Illustration by Denis Shifrin

The article is a general guide. In all specific circumstances, please consult your dentist.

There are many terms for this age-old embarrassing condition including halitosis, oral malodor and fetor ex ore. Many sufferers of bad breath aren't even aware just how much it can affect various aspects of their lives - personally, socially and professionally. However, bad breath is almost always a treatable condition and one shouldn't have to suffer – nor should those around them.

The fact that self diagnosis of this condition is difficult only exacerbates the embarrassment. Often sufferers have to rely on others to identify and alert them to the problem.

What causes bad breath?

In about 85% of sufferers the malodor arises from the mouth. Oral malodor is usually generated by bacteria which live off food debris and proteins, producing a number of unpleasant smelling compounds (including what dentists call Volatile Sulphur Compounds). The buildup of plaque in the mouth allows these bacteria to multiply. The most common sites where bacteria accumulate are the tongue, the areas between the teeth, just below the gum line, and on unclean dentures.

Dry mouth and infections in the mouth and surrounding areas (e.g. sinusitis, gum infections) can also be a source of malodor.

Furthermore, other medical conditions may lead to oral malodor usually originating further down the digestive or respiratory tract, whereupon medical advice should be sought.

How do I check if I may suffer from bad breath?

Bad breath is a very difficult condition to self diagnose. One method is to lick one's wrist and then smell it after about 5 seconds, once the saliva has started to dry (the smell is often stronger than would naturally be perceived). Another way is to take a plastic spoon and gently scrape near the back of the tongue, smelling the spoon as it dries.

What should I do if I think I have bad breath?

Please don't be embarrassed to seek help. It is important to realize that you are not suffering alone and that the condition IS treatable. Make an appointment with your dentist for an oral malodor/ bad breath consultation. A malodor consultation should not be carried out if you are on antibiotics, and ideally, you should refrain from eating, drinking or rinsing your mouth for an hour before your appointment. Your dentist will carry out a thorough examination, help discover what is causing your bad breath and discuss with you the best treatment options.

What can I do to improve the situation?

An important factor is to ensure there is no active disease (gum disease or caries) in your mouth. Regular dental examinations and visits to the hygienist are essential. In between visits to the hygienist it is important to prevent the buildup of plaque in your mouth with regular brushing and daily flossing.

Other ways to improve bad breath yourself at home are:

The tongue should be cleaned in a gentle but thorough manner; tongue scrapers are the most comfortable way of doing this (ask your dentist for guidance regarding tongue cleaning).

Some mouthwashes have been shown to help reduce oral malodor. Ask your dentist to recommend one and rinse with it just before bed. This can help reduce the bacterial buildup overnight.

Chewing sugarless chewing gum can encourage the production of saliva which decreases the intensity of the malodor.

Drinking lots of fluids and refraining from drinking caffeinated drinks is also advisable. Smoking and alcohol consumption are also contributing factors to oral malodor and should be kept to a minimum.

Dentures should be cleaned thoroughly everyday, along with the areas in the mouth where the denture sits.

Patients suffering from chronic diseases which cause dry mouth should discuss this with their doctor and dentist who may recommend saliva replacements.

No-one should suffer from bad breath in silence. Seek professional help and take steps at home to improve the condition. Furthermore, if someone close to you suffers from this embarrassing condition, perhaps mention it to them in a respectful, understanding and caring way. Make sure to reassure the person that you are telling them of their bad breath out of concern and because you would want to know if the roles were reversed. Wouldn't you want to know if you had bad breath?

Dr Sara Whitefield, a practicing dentist, began researching the causes and treatment of oral malodor (bad breath) over ten years ago and brings to ESRA Magazine’s readership some practical tips of how to deal with this often unspoken of but common condition.