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honey patel

i am a dentist with bachelor's degree. i will be soon pursuing masters in health care management.

How is foul-smelling breath caused?

6 October 2021

The issue of foul-smelling breath is not just bad for oral health but also embarrassing. No one wants their breath to stink but still every 5 out of 10 individuals suffer from it. Do you think they don’t brush their teeth? They do. They probably make efforts twice as much. But there are a few reasons behind the bad-smelling breath. Let us find out what are the factors behind Halitosis and How we can fix it.

Halitosis can be due to intraoral factors or from external sources. Intraoral cause involves volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan. These compounds are produced from a reaction with accumulated food particles. Once produced, they carry out enzymatic reactions and produce foul-smell-producing bacteria. Other intraoral chemicals that contribute to halitosis are alcohols, ketones, fatty acids and aldehydes.

Reasons behind the production of such compounds in the oral cavity

First off, poor oral hygiene is the foremost factor that leads to food accumulation. Several things can be behind poor dental hygiene maintenance like- malocclusion, periodontal problems, other medical issues leading to poor brushing dexterity, stress and so on. Oral hygiene retains plaque and hence, gingival and subsequently, periodontal inflammation. Periodontal/gum disorders further exacerbate halitosis. The relationship between periodontitis and halitosis is two-way. Severe halitosis will in turn worse the periodontal problems.

Besides, deep cavities can lodge food for days and produce a bad smell.

Other than that, poor tongue cleaning can have a major influence on bacterial retention. The coating on a tongue houses millions of odor-producing bacteria.

There can be extraoral medical issues like gastritis, GERD or other gastric problems, liver disorders, carcinogens of visceral cavities that may cause halitosis.

Physiopathology behind halitosis

Once the bacteria are produced in large numbers in the oral cavity, they degrade food compounds such as peptides and glucose. Volatile, odorous compounds like VSCs are produced on the degradation/ chemical reaction. These chemicals produce an unpleasant smell. This worsens especially at night when the saliva production is in fewer amounts and the mouth gets dry. It is because the antibacterial properties of saliva have a little impact at night time.

How is bad breath diagnosed?

It seems pretty obvious that the perception of unpleasant smell itself is the biggest indicator of halitosis. However, there are cases where patients complain of foul smell in their mouths but people around them do not. In such cases, to rule out halitosis, some tests are done.

  • BANA test- it detects an enzyme that foul-smelling bacteria produce.

  • Halimeter- it is a device that can detect sulfur levels in breath. Higher the sulfur levels, the greater the chances of halitosis


  • The first and the most effective answer to treating halitosis is maintaining one’s oral hygiene. Brushing twice daily along with flossing teeth is non-negotiable. Tongue cleaning in case of coarse tongue coating can be done. This is effective as it eliminates bacteria that accumulate on the tongue dorsum.

  • Hydration is effective in case of dry mouth. Methyl cellulose salivary substitute can be taken in extreme cases of chemotherapeutic radiation side-effects. Chewing gums with sugar substitutes can be chewed to stimulate salivary glands.

  • Avoid onions and garlic in your foods. Other than that, reduce tobacco consumption

It will be great, if you share your view on above write-up. 

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