Bad breath

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Dental teeth 12

Halitosis: When bad breath becomes a problem

When medical terminology refers to halitosis, it means bad breath that lasts for a long time. In fact, many people not only suffer temporarily from bad breath after eating garlic and the like, but the bad breath becomes a permanent issue. Often, those affected do not even notice it themselves. Outsiders, in turn, shy away from addressing the taboo subject. But only those who know that they suffer from bad breath can do something about it. Good to know: Persistent bad breath can sometimes be a symptom of an underlying disease. If in doubt, consult a doctor.



Short-term halitosis: triggers

The typical triggers of short-term bad breath include, in particular, food and stimulants such as garlic, onions, nicotine or alcohol.

In the case of garlic, for example, the so-called allicin is responsible for the well-known “vapors”. This substance is broken down in the body within 24 hours and excreted through breath, skin, sweat and urine.

Another typical phenomenon associated with temporary bad breath is morning breath. It occurs when the amount of saliva in the mouth is reduced overnight – so a dry mouth is typically accompanied by bad breath. If you drink a glass of water in the morning and then take care to maintain good oral hygiene, you can usually banish this form of bad breath quickly.


Good to know: Stress can also result in dry mouth and thus bad breath.

Last but not least, diets are often the cause of temporary bad breath. In particular, if the body is supplied with little or no carbohydrates, the body can only insufficiently convert fats into glucose. As a result, so-called ketone bodies are formed, which can make themselves felt in the form of “acetone bad breath” (rotten apple smell).
Causes of bad breath (persistent)

Persistent bad breath is far less likely to come from the stomach than is widely believed. Much more often, it is problems in the oral cavity that cause bad breath. In particular, anaerobic bacteria in the interdental spaces and on the back of the tongue are the “culprits” here. Among other things, these oral inhabitants break down proteins from food residues in the oral cavity and in this way release volatile sulfur compounds – bad breath develops.

In addition, dental problems such as caries or gingivitis can also be the cause of bad breath. So if bad breath persists despite tooth brushing and optimal oral hygiene, it is important to get to the bottom of the causes.

Last but not least, the nasopharynx (e.g. sinusitis, tonsillitis) can also be the starting point for bad breath. In rarer cases, it is underlying diseases such as reflux disease that can result in halitosis.
Halitosis: Causes in the oral region (oral)

  • Poor dental and tongue hygiene (bacterial plaque, bacterial tongue plaque).
  • Caries and other dental problems (e.g. open root canals)
  • Abscesses in the mouth
  • Gingivitis
  • Inflammation of the periodontium (periodontitis)
  • Fungal infection of the oral cavity
  • Dry mouth (e.g. due to stress, snoring, insufficient drinking)
  • Tumors

Bad breath: other causes (extraoral)

  • Problems in the ear, nose and throat area (e.g. sinusitis, tonsillitis)
  • Underlying diseases such as diabetes mellitus, reflux
  • Food allergies
  • Changes in hormone balance (e.g. menopause)
  • Medications (e.g. antidepressants, bisphosphonates, antibiotics)
  • Stress
  • Fasting

Bad breath & bacteria

In most cases, it is anaerobic bacteria in the oral cavity that cause bad breath. Especially in the interdental spaces and on the tongue surface, a large number of the microorganisms cavort. Thus, the bacterial density can increase 25-fold when the tongue is occupied.

The anaerobes break down food residues in the oral cavity, producing volatile sulfur compounds – these sulfides are noticeable in the form of bad breath when exhaled.

Good to know: During daily oral hygiene, care should be taken to also clean the interdental spaces and the surface of the tongue. Special toothbrushes and tongue cleaners provide suitable support here. Read more about proper oral hygiene and treatment of bad breath here.



Bad breath: stomach rarely the cause

Bad breath is often mistakenly attributed to stomach problems. In fact, however, this is rarely the case. If the cause is to be found in the digestive tract, disorders of the intestinal flora or so-called diverticula (protrusions) in the gastrointestinal tract may be possible.

Tip: In the case of bad breath, the dentist is the first port of call, as the cause usually lies in the oral cavity itself. If he cannot find an explanation for the complaints, he will refer you to your family doctor.
Not all bad breath is the same

In most cases, bad breath is caused by certain foods (e.g., onions, garlic) or problems in the mouth. In rarer cases, certain underlying diseases can also be the trigger for bad breath. Good to know: The type of bad breath sometimes also allows conclusions to be drawn about the respective cause. Of course, an exact diagnosis should always be made by a doctor or dentist.



What promotes bad breath?

Garlic, onions & Co. are among the well-known triggers of temporary bad breath. But there are special factors that can promote permanent bad breath. In this context, physicians speak of so-called co-factors. You can find an overview of common triggers of bad breath here.

Certain foods and stimulants We all know the problem: bad breath often occurs after eating garlic or onions. Nicotine and alcohol can also promote bad breath. However, in these cases it is only a short-term bad breath – not halitosis in the medical sense. How to get rid of “garlic mouth odor”: Chew fresh herbs for ten minutes. For example, parsley, peppermint or sage. Milk is also said to be able to help against bad breath caused by garlic.


Poor oral hygiene Bacteria in the oral cavity are the cause of bad breath in the vast majority of cases. These bacteria prefer to live in the spaces between the teeth and on the back of the tongue. Good to know: Dental problems such as gingivitis or periodontitis are also frequently accompanied by bad breath.


Dry mouth A dry mouth and bad breath often go directly hand in hand. In fact, decreased saliva flow promotes bad breath. Several factors can trigger dry mouth. These include:

  • Prolonged stress
  • Alcohol, coffee
  • Mouth breathing
  • Low fluid intake
  • Taking certain medications

Fasting Fasting cures and one-sided diets also frequently result in bad breath. In this case, a special “acetone mouth odor” often sets in. These “vapors” are due to the fact that during periods of hunger – especially when no or hardly any carbohydrates are supplied – fats can only be broken down incompletely by the organism. In this way, so-called ketone bodies are formed, which can become noticeable through the typical diet mouth odor of acetone. Especially during fasting, the body also “exhales” toxins through the skin and mucous membranes – i.e. also through the mouth.


Hormone changes during menopause Changes in hormone balance can also trigger bad breath. Menopausal women, for example, suffer more frequently from bad breath. There also seem to be fluctuations in bad breath during the menstrual cycle itself – bad breath seems to occur more frequently especially on the day of ovulation.


Certain medications Certain medications can reduce the flow of saliva in the mouth and thus promote bad breath. Known medications with bad breath as a “side effect” include certain antidepressants, sleeping pills, and antihypertensives. 

Short-term bad breath: triggers

  • Garlic
  • Onions
  • Alcohol
  • Nicotine
  • Stress
  • Diet
  • Too little to drink

  • Do I have bad breath? Measure by breathing on

    Bad breath despite brushing your teeth? Anyone who suspects they suffer from persistent bad breath should overcome their shame and ask a trusted person to help them with the “diagnosis”. In fact, breathing on the other person is the easiest way to detect bad breath.

    This “organoleptic diagnosis” is also the first step that is performed at the doctor’s office. In the process, the severity of the bad breath is assessed on a set scale:


    Severity  Bad breath – expression
    No bad breath
    1 (bad breath perceived from a distance of 10 cm)Slight bad breath
    2 (bad breath perceived from a distance of 30 cm)Medium bad breath
    3 (bad breath perceived from a distance of 1 m)Strong bad breath

     Important: Approximately 4 hours before the test, the following things are taboo:

    • Eating
    • Drinking
    • Dental care, use of mouth rinses
    • Smoking
    • Alcohol
    • Cosmetics with fragrances

    Already two days before measuring bad breath, it is important to avoid garlic and onions. Good to know: Selected dentists offer special “halitosis consultations” for in-depth diagnostics.



    Halitosis: Diagnostics

    Methods for instrumental diagnostics enable an even more precise, additional diagnosis of halitosis.

    The following measurement methods are available:

    • Sulfide monitor
    • Gas chromatograph
    • Bio Sniffer
    • Electronic Nose

    Bad breath diagnostics: focus on the oral cavity

    In more than 90 percent of all cases, the cause of bad breath lies in the oral cavity. Therefore, the classification of bad breath is usually followed by an inspection of the oral cavity.

    Attention is paid to, among other things:

    • Dental fillings
    • Crown margins
    • Caries signs
    • Tongue coating
    • Saliva flow rate (bad breath & dry mouth with low saliva flow often go hand in hand)

    Bad breath: treatment at a glance

    Fresh breath is an important prerequisite for a confident and likeable appearance. This makes it all the more important to tackle the taboo subject of bad breath openly and to initiate targeted treatment. But what helps against bad breath? In most cases, proper oral hygiene is the key. Bad breath is usually the result of bacteria in the mouth, especially in the interdental spaces and on the tongue. Optimal oral and dental care to reduce microorganisms is therefore indispensable in cases of bad breath.

    Important: If a dental problem or an underlying disease has been identified as the cause of bad breath, special treatment is required.

    Depending on the underlying cause, different measures may be required in each case to treat bad breath.


    Help against bad breath: Oral hygiene as a basic measure

    Oral hygiene against bad breath What helps against bad breath? If there is no underlying disease as the cause of bad breath, the first step is to optimize dental and oral hygiene. The following points in particular should be taken into account:

    Rule 1: Brush your teeth – thoroughly and regularly.

    • Brush your teeth twice a day (in the morning after breakfast, in the evening before going to bed)
    • Brush your teeth according to the so-called KAI method.
    • Do not exert too much pressure when brushing your teeth

    Rule 2: Do not forget the interdental spaces

    •  Bacteria in the interdental spaces are often the cause of bad breath. These must therefore be specifically eliminated – a normal toothbrush is often not sufficient here.
    • Dental floss is suitable for closely spaced teeth
    • For larger interdental spaces, interdental brushes or toothbrushes with special, fine bristles are recommended.

    Rule 3: Tongue cleaning as an integral part of oral hygiene

    • A large proportion of the bacteria that cause bad breath are found on the back of the tongue (especially in the rear area).
    • Daily tongue cleaning therefore plays an important role in combating bad breath, in addition to brushing the teeth.
    • Tongue brushes or tongue cleaners, for example, are suitable. Selected toothbrushes have an integrated tongue cleaner – this makes the daily cleaning of the tongue particularly easy
    • Important: the tongue is cleaned from back to front without pressure
    • After cleaning the teeth and tongue, it can be useful to use a mouthwash.

    Rule 4: Pay attention to hygiene

    • Replace your toothbrush with a new one every two months at the latest.
    • Interdental brushes should be replaced after 14 days.
    • Clean your toothbrush under running water after each use and store it afterwards so that it can dry.

    By the way, good oral and dental hygiene is also important for preventing bad breath.



    Remedies against bad breath

    Tablets against bad breath, toothpaste against bad breath, mouthwash against bad breath – remedies against “halitosis” are many. But what really helps?



    Bad breath remedies at a glance

    • Mouthwash against bad breath (e.g. with chlorhexidine) for daily use
    • Regular use of toothpaste against bad breath (e.g. with zinc to bind sulfurous odor particles or with antibacterially effective stannous fluoride)
    • Peppermint-flavored chewing gum and lozenges usually mask bad breath only briefly; however, they do stimulate saliva flow, which can be quite helpful. Finally, a dry mouth can sometimes be a trigger for bad breath.
    • Lozenges against bad breath (e.g., with chlorophyll) with a temporary, odor-neutralizing effect.

    Tips against bad breath

    Dealing openly with the taboo subject of bad breath is the first step to taking action against bad breath. Only those who really know that they have bad breath can take the necessary steps. Therefore, if in doubt, approach a person you trust and ask if you have bad breath. At the same time, if you know someone who has bad breath, it is important to take them aside and point out the problem in a quiet minute. This is because often those affected do not even notice themselves that they smell from their mouth.

    Chewing gum against bad breath? It would be nice! Because mentholated chewing gum usually only covers up bad breath for a short time. However, chewing gum stimulates the flow of saliva, which in turn can be positive. Because a dry mouth is considered a risk factor for bad breath. However, it is far more often bacteria in the oral cavity that trigger bad breath.

    Conscientious oral hygiene – tongue cleaning included In around 90 percent of all cases, problems in the oral cavity are the cause of bad breath. Bacteria in the interdental spaces and at the back of the tongue are often the culprits! Therefore, the following applies to bad breath: Ensure optimal oral hygiene! Brush your teeth twice a day and also clean the interdental spaces with dental floss or interdental brushes. The right toothpaste for bad breath can also be helpful. Last but not least: Integrate tongue cleaning into your daily oral hygiene program – because this way you can significantly reduce the number of odor-causing bacteria.

    Extra tip: A professional dental cleaning should be performed once or twice a year by the dentist.

    SOS help for garlic bad breath If eating garlic leaves you with bad breath, there are time-honored home remedies that can help. For example, chewing sage leaves for 10 minutes is said to have positive effects. A glass of milk can also drive away bad breath, at least in the short term. However, since exhalation also occurs through the skin and mucous membranes, the only solution is often to wait and “air it out.

    Mouth rinses The daily use of a mouth rinse can be helpful to specifically do something for fresh breath. This is because a mouth rinse also reaches hard-to-reach places. Selected products also have an anti-bacterial effect and can thus specifically counteract bad breath.

    Drink plenty Dry mouth can promote bad breath. In this respect, it is important to stimulate saliva production. A sufficient drinking quantity of about 1.5 liters per day is therefore a must. Since stress can also impair saliva flow, appropriate compensation can also have a positive effect. Last but not least, certain medications can promote dry mouth. However, never stop taking medically prescribed drugs on your own, but always ask your doctor for advice.

    In case of doubt: See a doctor If bad breath persists, a visit to the doctor is advisable. The first port of call is the dentist – because it is often inflammation or dental problems such as caries and open root canals, for example, that can result in “halitosis”. If another underlying disease is suspected as the cause of halitosis, the dentist will make the referral to a general practitioner or internist.



    Bad breath: home remedies

    Home remedies for bad breath – only effective in the short term and limited in scope.

    What helps against bad breath? Home remedies enjoy great popularity when it comes to this question. In fact, selected “secret recipes” can combat bad breath, at least in the short term. Typical “garlic bad breath” in particular can be alleviated in this way. However, anyone who suffers from frequent or persistent bad breath should focus on optimal oral hygiene and, if necessary, a visit to the dentist – after all, “halitosis” (the medical term for bad breath) originates in the area of the oral cavity itself in almost 90 percent of all cases.

    Black tea A cup of tea against bad breath? In fact, black tea seems to be helpful for bad breath. The reason: tea contains polyphenols that can inhibit bacterial growth in the mouth. And bacteria are in most cases the cause of bad breath.

    Lemon water Water with lemon can also be used as a freshness kick against bad breath. This is because salivation is stimulated in this way and dry mouth is reduced. A dry mouth and bad breath are often related.

    Milk against bad breath also falls into the category of home remedies. A U.S. study at Ohio State University confirms this: Approximately 50 percent of the sulfur compounds in the air we breathe can be neutralized in this way – and that ultimately benefits fresh breath.

    Chewing herbs An old home remedy for “garlic mouth odor”: chew fresh herbs for about 10 minutes.

    Suitable are for example:

    • Parsley
    • Sage
    • Peppermint

    When chewing, the green leaf pigment chlorophyll is released – and this is supposed to bind the odorous substances. By the way, chewing coffee beans is said to have a similar effect.

    Eat apple A piece of apple can help on the go to mask bad breath, at least in the short term. The positive effect seems to be due to the acid. In addition, chewing naturally stimulates the flow of saliva – and this can also help with bad breath.



    Better targeted treatment

    Bacteria in the interdental spaces and on the back of the tongue are usually responsible for persistent bad breath. Accordingly, thorough oral hygiene is the key to sustainably freshening breath. Special interdental brushes or tongue cleaners are suitable, for example. The right toothpaste and an antibacterial mouth rinse can also help against bad breath.

    Important: Diseases such as gingivitis, periodontitis or caries can also be associated with bad breath. A visit to the dentist provides clarity in case of doubt and offers the possibility of causal treatment.

    Bad breath: prevention If you want to avoid bad breath, you should follow a few general measures in everyday life. It’s worth it – after all, fresh breath is essential for a likeable and successful appearance.

    Careful oral hygiene Optimum oral hygiene is the key to combating bad breath. This is because odor-causing bacteria in the interdental spaces and on the back of the tongue are usually the culprits. Therefore: Brush your teeth twice a day and don’t forget the interdental spaces (dental floss, interdental brushes). Special toothpastes for fresh breath (e.g. with zinc) and antibacterial mouthwashes have proven effective.

    Important: Tongue cleaning should be an integral part of oral hygiene.

    Tongue cleaning is often neglected in this country. This is quite different in Switzerland, for example, where even children learn that cleaning the tongue is just as important as brushing their teeth every day. The reason: a particularly large number of anaerobic bacteria that cause bad breath are found on the back of the tongue.

    If you want to counteract this, you should clean your tongue at least once a day – special tongue cleaners have proven their worth. The application is always from the back to the front and should be carried out without strong pressure.

    Nutritions One thing is clear – if you don’t want to do without garlic, onions and the like, you’ll have to put up with temporary bad breath. In fact, however, the right diet can help prevent bad breath in the long term. The most important rules are:

    • Refrain from alcohol and coffee
      Reduce sugary foods and drinks – they impair the oral flora and promote the development of caries and gum problems, which can result in bad breath.
    • Eat plenty of fruit and vegetables

    Extra tip: Natural yogurt is also said to be able to prevent bad breath.

    Drink plenty & relax It may sound strange, but good fluid balance and relaxation can also prevent bad breath. This is because these factors can stimulate the flow of saliva in the mouth and thus counteract one of the central risk factors for bad breath – dry mouth.


    More infos about bad breath (in german)

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