Is Chronic Bad Breath A Sign Of Something Serious?

Chronic bad breath, also known as halitosis, is a common issue for many people. Although sometimes it is a temporary issue that comes after consuming certain foods or waking up in the morning, in some cases, it can be a sign of a more serious health issue.

The unpleasant smell that comes from the mouth should not be ignored, especially if it is persistent. It can be a sign of dental issues, bacterial infections, periodontal disease, or even other systemic disorders such as diabetes or problems with the digestive system.

What Is Halitosis? – Understanding It And The Most Common Causes 

Halitosis is known as bad breath that comes from the mouth while breathing or speaking. In most cases, the source of this issue is the mouth itself, more specifically, bacteria that accumulate in the tongue, teeth, and gums. When this bacterium is fed on these food particles, it releases sulfur compounds that have a strong and unpleasant odor.

The most common causes include:

• Not properly cleaning your mouth.
• Not cleaning the tongue.
• Dental cavities.
• Infected gums.
• Smoking and alcohol consumption.
• Foods with a strong odor.

But in some cases, halitosis is not related to the mouth at all. It can be as a result of a complex health issue that requires diagnosis and immediate treatment. 

Dental Causes: Teeth, Gums, And Poor Hygiene

In 85-90% of the cases, the cause of halitosis is the oral cavity itself. Here are some specific dental conditions that cause bad breath:

Periodontal disease

Gingivitis and periodontitis are two forms of periodontal disease that lead to inflammation, swelling, and damage to the teeth’s supportive structures. If not treated, they create deep pockets inside the gums where bacteria accumulate and cause persistent bad breath. 

Dental cavities

Decayed teeth are the perfect environment for anaerobic bacteria that release unpleasant gases like hydrogen sulfide and methyl mercaptan. If a tooth is decayed or has an internal infection, the odor can be very strong.

Dental plaque and tartar

If the teeth are not properly cleaned, bacteria will accumulate and form dental plaque. As time passes, this forms into tartar, affecting the gum health and causing continuous bad breath.

The tongue

Tongues that are not cleaned are a major source of bacterial accumulation. The surface of the tongue, especially the back, accumulates dead cells, food bacteria, and microorganisms that create halitosis. 

Prostheses and orthodontic appliances

If not properly cleaned, dental prostheses and fixed appliances can become a home for bacteria that cannot be removed with normal brushing. 

Non-Dental Issues That Can Cause Bad Breath

If the dentist confirms that your mouth is in good health, but bad breath continues, other factors beyond the mouth should be examined:

Gastroesophageal reflux (GERD)

This is a condition when the acid that comes from the stomach reaches the esophagus and even the mouth. It creates a foul smell, mixed with food remains. 

Inflamed tonsils and tonsil stones

When the tonsils are infected or contain tonsil stones, they release a foul smell that cannot be treated by normal mouth-washing products. 

Diabetes

People with diabetes, in most cases, develop a characteristic smell that is similar to the smell of acetone. This is a sign that the body is not processing sugar normally. 

Kidney and liver diseases

In cases when these two organs don’t work normally, the body will accumulate toxins that will spread through the blood and be released through breathing, a smell that is similar to ammonia or metal. 

Is Bad Breath A Sign Of Chronic Disease?

Mellitus Diabetes

For people who suffer from diabetes, especially those who don’t have the level of sugar in their blood under control, the mouth will start to smell like rotten fruit or acetonic. This happens when the body is not in condition to use glucose as an energy course and starts to burn fat, producing ketones that are released even though breathing. 

This is common for type 1 diabetes and can be a sign of diabetic ketoacidosis, an urgent condition that requires immediate treatment. 

Kidney Diseases

When the kidneys fail to filter waste from the blood, it will lead to uremia. One of its symptoms is bad breath that is similar to ammoniacal or stagnant urine.

This happens because compounds like urea and nitrogen waste accumulate in the body and are released through respiration. If someone has persistent halitosis and other signs such as fatigue, swelling, or high blood pressure, kidney function tests should be performed.

Liver Issues

In cases of advanced liver diseases such as hepatic cirrhosis, the body cannot process the toxins. These toxins pass through the blood circulation and reach the liver, creating a smell known as “foetor hepaticus”, a foul smell, metallic or similar to rotten fish. 

This is a classic sign of liver failure, which is often accompanied by jaundice, loss of appetite, and a state of confusion.

Severe Respiratory Tract Infections

Bacterial infections of the kidneys, bronchi, or sinuses can cause severe halitosis, especially when accompanied by foul-smelling secretions. In these cases, the smell has a putrid character similar to rotten things, and it is usually accompanied by fever, cough, or a weighted feeling in the chest. 

A clear example is chronic bronchiectasis or pulmonary abscess, both connected to halitosis that will not go away with the use of hygienic products. 

Gastrointestinal Tract Problems

In some cases, halitosis is a result of stomach or esophagus issues such as:

Gastroesophageal reflux(GERD): The acid will rise to the esophagus and reach the mouth. 

Helicobacter pylori infection: This bacterium is related to stomach ulcers and might also affect bad breath. 

Intestinal obstructions: In rare cases, the mouth smell can become decaloid, which means similar to the smell of feces. This is considered a medical emergency. 

Cancers 

Even though this is rare, some forms of oral, esophageal, or stomach cancer can cause halitosis that does not respond to any treatment. This comes due to tissue damage or the advancement of already existing infections. 

If someone has unexplained halitosis, accompanied by weight loss or unexplained bleeding, they should contact the doctor immediately. 

Sjögren Syndrome

This is an autoimmune disease that affects the salivary and tear glands. When the salivation production reduces, the mouth gets dry, and the bacteria will grow more easily.

As a result, patients with Sjögren syndrome experience constant halitosis and find it more difficult to maintain oral hygiene. 

How Is The Cause Of Halitosis Diagnosed

Halitosis diagnosis is a process that requires careful assessment from health professionals, especially if the mouth smell is chronic and doesn’t respond to usual hygienic measures. 

The cause can be visible, such as a rotten tooth, or hidden, such as a gastrointestinal or metabolic issue. The purpose of diagnosis is to understand the root of the bad smell, so the right treatment can be performed. 

Initial Diagnosis And Consultation With The Dentist

The initial visit should be done at the dental clinic. This is because in 85 -90% of the cases, halitosis is caused by the oral cavity. The dentist will:

• Examine the gums for signs of gingivitis or periodontitis.
• Check for cavities, abscesses, or the presence of dental infections. 
• Assess the level of the accumulated tartar, bacterial plaque, and tongue cleanliness.
• Will make questions regarding oral hygiene habits, the use of dental floss, and tongue scraping. 

If the dentist doesn’t identify any of the causes in the mouth, then he will recommend checking with other specialists, a general practitioner, ORL, gastroenterologist, or endocrinologist. 

Measurement Of Respiratory Gases

There are specific devices that measure the concentration of gases that cause bad breath. They are known as:

Halimeter: Measures the percentage of sulfuric gases in the breath. High levels indicate the presence of bacteria in the mouth or tongue.

OralChroma: This is a more advanced device that separately analyses some common compounds of the smell, such as hydrogen sulfide, mercaptan, methyl, and dimethyl sulfide. This helps identify where the problem is coming from: the mouth, stomach, or is systemic. 

These tests are mostly used in specialized dental clinics and provide an objective assessment, different from the patient’s subjective perception.

Assessment Of Saliva And Dry Mouth

The doctor or the dentist will assess the amount and quality of the saliva, taking into account that dry mouth, also known as xerostomia, is one of the main causes of halitosis. Examinations include:

• Saliva stimulation test, which will be performed with the help of swallowing and lime.
• The saliva flow test determines whether the glands work normally.
• Analysis of bacterial content in saliva.

If your mouth is constantly dry, other symptoms or conditions will be considered and examined, such as Sjögren syndrome or medication side effects. 

Blood Examinations And Lab Tests

If halitosis is not caused by dental issues and continues to get worse even after taking care of your mouth, the doctor will recommend blood examinations and other tests to identify any underlying disorders. 

• Glicemia (sugar level in the blood): To exclude diabetes.
• Kidney function (urea, creatinine): To check the renal insufficiency.
• Liver function(ALT, AST, bilirubin): For hepatic disorders.
• Analysis for hidden infections: Such as respiratory tract or digestive system infections.

In some cases, the doctor may also require analysis for Helicobacter pylori, a bacterium that lives in the stomach and is related to halitosis.

Imaging and specialist examinations

If the doctor and dentist suspect deeper issues, they might recommend:

• Panoramic radiography(OPG): To identify infections under the teeth or other dental structures. 
• CT scans for sinuses: If the doctor suspects chronic sinusitis. 
• Upper gastrointestinal endoscopy: To check for reflux, gastritis, ulcers, or tumours.
• Consult with an ENT specialist: If inflammation of the tonsils or a nose infection, and a throat infection are suspected. 

These examinations are essential for patients who are experiencing halitosis without any apparent cause. 

Effective Treatments For Bad Breath

Halitosis treatment is not universal because everything will depend on the main cause of the issue. If the halitosis is coming from the mouth, it is a dental and hygiene condition; but if it comes from the stomach, sinuses, or inner organs, a deeper treatment is required. Furthermore, we will present some proven and effective treatments to eliminate or manage halitosis, starting from the basic hygiene tips to the most specialized treatments. 

The Most Important Step – Advanced Oral Health

Daily hygiene is the most important step for eliminating bad breath:

• Brush your teeth twice a day for at least 2 minutes. Use a soft-bristled toothbrush and fluoride toothpaste, and antibacterial substances like triclosan or zinc. 
• Using dental floss is also essential. It will eliminate food particles from areas where the brush cannot reach, especially between the teeth. 
• Cleaning the tongue with a tongue scraper, not only a toothbrush, helps reduce the amount of anaerobic bacteria that are located on the back of it. 
• Antibacterial mouthwash. Choose products that contain chlorhexidine, zinc, or essential oils such as menthol, eucalyptus, and timol. They reduce bacteria without damaging the healthy mouth flora. 

Oral hygiene will not only affect the way teeth look, but it will also prevent the formation of tartar, reduce gum inflammation, and improve overall mouth condition. 

Professional Dental Cleaning And Periodontal Treatments

If the cause of bad breath is the presence of tartar or gum infection, a professional treatment will be required:

• Professional dental cleaning: eliminates plaque and tartar that have accumulated on the teeth surface and under the gums. 
• Scaling and root planing: This is a more complex procedure that aims to clean periodontal pockets that get filled with bacteria. 
• Local antibiotics on the gumline: They are applied on the deep pockets to fight bacteria that cannot be removed with normal brushing. 

In most cases, these procedures will be enough to eliminate halitosis in cases when the issue comes from the mouth. 

Practical Tips For Keeping Your Mouth Fresh Every Day

Start With Your Basic Cleaning Routine

• Brush the teeth twice a day, every morning and night, for 2-3 minutes.
• Don’t forget the gums – Keep the brush at a 45° angle to clean the line between the gums and teeth.
• Use an antibacterial toothpaste. This will not only keep the teeth white but will also help fight bacteria. 

Many people just brush their teeth superficially, neglecting infected areas. This is the reason why halitosis returns and is not treated correctly. 

Clean Your Tongue Every Day.

• Use a tongue scraper to clean your mouth, not just your toothbrush.
• Start from the back of the mouth, with a light but steady pressure.
• Clean the tongue until there is no more residue or yellowish/whitish saliva comes out.

The tongue is one of the main reasons for bad breath, which in most cases gets neglected. 

Do Not Forget Dental Floss

• Use dental floss every night, before sleeping, without exception.
• Pass the dental floss carefully through the teeth, without damaging the gums.
• In the beginning, it might look tiring, but as time passes, it becomes a habit. 

The remaining bacteria between the teeth will not be eliminated even by the best mouthwash, so dental floss is essential.

Rinse Your Mouth After Eating

• Water is enough if you don’t have mouthwash with you.
• Use alcohol-free mouthwashes so the mouth doesn’t get dry. 
• After every proteinic meal, rinse the mouth to neutralize the presence of sulfur.

Rinsing the mouth after eating is one of the most effective habits for preventing bad breath that is formed during digestion. 

Stay Hydrated

• Drink water during the day, especially after eating, drinking coffee, or smoking.
• Always keep a bottle of water with you, especially in indoor environments with dry air.
• If you feel like your mouth is dry, chew sugar-free gum to stimulate saliva. 

A dry mouth is the perfect environment for bacteria that cause halitosis. 

Reconsider Your Diet

• Avoid foods with a strong smell in social situations or when you have a date.
• Limit the consumption of meat, alcohol, and milk products if you still notice bad breath.
• Add foods that contain chlorophyll, such as spinach and parsley, since they help with natural mouth freshness. 

Mouth smell is closely connected to what we eat, not only with hygiene. 

Visit Your Dentist Frequently

• Attend professional check-ups every 6 months, even if you don’t feel any pain.
• Require a deep cleaning if tartar is present.
• Communicate openly with your dentist regarding bad breath; they might help you in ways that you don’t imagine. 

Halitosis can be a symptom of hidden infections that can only be identified in the dental clinic.

Take Care Of Your Mouth In The Morning And Night

• Morning: Clean your mouth before breakfast to get rid of night bacteria.
• Nighttime: Clean your mouth after the last meal to avoid bacterial damage during sleep.
• Don’t eat after brushing your teeth at night.