Almost everyone has bad breath first thing in the morning. During the day, movement of the tongue and cheeks dislodges food debris and dead cells, and these are washed away by saliva. While we are asleep our tongue and cheeks do not move much, and the flow of saliva is reduced. The food residues stagnate in the mouth, and mouth bacteria rapidly break them down, releasing an unpleasant stale smell. Breathing through the mouth when sleeping tends to make this worse. Fortunately, morning breath normally disappears after breakfast, cleaning the teeth or rinsing the mouth with water. Get your saliva going with a drink of water and lemon.
Temporary Bad Breath
Temporary bad breath is the lingering effect of cigarettes or something you have eaten or drunk in the past 24–48 hours. Alcohol, onions, cabbage, broccoli, radish, durian, garlic, curries and other highly spiced foods, cured foods such as salamis, and smoked foods such as kippers are particularly likely to remain on the breath. The problem isn’t simply that the smells stay in the mouth. These foods are digested and then broken down in the body, and the breakdown products of some, particularly alcohol, onions and garlic, are expelled in the breath for hours or days afterwards (this is the basis of the breathalyser test for alcohol).
Smoking also reduces the flow of saliva, which makes its smell linger even longer.
Traditional remedies such as eating parsley help, and mouth fresheners disguise the smell. Clean your mouth by rinsing it thoroughly with warm water, giving it a good brushing with toothpaste and then rinsing thoroughly again.
Bad breath can even result from not eating. When no food is available, the body starts breaking down fat. Waste products from fat breakdown, called ketones, are expelled in the breath, and smell like stale apples.
Persistent Bad Breath
Gum disease, also known as gingivitis, is the leading cause of persistent bad breath according to dentists. You may probably be unaware you have the problem because gum disease is not necessarily painful. Symptoms of gum disease may include redness, bleeding and swelling of the gums. Gum disease is caused by plaque, the sticky film of bacteria that naturally forms on the teeth of everyone each day. These bacteria tend to lodge between the teeth and where the teeth meet the gum. The waste products of the bacteria have a foul, stale smell. Apart from bad breath, gum disease can eventually cause loosening of the teeth.
Poor oral hygiene is an obvious cause. If you don’t clean your teeth, you will soon develop bad breath.
Postnasal drip can cause bad breath. This is when excess mucus trickles down the back of the throat. This can happen for a variety of reasons, such as allergies, viruses or sinus infections. It can often cause a ticklish cough, particularly when lying flat at night.
Bacteria on the back of the tongue is another common cause of bad breath. Food particles, postnasal drip and stagnant saliva build up in the ‘fur’ at the back of the tongue, providing a breeding ground for bacteria. These bacteria produce many nasty-smelling chemicals.
Anything that dries the mouth makes bad breath worse because saliva cleanses the mouth. Certain medications, such as some antidepressants, blood pressure medication and antihistamines may reduce saliva production resulting in dry mouth. Alcohol, alcohol-containing mouthwashes, heavy exercise and fasting can all result in a dry mouth and worsen a bad breath problem.
Gut problems. Gastro-oesophageal reflux disease (GORD) and Helicobacter pylori are two gut problems that can contribute to bad breath.
Chest problems, such as obstructive airways disease (chronic bronchitis), can cause bad breath. Furthermore, it can be caused by short-term infections such a sinusitis, tonsilitis or pneumonia but also more chronic lung diseases such as cystic fibrosis.
Bad breath in a small child may mean that the child has inserted a small object (e.g. a seed or small toy) into the nose, where it has stuck and caused an infection. For this reason, small children with bad breath should be seen by a doctor.
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Anna Cantlay
Last updated: October 2020