bad breath
In the vast majority of cases it arises in the mouth — not in the stomach.
Bad breath is a subject hardly anyone raises of their own accord — neither those affected nor the people around them. That is unfortunate, because in most cases it is readily explicable and in almost as many cases can be put right.
How it arises
Bacteria in the mouth break down protein — from food residues, from shed mucosal cells, from blood where the gums are inflamed. In the process volatile sulphur compounds are formed, which cause the characteristic smell. These bacteria work best where little oxygen reaches: in niches, under deposits, in periodontal pockets — and between the papillae on the back of the tongue.
The causes, by frequency
- Tongue coating. By far the most common single location, above all the rear third. The surface is deeply fissured and offers a great deal of sheltered area.
- Gum inflammation and periodontitis. In the pockets, precisely the conditions prevail under which the odour-forming bacteria thrive.
- dry mouth. Saliva rinses and supplies the mouth with oxygen. Where it is lacking, the bacteria multiply undisturbed. That is why the breath is less pleasant in the morning for almost everyone — less saliva flows at night.
- Niches in the teeth. Untreated caries, leaking fillings, uncleaned dentures, spaces beneath bridges.
- Tonsil stones. Small whitish deposits in the tonsils that smell intensely. Harmless, but persistent.
Only after that come causes outside the mouth: chronic sinus infections, diseases of the airways, reflux and, in rare cases, metabolic disorders. The stomach plays practically no part — the passage to the oesophagus is normally closed.
What helps
- Clean the tongue daily, with a tongue scraper. Pull from back to front, several times, with gentle pressure. That is the most effective single measure.
- Clean the Clean the interdental spaces daily. A large part of the protein-containing material lies there.
- Have the gums treated if they bleed. Persistent bad breath with no other recognisable cause is a serious indication of periodontitis.
- Make sure there is saliva: drink enough, chew sugar-free gum, and consult your doctor about medicines with a drying effect.
- Clean dentures daily — and take them out at night as well, so that the mucosa can recover.
- Regular check-ups, so that caries and leaking margins are found.
Mouthwashes with zinc compounds or essential oils can help, because zinc binds the sulphur compounds. They complement the cleaning; they do not replace it. Chewing gum and lozenges mask it for twenty minutes and change nothing else.
How to check for yourself
You cannot smell your own breath — the nose becomes accustomed to constant stimuli. Cupping a hand in front of your mouth does not help. Two usable makeshifts: wipe a spoon over the rear third of the back of the tongue and smell it, or lick a wrist, let it dry and check after a few seconds.
More reliable is asking someone you trust to answer honestly. And most reliable of all is the examination at the practice: some practices measure the sulphur compounds with a device and can thereby also demonstrate the success of a measure.
When to have it investigated medically
When the smell persists despite thorough oral hygiene, a cleaned tongue and unremarkable dental findings. It is then worth going to an ear, nose and throat practice — the sinuses and tonsils are the next most frequent locations. A sweetish or noticeably altered smell of the breath that appears for the first time should be looked at by a doctor.
The essentials at a glance
- About 85 to 90 per cent of cases arise in the mouth. The stomach is almost never the cause.
- The most common single location is the rear third of the back of the tongue.
- Mouthwashes and chewing gum mask the smell for a short time. They do not remove the cause.
- Persistent bad breath can be an indication of periodontitis and should be investigated.
Answered briefly