Bad Breath: Causes and How to Treat It

Where does bad breath come from?

The mouth is home to bacteria that break down food debris and dead cells, releasing sulphur-containing gases that cause the unpleasant smell. The more places these bacteria can hide, and the less saliva there is to wash them away, the stronger the odour. Common causes include:

• A white or yellow coating on the back of the tongue.
• Gingivitis or periodontitis, with the pockets that form around the teeth.
• Dry mouth and reduced saliva.
• Tooth decay, broken fillings, and food trapped under dental work or in unclean dentures.
• Certain foods and drinks such as garlic, onions and coffee.
• Smoking of any kind, including shisha.

The tongue and dry mouth: two causes people overlook

The surface of the tongue is not smooth. It has tiny bumps that trap bacteria and food, especially towards the back. That is why someone can brush well and still have bad breath: they are not cleaning their tongue. Gently using a tongue scraper or brush from back to front makes a clear difference for many people.

Saliva is the mouth's natural cleanser. When it drops, bacteria multiply and the smell gets worse, which explains morning breath. Causes of dry mouth include breathing through the mouth, not drinking enough water, long hours in dry air-conditioned air, and some medicines such as antihistamines, antidepressants and certain blood pressure drugs. Do not stop any medicine yourself; discuss it with your doctor.

Could it come from the nose or stomach?

Yes, but less often. Sinusitis and post-nasal drip, tonsillitis, or small stones forming in the folds of the tonsils can cause persistent odour. Acid reflux may contribute in some people.

Less commonly, an unusual smell can point to a general health issue, such as poorly controlled diabetes, which may give a fruity smell, or kidney and liver disease. So assessment usually starts with the dentist, and if the mouth is healthy you will be referred to the right specialist.

Practical steps to get rid of bad breath

These steps deal with most mouth-related causes, and results usually show within days to weeks:

• Brush twice a day with a fluoride toothpaste, for two minutes each time.
• Clean your tongue daily with a scraper or brush, especially at the back.
• Floss or use interdental brushes daily to remove food between teeth.
• Sip water through the day rather than relying on coffee and fizzy drinks.
• Chew sugar-free gum after meals to stimulate saliva.
• Clean dentures and removable appliances every day, and take them out at night if your dentist advises.
• Stop smoking, which causes bad breath and harms the gums at the same time.

Bad breath while fasting in Ramadan

During fasting, saliva flow drops and the mouth stays dry for many hours, so breath tends to get worse later in the day. This is partly normal, but good care between iftar and suhoor can reduce it a lot.

Brush and clean your tongue after iftar and after suhoor, and drink enough water in small amounts spread between the two meals rather than all at once. Limit salty and spicy food and coffee at suhoor, as they increase thirst and dryness. Many people who fast also use a miswak during the day to clean their teeth.