A common problem that usually starts in the mouth
Bad breath (halitosis) affects many people, often without them realising, because it is hard to notice our own smell. Yet it can cause real embarrassment in social and working life.
In most cases, the source is in the mouth. Bacteria break down food debris, dead cells and proteins in saliva, releasing volatile sulphur compounds that cause the unpleasant smell. These bacteria live mainly at the back of the tongue, between the teeth and just under the gum line.
Two situations should be distinguished:
- morning breath, which is normal and temporary: saliva flow drops during sleep, and the smell goes after breakfast and brushing;
- persistent bad breath, present throughout the day despite brushing, whose cause needs to be found.
Causes inside the mouth
The most common sources in the mouth are:
- Tongue coating: a whitish or yellowish film on the top of the tongue, especially towards the back, harbours large numbers of bacteria. It is one of the leading causes of bad breath.
- Gum disease: gingivitis (red gums that bleed when brushing) and periodontitis, in which pockets form between tooth and gum. These pockets trap bacteria and debris that are hard to remove at home.
- Tartar, whose rough surface lets plaque build up.
- Deep cavities and poorly fitting fillings or crowns that trap food.
- Food stuck between the teeth when cleaning between them is neglected.
- Removable appliances and aligners or guards that are not cleaned well enough.
- A partly erupted wisdom tooth, under a flap of gum where debris collects.
If your gums bleed regularly, our article on bleeding gums will help you understand why.
Dry mouth, diet and smoking: factors that make it worse
Saliva cleans the mouth naturally. Anything that reduces it encourages bad breath:
- Dry mouth: certain medicines (antidepressants, antihistamines and diuretics, among others), mouth breathing, stress or not drinking enough.
- Fasting: going a long time without eating or drinking, during Ramadan for example, reduces saliva and changes the breath. This is normal and reversible.
- Certain foods: garlic, onion and some spices leave a smell that can last several hours, because their compounds pass into the blood and then into exhaled air. Coffee and alcohol dry the mouth.
- Very high-protein or very low-carbohydrate diets, which can change the smell of the breath.
- Tobacco in all its forms (cigarettes, shisha), which leaves its own smell, dries the mouth and worsens gum disease.
These factors often add to a cause in the mouth: correcting them improves the breath, but does not replace a check-up if the smell persists.
When the cause is not dental
Less often, bad breath comes from somewhere other than the mouth. Possible causes include:
- an ear, nose and throat cause: chronic sinusitis, post-nasal drip, or tonsils with small whitish deposits (tonsil stones);
- gastro-oesophageal reflux, sometimes with acid coming back up;
- certain general conditions, such as poorly controlled diabetes or liver or kidney problems, which can give the breath a particular smell.
This is why the dentist starts by examining the mouth. If no cause is found there, or if other symptoms are present (fever, repeated sore throats, heartburn, intense thirst, unexplained weight loss), they will refer you to your doctor or to an ear, nose and throat specialist.
Tongue cleaning and good daily habits
Thorough hygiene resolves much of the bad breath that starts in the mouth:
- Brush your teeth twice a day, for two minutes, with a fluoride toothpaste.
- Clean between your teeth every evening, with floss or suitably sized interdental brushes.
- Clean your tongue every day with a tongue scraper, or with the textured back of some toothbrushes. Place it as far back on the tongue as is comfortable and draw it gently forwards, several times, rinsing it between strokes. There is no need to press hard: the tongue is delicate.
- Clean removable appliances every day (dentures, guards), following your dentist's instructions.
- Drink water regularly through the day.
- Chew sugar-free gum after meals to stimulate saliva when you cannot brush.
Mouthwashes, mints and sprays mask the smell for a limited time without treating the cause. Your dentist may recommend a specific mouthwash for a set period.
When to see a dentist and what they do
Make an appointment if your breath remains unpleasant after two to three weeks of careful hygiene, or if it comes with bleeding gums, loose teeth, a persistent bad taste or pain.
At the appointment, the dentist asks about your habits, medication and general health, then examines the tongue, teeth and gums, measuring the depth of the pockets around the teeth if needed. Depending on the findings, they may suggest:
- a scale and polish to remove tartar and plaque;
- gum treatment for periodontitis, to clean out the pockets;
- treating cavities and redoing faulty restorations;
- personalised hygiene advice, especially for the tongue and the spaces between the teeth.
In Agdal, German Dental Clinic sees patients from Rabat from Monday to Saturday for this assessment. You can book an appointment online or by phone.
Sources
Frequently asked questions
How can I tell if I have bad breath?
It is hard to judge your own breath, because your sense of smell gets used to your own odours. The simplest approach is to ask someone close whom you trust. You can also look at your tongue: a thick coating at the back is a clue. Your dentist can assess it during an examination.
Is mouthwash enough?
No. It gives a temporary feeling of freshness but does not remove tongue coating, tartar or the bacteria living in gum pockets. Used on its own, it can delay the diagnosis of gum disease. Ask your dentist before using one for a long period.
How can I limit bad breath during Ramadan?
While fasting, saliva decreases and a temporary smell is normal. Brush your teeth and clean your tongue after iftar and after suhoor, drink enough water between the two meals, and go easy on garlic, onion and very salty food at suhoor. If the smell persists after Ramadan, see your dentist.
Can bad breath come from the stomach?
It can, but less often than people think. Reflux may contribute. In most cases the cause is in the mouth, so it makes sense to start with a dental examination and then see a doctor if no cause is found in the mouth.
The information on this page is general. Only a consultation allows a diagnosis and a suitable treatment plan.
