Bad Breath

Bad breath (halitosis) is most often a sign of something going on in the mouth — plaque, tongue coating, cavities, or gum disease. Occasionally it points to an ENT or digestive problem, and rarely to systemic disease. It is treatable in the overwhelming majority of cases — and no mouthwash fixes it for long without addressing the cause.

Common causes

• Tongue coating — the biggest single cause; bacteria on the back of the tongue produce volatile sulphur compounds.
• Plaque, tartar, gum disease, unfilled cavities.
• Dry mouth — dehydration, mouth breathing, some medicines.
• Tobacco (all forms), alcohol, certain foods — garlic, onion, fish; coffee.
• Tonsil stones — white pellets coughed up, smelling bad.
• Chronic sinusitis and post-nasal drip.
• Acid reflux (GERD).
• Diabetes (ketones, fruity breath), advanced kidney or liver failure, H. pylori (debated).

Fixing it

• Brush twice a day with fluoride toothpaste; floss daily.
• Clean the tongue — use a tongue scraper (cheap, available at any medical store) from the back forward; or the back of the toothbrush.
• See a dentist to check for plaque, tartar, gum disease, and cavities — often the single most effective step.
• Stay hydrated; chew sugar-free gum if dry mouth is a problem.
• Treat reflux, sinusitis, tonsil stones if present.
• Stop tobacco; limit alcohol; cut down on the biggest dietary contributors.
• Mouthwash helps temporarily — choose alcohol-free antibacterial rinses; don't rely on it alone.

When to see a doctor, not just the dentist

• Bad breath with weight loss, persistent cough, difficulty swallowing.
• Persistent ulcer, lump, or red/white patch in the mouth — screen for oral cancer (especially in tobacco users).
• Fruity breath with thirst and frequent urination — check for diabetes.
• Ammonia-smelling breath with fatigue and swelling — check kidney function.