Unpleasant breath, also known as halitosis, is one of the most common yet most uncomfortable problems people of all ages face. In addition to causing discomfort in social and professional situations, bad breath often indicates an underlying health issue – whether related to oral hygiene or systemic diseases.
In this article, we explain in detail what causes halitosis, debunk common myths surrounding it, and provide practical advice on how to prevent and treat it. The focus will be on professional dental recommendations, but also on a broader approach that includes nutrition, habits, and medical check-ups.
What is halitosis, and why does it occur?
Halitosis is a medical term referring to a persistent, unpleasant odour in the breath. Although everyone occasionally experiences bad breath – for example, after eating onions or garlic – true halitosis refers to a smell that doesn’t go away with brushing or chewing gum.
In more than 85% of cases, the cause lies within the oral cavity. Other causes can be related to respiratory, gastrointestinal, or systemic diseases.
The most common causes of bad breath
1. Insufficient oral hygiene
The accumulation of plaque, food debris, and bacteria on the teeth, tongue, and gums creates an ideal environment for unpleasant odours to develop. Plaque particularly builds up on the back of the tongue, where anaerobic bacteria break down and release sulfur compounds – the main culprits of bad breath.
2. Gum disease
Gingivitis and periodontitis are often associated with halitosis. Inflamed and bleeding gums contain bacteria and inflammatory by-products that further worsen the smell.
3. Dry mouth (xerostomia)
Saliva plays a key role in washing away bacteria and food particles. When saliva production decreases (due to dehydration, stress, medication, or mouth breathing), the mouth becomes dry and the odour intensifies.
4. Food and beverages
Certain foods, such as onions, garlic, alcohol, and coffee, leave a lingering smell in the mouth, and their compounds are released through the lungs via the bloodstream, making the odour resistant to ordinary breath fresheners.
5. Smoking
Tobacco not only leaves a characteristic smell but also promotes gum disease and dry mouth. Over time, smoking worsens all factors that contribute to halitosis.
6. Dental fillings, bridges, and dentures
Poorly fitted restorations, fillings with rough edges, or dentures that aren’t cleaned properly can trap food debris and bacteria, contributing to unpleasant breath.
7. Upper respiratory infections
Sinusitis, tonsillitis, nasal, or throat infections can cause bad breath due to the presence of pus and bacteria in the nasal passages and throat. These cases require specialist treatment.
8. Gastroesophageal reflux (GERD) and digestive problems
In some people, bad breath originates from the stomach – especially if acid reflux is present. Digestive issues, gastritis, or Helicobacter pylori infection can also play a role.
9. Diabetes, liver and kidney disease
In certain cases, unpleasant breath can be the first sign of a more serious systemic disorder. For example, diabetics may have a “fruity” breath due to ketosis, while kidney or liver diseases can cause an ammonia-like odour.
Common myths about bad breath
Bad breath is often surrounded by misinformation and myths that can prevent people from seeking timely help. Here are some of the most common misconceptions that should be clarified:
Myth 1: “If I brush my teeth regularly, I can’t have bad breath.”
Regular brushing is essential, but not always enough. If you neglect tongue cleaning, interdental care, and regular dental check-ups, unpleasant breath can still appear.
Myth 2: “Chewing gum and breath sprays solve the problem.”
These products may temporarily mask the odour but do not address the underlying cause. In some cases, they can even worsen the situation if they contain sugar, which promotes bacterial growth.
Myth 3: “Halitosis is always a sign of poor hygiene.”
Although hygiene is the most common cause, several systemic conditions can also lead to unpleasant breath, so it’s important not to jump to conclusions.
Myth 4: “If I can’t smell my own breath, it means it’s fine.”
People can become accustomed to their own scent and fail to notice the odor. A dentist can use specific tests or confirm the issue through a clinical examination.
How to properly maintain fresh breath
1. Thorough oral hygiene
• Brush your teeth at least twice a day for two minutes each time.
• Use dental floss or interdental brushes daily.
• Regularly brush and clean your tongue, where bacteria accumulate.
• Use mouthwash – preferably alcohol-free and with antibacterial agents such as chlorhexidine or cetylpyridinium chloride.
2. Hydration
Drink plenty of water throughout the day. A dry mouth promotes bacterial growth. Avoid excessive caffeine and alcohol intake, as they have a dehydrating effect.
3. Balanced diet
• Reduce sugar and refined carbohydrate intake.
• Eat fibre-rich foods and fresh fruits and vegetables that stimulate saliva production.
• Avoid strong spices, alcohol, and tobacco.
4. Regular dental check-ups
• Visit your dentist every six months.
• Professional cleaning and tartar removal help prevent gum disease.
• Checking fillings, bridges, and dentures is also important since damaged edges can trap bacteria.
When is it time to see a doctor?
If bad breath persists despite good oral hygiene and dietary changes, it’s important to see a dentist for a thorough examination. If no oral cause is found, your general practitioner may refer you to a gastroenterologist, ENT specialist, or endocrinologist.
Signs that further evaluation is needed:
• The odour is constant and unresponsive to hygiene improvements
• Other symptoms appear – stomach pain, swallowing difficulties, frequent burping
• There is a family history of diabetes, liver disease, or kidney disease
Bad breath in children and older adults
In children
Bad breath in children is most often caused by:
• Poor tooth brushing
• Cavities and gum inflammation
• Mouth breathing (e.g., due to enlarged adenoids)
• Foreign objects in the nose (common in small children)
Parents should ensure that children brush their teeth regularly under supervision, use children’s toothpaste, and visit a pediatric dentist at least once a year.
In older adults
Older adults are more prone to halitosis due to:
• Dry mouth caused by medication
• Use of dentures that aren’t properly maintained
• Conditions such as diabetes, GERD, or liver disease
Regular denture checks, good hydration, and using moisturising sprays or gels for the oral mucosa are recommended.
How to permanently solve halitosis
Halitosis is a condition that, in most cases, can be resolved – but it requires timely recognition of the cause and a systematic approach. Consistent and thorough oral hygiene is the foundation of prevention, but it’s also important to recognise other contributing factors such as diet, systemic diseases, and lifestyle habits.
If you suspect you suffer from halitosis, the best first step is a dental examination to identify the source of the problem and recommend appropriate treatment.
The Esthea team is at your disposal for diagnostics, professional cleaning, and advice on maintaining fresh breath – for a healthier smile and greater confidence in everyday life.