Bad breath (also known as halitosis) is breath containing an unpleasant odor. This odor may strike periodically or be persistent, depending on the cause. The primary cause of bad breath is the millions of bacteria that live in the mouth (particularly on the back of the tongue). Your mouth's warm, moist conditions make an ideal environment for these bacteria to grow. About 80 percent of bad breath is caused by something in the mouth.

Some types of bad breath, such as "morning mouth," are fairly normal, and do not pose health concerns. Bad breath in the morning happens because the saliva that regularly washes away decaying food and odors during the day diminishes while you sleep at night. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.

Bad breath can also be caused by:

1. Poor dental hygiene — infrequent or improper brushing and flossing can leave food particles that decay inside the mouth
2. Infections in the mouth — periodontal (gum) disease
3. Respiratory-tract infections — throat infections, sinus infections, lung infections
4. External agents — garlic, onions, coffee, smoking, chewing tobacco
5. Dry mouth (xerostomia) — this can be caused by salivary gland problems, medication or by breathing through the mouth
6. Systemic illnesses — diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others
7. Psychiatric illness — some people believe that they have bad breath, but this cannot be confirmed by oral-healthcare professionals or others. This is referred to as "pseudohalitosis"

 
Symptoms
You may not always know when you have bad breath. The odor-detecting cells in the nose can eventually become accustomed to the constant flow of bad smells from the mouth, masking your own scent from yourself. Other people may notice your bad breath though, and react by recoiling as you speak.

Other associated symptoms depend on the underlying cause of bad breath:

1. Poor dental hygiene — teeth may be coated with film or plaque, food debris may become trapped between teeth, pale or swollen gums
2. Infections in the mouth — gums may be red, swollen and bleed easily, especially after brushing or flossing; pus may drain from between teeth; a pocket of pus (abscess) at the base of a tooth; loose teeth or a change in "fit" of a denture; painful, open sores on the tongue or gums
3. Respiratory-tract infections — sore throat, swollen lymph nodes ("swollen glands") in the neck, fever, stuffy nose, a greenish or yellowish nasal discharge, a mucus-producing cough
4. External agents — cigarette stains on fingers and teeth, a uniform yellow "coffee stain" on teeth
5. Dry mouth — difficulty swallowing dry foods, difficulty speaking for a prolonged period because of mouth dryness, a burning sensation in the mouth, an unusually high number of dental caries, dry eyes (in Sjagren's syndrome)
6. Systemic illnesses — symptoms of diabetes, lung disease, kidney failure or liver disease

Prevention
You can easily prevent bad breath caused by dental problems. The American Dental Association recommends brushing your teeth, tongue and gums after meals, flossing daily and rinsing your mouth out with approved mouthwashes. Do visit your dentist regularly (at least twice a year) for dental examinations and for professional teeth and gum cleaning.

You can also combat bad breath by drinking plenty of water every day to encourage saliva production. A simple swish of the mouth with water can loosen food particles that may become trapped between your teeth. You can also try breath freshening products that prevent plaque from forming like sugar-free gum and sugarless lozenges, or eat raw carrots and celery.

Treatment
The treatment of bad breath depends on its cause.

When to Seek Medical Assistance
Call your dentist promptly if you have bad breath with painful, swollen gums that bleed easily or loose teeth. Also, call your doctor if your bad breath occurs together with a fever, sore throat, a postnasal drip, a discolored nasal discharge or a mucus-producing cough. Even if you have none of these associated symptoms, call your dentist or physician if you experience persistent bad breath despite having a good diet and proper dental hygiene.

If you are a diabetic, have gastroesophageal reflux disease (GERD) or have chronic liver or kidney disease, ask your doctor how bad breath can be a sign that your underlying medical condition needs immediate medical attention.

Prognosis
Once halitosis has been diagnosed, the prognosis for fresh breath is usually excellent as long as you adhere to your dentist's or physician's treatment plan.

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