In most cases of bad breath or halitosis (85-90%) , the bad smell originates from the mouth itself. The intensity of bad breath differs during the day, depending upon oral wetness or dryness. Because the mouth is dry and inactive during the night, the odor is usually worse upon awakening ("morning breath"). On the other hand oral dryness depends upon various factors such as stress, fasting, eating certain foods (such as garlic, onions, meat, fish and cheese), obesity, smoking and alcohol consumption.





Bad breath can be transient meaning that it can often disappear after eating, brushing the teeth, flossing, and rinsing with specialized mouthwash.





Bad breath may also be persistant (chronic bad breath), which is a more serious condition, affecting some 25% of the population in varying degrees. Bad breath can negatively affect an individual's personal, social and business relationships, leading to poor self-esteem and increased stress. Persistent bad breath is usually caused by the metabolic activity of certain types of oral bacteria. Persistent odor can originate from:





1. THE MOUTH - Most unpleasant odors are known to arise from proteins trapped in the mouth which are processed by oral bacteria. There are over 600 types of bacteria found in the average mouth. Several dozens of these can produce high levels of foul odors when incubated in the laboratory. The most common location for mouth-related bad breath is the tongue. Large quantities of naturally-occurring bacteria are often found on the posterior dorsum of the tongue, where they are relatively undisturbed by normal activity. This part of the tongue is relatively dry and poorly cleansed, and bacterial populations can thrive on remnants of food deposits, dead epithelial cells and postnasal drip. Other parts of the mouth that may also contribute to the overall odor include: the inter-dental and sub-gingival niches, faulty dental work, food-impaction areas in-between the teeth, abscesses and unclean dentures;





2. THE NOSE - The odor coming from the nostrils has a pungent odor which differs from the oral odor. Nasal odor may be due to sinus infections or foreign bodies trapped in the nose;





3. THE TONSILS - Putrefaction from the tonsils is generally considered a minor cause of bad breath, contributing to some 3-5% of cases;





4. THE STOMACH – The stomach is a very uncommon source of bad breath (except during belching). The esophagus is a closed and collapsed tube, and continuous flow (as opposed to a simple burp) of gas or putrid substances from the stomach indicates a health problem - such as reflux or a fistula between the stomach and the esophagus - which will demonstrate more serious manifestations than just foul odor;





5. SYSTEMIC DISEASES – there are several diseases that can cause bad odor such as Liver failure; Lower respiratory tract infections (Bronchial and lung infections); Renal infections and renal failure; Carcinoma; Trimethylaminuria ("fish odor syndrome"); Diabetes mellitus, and certain metabolic dysfunctions.





You can first consult a dentist and then seek help from an internal medicine specialist to identify the real origin of the bad odor from your breath.

i had bad breath for 4 years thinking it was sinuses..i started getting fevers and i could not sleep at night due to my tonsils..finally i had to go to the doctor..they told me I had tonsilitis.. i took antibiotcs then my sympthoms went away but it seems like the smell will not go away even when i brush my teeth..i've been to many ent clinics and they say everything is fine...everyone complains about my breath and i dont know what to do???

Hello glendav456

Thank you for your post.
By far the commonest source of bad breath (halitosis) is the mouth.
There are several areas that need particular attention.
1)Teeth. Cavities can trap plaque & food particles which will produce an unpleasant smell.
2)Gums. Gum disease is a major cause of bad breath.
3)Tongue. Normal oral bacteria can build up on the rough upper surface of the tongue. They become covered with food, which cuts off their oxygen supply (which is what they like)
and multiply & multiply.
Some of these bacteria produce sulphur-based compounds that smell really offensive.

So you should visit your dentist & :-
1)Have your teeth & gums checked.
2)Have oral hygiene instruction
3)Be shown how to use a tongue scraper.

Hope this helps,
Dr. John.