwash and is a proven home remedy for bad breath.

Peppermints and chewing gum containing sugar are not suitable for bad breath! Rather, the carbohydrates they contain promote bacterial growth and thus the development of bad breath.

Bad breath: when do you need to see a doctor?

Bad breath mostly has harmless causes that can be eliminated with thorough oral care. However, if your symptoms persist for a longer period of time and cannot be controlled by brushing your teeth or rinsing your mouth, you should see your family doctor or dentist.

Bad breath: what does the doctor do?

The family doctor or dentist will first examine the mouth and throat. In most cases, the cause of halitosis or foetor ex ore can be found here – whether inflamed tonsils, a runny nose with a sinus infection or diseases of the teeth or gums.

The doctor’s most important instrument is his nose . He can judge the intensity of the smell at different distances. In addition, various odors indicate possible illnesses: in the case of kidney failure, for example, the breath smells slightly of urine, and purulent infections are also unmistakable. Although technical methods such as sulfur detectors are rarely used, they can convince doubting pseudohalitosis patients.

A detailed physical examination must also be carried out in order to rule out diseases of the kidneys , liver, stomach or metabolism (e.g. diabetes mellitus) as the cause of bad breath. It may be necessary to involve doctors from other disciplines.

treatment of bad breath

If the cause is in the mouth, the foetor can be eliminated with simple means:

  • A professional tooth cleaning removes plaque in places that are difficult to reach yourself.
  • Removing tooth decay, damaged fillings, crowns or bridges eliminates nesting sites for other bacteria.
  • Diseases of the periodontium or gums may need to be treated with antibiotics.

For all other causes of bad breath, the doctor will also suggest a suitable therapy. For example, in the case of nasal polyps, surgical removal can be useful.

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