Halitosis (Bad Breath): Symptoms, Causes, Diagnosis, Treatment and prevention

A women whos smelling her mouth to check if she have Halitosis(bad breath)


Bad breath, also known as halitosis, can be embarrassing. People have all been there.
After eating certain foods or having a dry mouth, the breath may smell bad. However, there is a difference between an occasional bad breath and a chronic bad breath.

Halitosis is a chronic problem, and in some cases, certain foods, habits and health conditions cause bad breath. It’s a common problem among individuals and sometimes,
it can’t just be solved by mints, a good brushing, and mouthwash. This condition often lingers after a tuna sandwich or throughout the day. When chronic bad breath status for long periods, it might signal an underlying health condition.


The types of bad breath odors vary depending on the underlying cause of the condition.
In some people, they are aware of their health problem while others may not know that they had bad breath. The most common symptom is a foul smell in the mouth when a person talks or breathes.

Since it’s hard to detect if you have bad breath, it’s important to ask others to confirm your questions. Bad breath may seem simple and manageable, but it is important to know that certain diseases can also cause it.

If you think you have bad breath or a friend or relative has confirmed it, you need to review your oral hygiene habits. If you have tried practicing good oral hygiene and still have the bad breath, you may want to visit your dentist for a thorough checkup.

It is also important to seek medical help to determine if an underlying medical condition has caused the halitosis.


Halitosis or bad breath can be caused by a wide range of factors, including:


The initial phase of digestion happens in the mouth. The breakdown of food particles in the mouth and around the teeth can increase the presence of bacteria and cause a foul odor. If you’re fond of eating certain foods like garlic, onions and other spices, you can have bad breath. After digestion, the food can enter the bloodstream and eventually reach the lungs. This will affect your breath.

Poor dental hygiene

People who do not brush or floss daily are at a higher risk of developing halitosis. If you don’t brush or floss at least twice a day, the food particles could remain in the mouth, causing bad breath.

A plaque, or a colorless film of bacteria forms on the teeth and eventually, if these are not cleaned regularly, they can irritate the gums and cause cavities on the teeth. Deep pockets of gum disease and cavities give the bacteria that cause bad breath to have more areas to proliferate and hide.

Mouth, nose and throat infections

When there is an infection in the mouth, nose, and throat, these may lead to postnasal drip. As a result, bad breath could be observed. The bacteria feed on the mucus the body creates when warding off an infection, leaving the breath malodorous.

Dry mouth

Saliva is important because aside from aiding digestion of food, it helps cleanse the mouth. It removed the food particles that may cause bad breath. When a person has dry mouth or otherwise called xerostomia, it may lead to bad breath because there is a reduced amount of saliva in the mouth. In the morning, most people have bad breath or “morning breath”. This is because, during sleep, the mouth is dry.


Using tobacco products causes a foul mouth odor. Smokers are also more likely to develop gum disease, which could also lead to halitosis.


Certain medications can produce bad breath by causing dry mouth. In some cases, drugs can be broken down in the body and it releases chemicals that can be noticed on the breath.

Infections in the mouth

Certain infections like surgical wounds from extractions or oral surgeries may lead to bad breath. Moreover, when you have gum disease, mouth sores or tooth decay, these may lead to halitosis.

Other causes

Some diseases like cancer, metabolic disorders, chronic reflux of stomach acids, and other conditions like liver and kidney disease may all lead to bad breath.

Mouth breathing

Mouth breathing accounts for 40 percent of children with bad breath. Mouth breathing leads the drying if the mucosa because the water from the saliva evaporates.

Respiratory diseases

In respiratory diseases, the excessive mucus and phlegm production and accumulation attract bacteria, leading to halitosis.

Systemic conditions

Various medical conditions influence the odor on the patient’s breath:

  • Diabetes – citrusy or fruity scent
  • Kidney problem – ammonia scent
  • Asthma or cystic fibrosis – acidic smell
  • Nasal malodor – Smells like cheese
  • Trimethylaminuria – Fishy Odor
  • Hepatic cirrhosis – Musty or mousey odor
  • Bowel obstruction – Fecal Odor


The dentist can diagnose halitosis through the smell of the breath from the mouth and the nose. However, there are modern detectors that can determine the chemicals present on the mouth surface. These are not always available. Hence, many patients still rely on the diagnosis of a dentist.

Oral malodor, bad breath or halitosis can be measured in many ways, including using an organoleptic intensity instruments and organoleptic hedonic indices. These can determine the number of bacterial enzymes and volatile compounds that contribute to the production of malodorous compounds.

The intensity of bad breath can be based on the Rosenberg scale:

0 = no odor detected

1 = odor is barely noticeable

2 = there is slight malodor

3 = odor is detected

4 = malodor is strong

5 = malodor is very strong

Other diagnostic tests:


This test detects low levels of sulfur.

BANA test

The BANA test measures the amount of a particular enzyme produced by bad breath-causing bacteria.

Gas chromatography

This test measures three volatile sulfur compounds – dimethyl sulfide, hydrogen sulfide and methyl mercaptan.

Beta-galactosidase test

This test checks for the levels of beta-galactosidase, an enzyme that has been found to contribute to mouth odor.


If you notice your breath has an odor, you can start managing it by practicing good oral hygiene and shifting to a healthier diet. Make sure you brush your teeth twice daily and clean between each tooth at least once a day. However, if the condition persists, you need to visit a dentist.

The treatment for bad breath depends on the underlying case. However, one of the most effective treatments is improving one’s oral hygiene.

Brushing the teeth

  • Brush your treat for two to three minutes at least twice daily
  • Floss between your teeth
  • Clean your tongue
  • Use electric toothbrush if possible
  • Replace your toothbrush every three to four months
  • Brush all areas of the teeth
  • Use mouthwash daily

Cleaning dentures

For people who are wearing dentures, it is important to practice hygiene and good oral care just the same. People should take the dentures out at night to give the mouth a chance to rest. Before putting it back in the morning, make sure you cleaned the dentures properly.

To have fresh breath, you can do the following:

  • Stop smoking
  • Eat a healthy and well-balanced diet
  • Avoid sweet foods or those which are spicy and strongly flavored. Avoid eating too much onion and garlic.
  • Reduce alcohol consumption
  • Reduce coffee intake
  • Drink plenty of water
  • Chew sugarless gum after meals to stimulate saliva flow
  • Visit your dentist regularly and undergo consultation and oral prophylaxis

Gastrointestinal problems

The treatment recommended depends on the type of underlying cause. For instance, when the cause is a gastrointestinal problem like a gastroesophageal reflux disease (GERD) or Helicobacter pylori infection, you may need to visit a gastroenterologist for further evaluation and treatment tailored to the conditions.

6How to prevent halitosis or bad breath?

Practice good hygiene

Make sure you brush your teeth with fluoride toothpaste twice a day. This will help remove food particles, debris, and plaque on the teeth and in between them. Brush your teeth after eating and don’t forget to include your tongue.

The toothbrush should be replaced every three to four months or after an illness. Moreover, use a dental floss to remove food debris in between teeth.

Visit your dentist regularly

Seeing the dentist regularly will help manage oral problems like cavities and gum disease. Moreover, professional teeth cleaning will regularly be performed.

Drink lots of water

One of the main reasons why people have bad breath is due to dry mouth. Drinking lots of water will keep the mouth moist.

Do not smoke

Smoking cigarettes may lead to bad breath. Do not smoke or chew tobacco-based products.

Avoid foods that cause bad breath

Keep a log of the food you eat and if you notice that you have bad breath after eating a certain food, try reducing the amount you consume or remove it altogether.

Eat a healthy and well-balanced diet

Eat a healthy and well-balanced diet and avoid eating strongly spicy or flavored food.

Reduce intake of sugary food

Cut down on sugary food and drinks because these can increase the number of bacteria in the mouth.

Reduce intake of alcohol and coffee

Limit your alcohol intake and for coffee drinkers, cut down on coffee.

Chew sugar-free gum

After eating, chew sugar-free gum to stimulate the production of saliva and clean away any remaining food debris in the mouth.