Bad breath can be caused by any number of problems in the body. While the most common causes of bad breath stem from oral or dental health issues, there are others. Issues with your respiratory tract, gut bacteria, and the digestive system can also cause bad breath.
If you have persistent bad breath, it’s important to understand your treatment options.
In order to treat and cure bad breath, you have to find the root cause. Otherwise, any treatment may simply MASK bad breath.
In this article, we’ll explore testing options to find the cause of the condition.
At the end, you will find the 9-steps to cure bad breath.
If you’ve followed the 9-steps to cure bad breath and still have bad breath, you may need further tests.
The cause may be more complex than a breakdown of food in the mouth. Your health professional has certain tools at their disposal to help you find the cause of bad breath.
However, before booking for testing, there are a few ways to test for bad breath at home. It’s a good idea to confirm your bad breath with the help of a relative or friend.
Ask them to abstain from alcohol, coffee or aromatic foods for 24 hours and test your breath.
Alternatively, you can do a simple test yourself.
Self-Help Ways to Detect Bad Breath
Here are a few ways you can check for bad breath yourself:
- Lick the back of your hand, let the saliva dry and then smell the saliva.
- Floss your back teeth and smell the floss.
- A whitish, fuzzy tongue may also indicate the presence of bacteria and any VSCs (sulfur compounds). Try using a clean cotton ball to wipe the coating on your tongue and then smell it.
- Scraping the back of the tongue with a clean, plastic spoon and smelling the saliva and/or coating it removes can help you detect odorous breath too.
When you decide to seek help for your bad breath, your first port of call should be a dentist who treats bad breath.
Let’s look at the tests they may perform to identify the causes of bad breath.
The Bad Breath Smell Test
This is as simple as it sounds. The most basic test for bad breath is when a dentist or doctor smells your breath. It may sound embarrassing, but don’t worry. This is their job. They are well-trained to find the cause of your bad breath.
They will ask you to prepare for this test by avoiding a few things beforehand:
- food and drink for 12 hours
- garlic, onions and spicy foods for 48 hours
- scented cosmetics for 24 hours
- antibiotics for 3 weeks beforehand
Your dentist will also ask you NOT to follow your usual oral hygiene practices or use oral rinses and breath fresheners. They will ask you not to smoke, too.
The test is quick, simple and inexpensive.
It’s subjective, so it’s prone to human error. Bad breath odors can often be mixed and difficult to separate and identify exactly. Human error can creep in. Another problem with smell testing is lack of standard
Whilst this test, performed by an experienced specialist, can be very successful, smell test results often appear alongside data from more tests. The smell test is best used with other tests.
Sulfide Monitoring: The Halimeter
The most common causes of bad breath are volatile sulfur compounds (VSCs) that smell like rotten eggs. A halimeter is a device designed to measure VSCs in your breath. It’s sometimes used by dentists or doctors.
You will blow into a small opening at one end of the detector.
Seconds later, your results will appear on an LCD screen. Results may show no VSCs or may low levels that indicate moderate bad breath. They may also show intense VSC activity, indicating the cause of breath.
This is one of the cheapest and most accessible tests for bad breath, giving a quick, clear result. A halimeter score of > 75 ppb is recognized as clearly detected halitosis.
While the halimeter can be more reliable than a smell test, it only measures general levels of sulfide gases. It can’t identify which particular compound is present, making it difficult to find the exact origin of your bad breath and decide on treatment.
Chemical analysis of the gases from breath is a useful tool for identifying the cause of your bad breath. VSCs are emitted by bacteria feeding on mouth debris (food particles, dead tissue, and mucus). These compounds emit foul, sulfurous odors that cause bad breath.
By far the most accurate method of measuring bad breath. It can identify and analyze each of the compounds in your samples, such as bad breath culprits hydrogen sulfide and methyl mercaptans. This means it’s highly useful in pinpointing the malodorous compounds that are to blame for your bad breath, allowing the dentist to plan treatment accordingly.
However, gas chromatography for bad breath diagnosis remains expensive and difficult to access due to the large and immobile equipment involved and the level of training needed by practitioners.
BANA Test Strips
The BANA test detects certain species of anaerobic bacteria. These gas causing bugs are often associated with gum disease and also known to cause bad breath.
The BANA test can be done chairside in a dental practice or doctor’s office. You can also order home tests.
Using a sample of your saliva, dental plaque or a tongue swab, the BANA test looks for enzymes in your sample. If the enzyme is there, (turns blue) it tells you that the bacteria that cause bad breath are present.
The BANA test is more accurate than a halimeter. It can also be done in the privacy of your own home. The kit contains enzyme-coated test strips and interdental cleaners to gather your sample. Results are available in 24 hours, without having to mail the kit to a lab – much quicker than the old ‘Saliva Test’. The BANA test is also reasonably priced.
The BANA test won’t determine other causes of bad breath.
Testing for H. pylori symptoms that cause bad breath
Imbalances in intestinal bacteria or infections within your gut microbiome can cause linked to bad breath. A major culprit is H. pylori bacteria, which is the bacteria that causes GERD. Several tests are available to diagnose H. pylori symptoms. Your doctor will decide which is most appropriate.
If you suffer bad breath and GERD symptoms, you may need one of these tests:
This allows your doctor to see inside your stomach and to take a biopsy (sample). H. pylori can be diagnosed from biopsies of the stomach wall taken during an endoscopy or gastroscopy. In this test, a small flexible tube is passed through the mouth, down the esophagus, and into the stomach.
This tube is fitted with a camera, allowing your doctor to view the digestive system. A small piece of stomach lining can also be removed and then tested for H. pylori. It is usually done under light sedation and should only cause minor discomfort.
H.pylori symptoms can also be diagnosed through breath-testing. H. pylori break down urea to produce the enzyme urease, which is not normally found in the human stomach.
You will be asked to swallow a capsule or drink a liquid, containing a tiny amount of a radioactive substance and urea. This is not harmful, exposing you to the same amount of radiation as each one of us is exposed to naturally in 12 hours of everyday life.
10 minutes later, you will blow into a balloon, which is then sealed. The contents will be tested in the lab. If H. pylori is present in your stomach, it will have broken down the urea. The compound will be present in your breath sample.
This breath test is often used after antibiotic therapy to confirm that the antibiotics have eradicated the H. pylori.
There is a blood test that confirms the presence of H. pylori symptoms by detecting the antibodies your body produces against it.
Stool samples can be tested for the presence of antigens (foreign proteins) associated with H. pylori symptoms. This type of test is usually used to test for H. pylori in children.
Tests for Bad Breath Caused by SIBO & IBS
Bad breath not caused by VSCs can be due to poor absorption in the digestive system and food intolerances.
Malabsorption conditions such as SIBO and IBS should, therefore, be diagnosed to get to the root cause of bad breath.
IBS & Malabsorption of Any Dietary Sugar
In a person with Irritable Bowel Syndrome (IBS), IBD or any gut disorder, poor digestion of sugar can cause them to ferment This can produce gas and a potential laxative effect leading to digestive pain, flatulence or bloating. Other less common symptoms include fatigue, nausea, heartburn, and urgent bowel movements.
Breath tests can be ordered without a doctor’s referral. For self-referred patients, the below table is a guide only.
|Fructose||For fructose malabsorption. Recommended in all IBS patients, especially those with symptoms related to fruits, vegetables, honey and foods containing high fructose corn syrup.|
|Lactose||For lactose malabsorption (lactase deficiency). Recommended in all IBS patients, especially those with symptoms related to milk/dairy products.|
|Sorbitol||For suspected sorbitol malabsorption. Sorbitol is found in some fruits (e.g. stone fruits) and as an artificial sweetener in sugar-free foods.|
|Sucrose||For suspected sucrose malabsorption. Sucrose is found in processed foods (as common table sugar), and in fruits and vegetables.|
|Mannitol||For suspected mannitol malabsorption, particularly in vegetarians. Mannitol is used as a sugar substitute and occurs naturally in some vegetables e.g. mushrooms, snow peas, cauliflower.|
|Glucose||Recommended for investigation of small intestinal bacterial overgrowth.|
SIBO Breath Test
Breath testing measures the hydrogen and methane gas produced by bacteria in the small intestine. These gases diffuse into the blood and then the lungs. They can then be detected in your breath. The advantage of these breath tests is that they are painless and non-invasive.
- You will be asked to prepare for your test in advance to ensure accurate results.
- You will also be asked to follow a 1 or 2-day preparatory diet that removes much of the bacteria-feeding food. Milk and dairy products, canned and dried fruit, fruit juices, soft drinks and honey and high fiber foods (beans, oats, corn) are restricted. You must also stop taking any fiber supplements (e.g. Metamucil) and laxatives.
On the day of your test, you will be asked to drink a sugar solution of glucose or lactulose.
Lactulose Breath Test (LBT)
Humans can’t digest or absorb lactulose. Only bacteria have the proper enzymes to do this. After the bacteria consume lactulose, they make gas. If there is an overgrowth of these bacteria, this will be reflected in your levels of hydrogen and/or methane.
The advantage to this test is that it can diagnose overgrowth in the distal end of the small intestine
This test cannot diagnose bacterial overgrowth as well as the Glucose Breath Test (GBT).
Glucose Breath Test (GBT)
Both humans and bacteria absorb glucose. Glucose is absorbed within the first three feet of the small intestine. Therefore, if hydrogen and/or methane are detected in this test, it reflects an overgrowth in the proximal/upper end of the small intestine (within the first two feet).
This test can successfully and accurately diagnose proximal bacterial.
It cannot diagnose the more common distal overgrowth.
Before You Get Tested: 9 Steps To Cure Bad Breath
These steps may help you cure your bad breath at home. 90% of bad breath begins and ends in the mouth. So, before you start this program, visit the dentist and ensure your mouth is healthy. Follow any oral hygiene tips they give you, as this may cure your problem.
No luck? Then it’s time to go get tested.
Step 1) Remove obvious odor-causing foods such as garlic, sprouts or durians.
Step 2) Avoid smoking or using tobacco.
Step 3) Increase your intake of high-fiber foods and reduce sugar, grains, dairy, and meat in your diet.
Step 4) Keep well hydrated. Avoid diuretics like coffee.
Step 5) Perform oral hygiene after every meal (brushing and flossing).
Step 6) Use a tongue scraper to regularly brush and clean your tongue.
Step 7) Rinse your mouth with warm salty water daily.
Step 8) Chew sugar-free gum.
Step 9) Get a dental check-up to identify oral hygiene habits and a dental clean and gum treatment. This will identify any areas where your dental hygiene is still not as good as it could be.
Curing Your Bad Breath: What NOT to Do
- Chew on mints – they often contain sugars and simply mask the problem. This makes you less likely to look for the root cause.
- Use mouthwashes. Again, these simply mask the problem.
- Take proton pump inhibitors g. Omeprazole for acid reflux. Bad breath due to acid reflux or GERD symptoms is not helped by reducing stomach acid.
- Take antibiotics without discussing the implications for your bad breath with your healthcare practitioner.
Have you completed the 9-Step cure bad breath program?
If you’ve followed all of these steps and are still suffering from bad breath, you need to find its cause. As you’ve seen, problems with your gut microbiome, intestinal bacteria, and the digestive system can all cause bad breath. Consult your doctor and ask which tests and services they offer to help address your bad breath.
Now we want to hear from you. Please leave your questions in the comments below.
Want to know more? Dr Steven Lin’s book, The Dental Diet, is available to order today. An exploration of ancestral medicine, the human microbiome and epigenetics it’s a complete guide to the mouth-body connection. Take the journey and the 40-day delicious food program for life-changing oral and whole health.
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