50 million people suffer from chronic halitosis (bad breath) in the US, but many don’t seek help because they’re embarrassed. That’s a shame because although bad breath is often caused by oral problems, other bad breath causes are associated with other health problems. And bad breath can be a sign of serious disease.
Studies suggest 5-10% of bad breath causes are due to disease outside the mouth. That’s 2-5 million people whose bodies are warning them of a serious problem.
Dental disease and bad breath
90% of bad breath comes from proteins broken down in your mouth. When bad breath is caused by oral problems, it usually smells like rotten eggs. This is caused by the breakdown of cysteine at the front of the tongue or on the gums. It’s a sign of poor oral hygiene.
More rarely, dental bad breath can be a fecal odor like odor from the gums or the top of the tongue. This is caused by imbalances within the mouth or from protein breakdown on the gum tissue or tongue.
If you have bad breath, your first step is a dental exam and good oral hygiene. However, the mouth-body connection means that other bad breath smells can tell you about problems elsewhere in your body.
Types of bad breath
If you or your dentist can identify the type of smell in your bad breath, this can help to pinpoint its origin. This oral-systemic link means your dentist may identify potential problems elsewhere in your body – just as an optician can by examining your eyes.
Here are the types of smells different systemic disease bad breath:
- A cheesy smell usually indicates your bad breath has a nasal origin.
- A fruity smell may indicate uncontrolled diabetes due to increased
- A fishy smell may indicate kidney disease, as increased urea levels can cause a fishy smell such as in (trimethylaminuria)
- An acidic smell can be a sign of asthma or cystic fibrosis
- A scent of ammonia can indicate kidney problems
- A sweet, musty odor may signal liver cirrhosis
- A fecal odor may point to a bowel obstruction
There are 12 types of ‘bad breath’ caused by disease in your body
- Tonsil breath
- Sinus breath
- Lung breath
- Gut breath
- Metabolic breath
- Diabetes breath
- Drug breath
- Liver breath
- Trimethylaminuria breath
- Menstrual breath
- Drug-induced bad breath
1) “Tonsil Breath”: Bad Breath Causes and Your Tonsils
Tonsillitis or tonsil stones may be the cause of your bad breath.
Bad breath linked to tonsillitis can occur in acute, chronic and recurrent forms of tonsillitis.
Your tonsils are two small pads of glandular tissue at each side of the back of your throat. They form part of your immune system, making antibodies and white blood cells to attack germs inside your mouth. They are part of your first line of defense against bacteria in food or air.
The symptoms of tonsillitis include:
- White or yellow spots of pus on the tonsils
- A sore throat – pain in the throat is sometimes severe, especially when swallowing, and may last more than 48 hours.
- Swollen lymph glands under each side of the jaw
- Bad breath
- Earache or infection
- Small children may complain of abdominal pain
- Loss of voice or changes in the voice
- A red throat
- Swollen tonsils, sometimes coated or with visible white flecks of pus
- Possibly a fever (high temperature)
Around 15-30 percent of tonsil infections are caused by bacteria – usually a streptococcus bacterium (strep throat). Others are caused by viruses. It can be difficult to establish the cause of tonsillitis, so your doctor may do a throat swab (gently rubbing a sterile cotton wool bud over the tonsil) to send for testing.
Antibiotics are only effective against bacteria and won’t cure tonsillitis caused by a virus.
Tonsil stones or ‘tonsiliths’
Sometimes bacteria, food debris, dead cells, mucus, and other materials may get trapped in the crevices in your tonsils. These materials can build up and eventually calcify (harden), forming tonsil stones (tonsoliths). This occurs most often in people who suffer from chronic tonsil inflammations or repeated bouts of tonsillitis. Bad breath (halitosis) that accompanies a tonsil infection is a prime indicator of a tonsil stone.
Patients that have post-nasal problems often report coughing up small, white smelly stones. These, along with throat mucus, indicate nasal problems that may cause bad breath.
Tonsil stones contain compressed sulfur compounds, mucus, and bacteria. One study of patients with chronic tonsillitis tested for volatile sulfur compounds in the subjects’ breath. The presence of these foul-smelling compounds provides objective evidence of bad breath. Researchers found that 75% of people with abnormally high concentrations of these compounds also had tonsil stones.
Other researchers have suggested that tonsil stones should be considered when the cause of bad breath is unclear.
An appointment with an ear, nose and throat specialist is recommended if you have tonsil symptoms and suffer from bad breath.
Remedies and treatment for tonsil stones:
- No treatment. Many tonsil stones, especially ones without symptoms, require no special treatment.
- At-home removal. It’s possible to carefully dislodge tonsil stones at home with the use of picks or swabs. Do not attempt to use sharp instruments.
- Salt water gargles. Gargling with warm, salty water may help alleviate the discomfort of tonsillitis, which often accompanies tonsil stones.
2) “Sinus Breath”: Bad Breath Causes and Sinuses
Bad breath can be caused by microbial build, growth or infections your sinuses.
Sinus infection or sinusitis
Sinusitis is an inflammation of the nasal sinuses. It may be a short-term, acute inflammation caused by an infection. Other times it can be a long-term, chronic condition, complicated by allergies and/or structural problems in the nose. Long-term sinusitis can greatly affect your quality of life.
Nasal sinuses are located within the cheeks, around and behind the nose. They act to warm, moisten and filter the air entering the nasal cavity. They also help us vocalize certain sounds.
Symptoms of sinusitis vary depending on the severity and which sinuses are involved. They may go alongside bad breath.
Potential symptoms include:
- Thick, green or yellow colored mucus from the nose or down the back of the throat
- Loss of sense of smell or taste
- Bad taste in the mouth
- Sore throat/cough
- Temperature or shivers (fever)
- Facial congestion (a feeling of fullness) and pain
- Sensation of pressure that worsens when leaning forward
- Obstructive sleep apnea
- Post-nasal drip
Nasal polyps are soft, jelly-like overgrowth of the sinus lining and look like grapes on the end of a stalk.
They do not always cause symptoms. As they usually grow through the tunnel that connects the sinuses to the nose, they often cause a blocked nose. However, they can also block the airway, which can lead to sinus infections. These infections can cause bad breath due to run-over of post-nasal drip.
Your respiratory system makes a lubricant called mucus. Mucus is a thick, wet substance that moistens your respiratory system and helps trap and destroys bacteria and viruses before they cause infection.
Sinusitis, nasal polyps and post-nasal drip can all cause bad breath as they encourage the build-up of microbes, foreign objects, and metabolites that cause bad breath.
3) “Lung Breath”: Bad Breath Causes and Lung Infection
Lower respiratory tract infections
Bad breath can be caused by lung infections and conditions such as bronchitis, pulmonary abscess, tuberculosis, emphysema, and pneumonia.
Types of lung infections include:
- Bronchitis (infection of the large airways or bronchi)
- Croup (infection of the trachea or windpipe in children)
- Influenza (widespread infection of the upper and lower respiratory tract including the nose, throat and, occasionally, bronchi and lungs)
- Pneumonia (infection of the alveoli and surrounding lung tissue)
Lung cancer usually causes a distinct bad breath, and breath is now being used in early detection.
If lower respiratory tract infection presents with increased mucus production, it may be hard to determine the cause of bad breath. Unfortunately, aside from treating the source of infection, this type of bad breath may have no other cure than time.
People with asthma are more likely to suffer from dry mouth. This is because asthma restricts air flow, making sufferers more likely to breathe through their mouth. The medication in inhalers can also dry out the mouth and cause irritation, sometimes leading to mouth ulcers or thrush.
A genetic disease that affects many organs including the lungs, digestive tract, and sinuses. Patients will have swollen, thick and immobile mucus that leads to sinus blockage in the lungs.
The most common symptoms are respiratory, including a chronic cough, wheezing, and recurrent upper or lower airway infections. Patients with upper respiratory symptoms often have severe nasal polyposis and thick tenacious mucus.
4) “Gut breath”: Bad Breath Causes and the Digestive System
The digestive system causes many cases of bad breath. Any condition that allows air from the stomach to move up into the esophagus and the oral cavity may cause halitosis. However, bad breath caused by the gut is usually a sign of general imbalance in the digestive system.
Digestive causes may include:
- GERD symptoms or GORD (Gastroesophageal Reflux Disease), which causes acid reflux (heartburn). Any kind of condition that causes stomach acid/heartburn/stomach distress may cause an odor, especially if you’re aware of an unusual taste; this is nearly always accompanied by a smell.
- Bloating, gas, and burping: any digestive condition that makes you belch (burp) can cause bad breath. These include imbalances seen in digestive conditions like IBS, food intolerances or high sugar consumption.
- Bowel obstruction or constipation: when your body is not digesting food, an unfortunate side effect can be bad breath that resembles feces.
5) “Metabolic breath”: Bad Breath Causes and Certain Diet Types
Ketone (fat-metabolism) breath
Low-carb or ketogenic diets can force your body to burn fat for fuel instead. This produces chemicals called ketones that are released in the breath, producing an odd fruit-and-nut or acetone odor.
The good news is that if you have bad breath, you’re probably sticking to that low-carb diet well – and often, the bad breath is a short-term problem while your body adjusts to fat metabolism.
This is caused by regularly skipping meals, or fasting, which can reduce the amount of saliva in your mouth. A dry mouth may prevent clearance of harmful bacteria, causing a sulfuric odor.
6) “Diabetes breath”: Bad Breath Caused by Insulin
Diabetics suffer from inadequate insulin production, causing them to burn fat and produce ketones. This means they’re prone to the ‘ketone breath’ discussed above. Another bad breath cause in diabetics may be chronic kidney failure.
Chronic kidney failure
This may cause breath that smells “fishy” or like ammonia. Known as “uremic fetor,” the high amount of urea in the saliva and its breakdown to ammonia causes the smell.
7) “Liver breath”: Bad Breath Causes and Liver Disease
Sometimes, the liver is the source of halitosis.
Frank liver failure leading to hepatic coma is often signaled by a sweet-smelling, musty odor on the breath as the body tries to excrete by-products of sulfur-containing amino acid breakdown. Cirrhosis may cause a breath odor described as decayed blood or rotten eggs.
Late-stage liver failure can also cause bad breath, known as ‘Fetor hepaticus’ – a sweet, musty aroma caused by dimethyl sulfide, not ketones. This had led Belgian researchers publishing in the Journal of Chromatography suggesting bad breath as a potential diagnostic tool for detecting liver problems.
8) “Trimethylaminuria breath”: Bad Breath Causes and Genetic Disease
An underdiagnosed disorder, known as TMAU or fish-odor syndrome, may affect as many as 1% of U.S. citizens. It causes a body odor and breath odor that’s often described as ‘fishy’, but sometimes resembles rotting eggs, garbage, or urine.
This genetic disorder affects the ability to break down choline, leading to a buildup of trimethylamine. The fishy odor is excreted via sweat, urine, saliva, blood, and air exhaled through the mouth and nostrils. Patients with trimethylaminuria may need to eliminate or reduce their intake of high-choline foods such as broccoli, beans, eggs, legumes, kidney, and liver.
9) “Menstrual Breath”: Bad Breath Causes and Menstruation
Research have reported that bad breath in women tended to increase before and during their period. They noted that during menstruation, the average female breath odor contained much more VSCs than that of male counterparts. While oral bacteria levels were the same across both genders, women had lower saliva levels during menstruation, which may account for their bad breath.
So, unfortunately, if temporary halitosis tends to arrive at the same time as your premenstrual syndrome (PMS), it’s down to hormonal changes.
10) “Drug Breath”: Bad Breath Causes and Medication
Many medicines can cause bad breath by drying up your saliva. Seven out of the top ten prescribed medicines list dry mouth as a side effect.
The worst culprits tend to be medicines that treat:
- Nasal congestion
- Urinary incontinence
- Parkinson’s disease
If you are on any of these medications and experiencing bad breath, talk to your physician and dentist. Try to avoid diuretics such as coffee that can make your dry mouth worse.
11) “Halitophobia”: Fear of Bad Breath
While most people are at least slightly concerned about how their breath smells, for some people, fear of halitosis grows to become a phobia. Although severe halitophobia is uncommon, estimated to affect less than 1% of adults, it can be a serious problem.
Dentists have estimated that up to 25% of people who come to them with halitosis are afflicted with halitophobia. Left untreated, it can have a huge impact on a sufferer’s personal life and confidence, causing:
- Social anxiety
- Withdrawal from social situations
- Fear of vocal projection when speaking (in extreme cases, not speaking at all)
- Anxiety about being close to others and physical affection
- Constant gum chewing/mint sucking
- Refusal to eat certain foods
- Living in fear of offending people with bad breath
- Excessive teeth brushing
Find the cause of bad breath.
So, why does bad breath matter?
Firstly, as we’ve seen, bad breath can be a clue to poor oral health and hygiene.
Secondly, halitosis – severe bad breath – can indicate a disease elsewhere in the digestive system and other organs.
There a number of natural remedies and supplements that can help you heal bad breath.
To get started, these supplements can help you to reverse bad breath in order to:
1) Kick-start digestion
2) Rebalance the gut microbiome
3) Recalibrate the immune system
- Probiotic – GutPro® by Organic 3, Inc.
- Enzyme (with HCl) – GutZyme® HCl by Organic 3, Inc.
- Enzyme (without HCl) – GutZyme® by Organic 3, Inc.
- Cod Liver Oil – Rosita Real Foods (Liquid)
- Cod Liver Oil – Rosita Real Foods (Softgels)
- Magnesium – Goodnight Maggie™ by Organic 3, Inc.
- Magnesium – Wake Up Maggie Capsules by Organic 3, Inc.
Has your dentist identified a general health issue or are you suffering from bad breath?
Let us know your issues with bad breath. Did you find anything that helped?
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.
Click below to order your copy now:
If you are looking for a dentist in Gosford, New South Wales, Australia, consider visiting Dr. Steven Lin at Luminous Dentistry.