How you can tell if you have bad breath and what you can do about it

By Melinda Wenner Moyer

Garlic and onions are two of my favorite foods — I have been known to eat roasted garlic cloves like candy — so it’s no surprise that I often find myself surreptitiously smelling my breath and wincing. Studies on the prevalence of bad breath are hard to come by, but research has estimated that up to half of all Americans have been concerned by the smell of their breath over the course of their lives. (The other half clearly lack self-awareness.)

The bad news is that smelly breath can have many causes, some more serious than others. The good news is that there are a handful of ways to address it, depending on the underlying cause. I spoke to two restorative dentists who have studied bad breath; an ear, nose and throat doctor; and a periodontist to get their suggestions.

Determine if your breath is that bad.
One key problem with bad breath is that you can’t always tell when you have it, even though everyone around you probably can.

A popular and useful litmus test is to cup your hands over your nose and mouth, exhale and then inhale, said Dr. Mark Wolff, a restorative dentist at Penn Dental Medicine. Another method is to lick (yes, lick) the back of your hand a few times, wait a minute for the water to evaporate so that the odor molecules concentrate, then give the back of your hand a good sniff. If what you smell makes you want to keel over, you may want to do something about your breath, Dr. Wolff said.

That said, we are not always the best judges of our mouth odors, said Dr. Antonio Moretti, a periodontist at the University of North Carolina Adams School of Dentistry. Sometimes people think they have bad breath when they don’t, so he suggested asking a brave friend or loved one to do a breath check for you instead.

Consider what you eat.
Onions and garlic are common bad breath culprits because of their strong aromas — but other foods can lead to stinky breath, too. For instance, foods and drinks that can cause gastrointestinal reflux, such as alcohol, coffee, tomatoes, citrus fruits and onions, can incite bad breath because they cause you to burp up or even regurgitate small amounts of food, said Dr. Landon Duyka, an ear, nose and throat doctor at Northwestern Medicine.

Get rid of smelly mouth bacteria.
Bacteria in the mouth are another common cause of bad breath. These bacteria release what are called volatile sulfur compounds, which “smell like rotten eggs, smelly toes,” Dr. Wolff said. Brushing your teeth twice a day and flossing once a day can help eliminate these germs as well as the food particles that might be stuck in and around your teeth.

Bacteria can also thrive if you have dry mouth — a condition caused by dehydration, diseases such as Sjogren’s syndrome and diabetes, and as a medication side effect. Saliva helps to kill bacteria as well as to break down food particles and coax us to swallow them, so when we don’t have enough, germs can thrive, Dr. Duyka said. Staying hydrated can therefore prevent bad breath, as can rinsing with a mouthwash that treats dry mouth, he said.

Other kinds of mouthwashes can help with bad breath, too — but some work better than others. Dr. Violet Haraszthy, a restorative dentist at the University at Buffalo, recommended against rinses that contain alcohol, because they “dry the patient’s mouth out, and it’s a vicious cycle — once the alcohol dries it out, the bad breath comes back even worse,” she explained. She recommended alcohol-free rinses that contain antibacterial ingredients such as CPC (cetylpyridinium chloride).

Gum disease can be another bad breath culprit. If your gums frequently bleed, you see pockets around your gums or your teeth feel loose, you should see a dentist to determine if you have diseased gums, Dr. Moretti said. Gum disease can cause bad breath because bacteria get stuck in little pockets around the gums, “making a real stink-a-thon,” Dr. Wolff said.

Don’t forget your tongue, tonsils and the rest of your body.
Odor-causing bacteria don’t just grow around the teeth and gums — they can also grow in little crevices on your tongue. If your tongue has a white or yellowish tinge to it, it likely harbors stinky bacteria, Dr. Moretti said. You may want to brush your tongue gently with your toothbrush or a tongue scraper after you brush your teeth to remove them, he suggested. Research has shown that tongue brushing plus regular brushing improves bad breath more than just tooth-brushing alone.

Tonsils are another little-known cause of bad breath, Dr. Duyka told me. Tonsils have crevices that harbor bacteria. Sometimes, the bacteria can mix with food debris and harden and become what are called tonsil stones, which look like little white bumps. You can’t prevent tonsil stones, Dr. Duyka said, but you can eliminate them by gently poking your tonsil with a blunt object or (clean) finger; by gargling with salt water; or by rinsing them with a water flosser.

In rare cases, bad breath can be caused by other kinds of illnesses or infections — tonsillitis, sinus or lung infections, liver cirrhosis, kidney diseases, pharyngitis or even mouth or neck cancer, Dr. Moretti said. If your bad breath doesn’t improve with other remedies, consider seeing your primary care physician or an ear, nose and throat doctor to rule out other causes, Dr. Duyka suggested.

I had no idea that bad breath was such a complex phenomenon. I may not be willing to give up garlic — apologies to my husband — but I’ll try to stay hydrated and, perhaps, invest in a tongue scraper to keep my mouth bacteria under control. Although bad breath can be unpleasant for those on the receiving end, remember that it’s common and it’s not the end of the world.
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Credit: The New York Times