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Healthy Aging

Bad Breath: The Culprits

By Sheryl Kraft

Created: 02/23/2010
Last Updated: 10/16/2012

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I've been holding onto an email a reader sent me a few months ago (sorry!). In it, she asked a question that frankly, I couldn’t answer: How to tell someone that they just plain stink. She wrote to me asking this, "I have a co-worker who is a great guy. And I might even date him, if he didn't have such bad breath. But I don't have a clue how to tell him. Any suggestions would be appreciated!"

I thought about it and thought about it, and couldn't come up with a great answer. (And I must admit that I'm curious whether or not they're a couple yet.)

So instead, I contacted dentist Nancy Rosen, a NYC dentist who is a frequent contributor to NBC's Today Show, among others. The easy part was tapping into her knowledge to shed some light onto this all-too-familiar condition. The harder part?  Figuring out how to break the news, gently.

If you're curious too, here's her take. And, of equal importance is this: if you have a solution for my beleaguered reader, please make her happy and share below!

Q. What is the major cause/causes of bad breath?

A. If you don't brush, floss and brush your tongue daily, particles of food remain in your mouth.  There is bacteria that lives in our mouth and will feed off these particles.  The bacteria release "volatile sulfur compounds" which cause the odor in your mouth.  

Q. Is it true that certain foods, like onions and garlic, are notorious for causing bad breath? Conversely, are there any foods or liquids that are actually helpful in keeping our breath fresh?

A. Sure certain foods like garlic and onions can contribute to bad breath.  Once the food is in the bloodstream, it is transferred to the lungs and we expel that air that contains the foul smells. The stomach can also be a cause- if the stomach is not properly digesting foods, it can cause gases and the air you expel can give off the foul smell as well. Some foods known to help are crunchy, hard fruits and vegetables, yogurt, chewing on some parsley, spearmint or tarragon, berries high in vitamin c.

Q. What foods or liquids should someone concerned about their breath avoid like the plague?

A.  Onions, garlic, acidic foods or drinks like coffee, alcohol, candy - bacteria have a feast on these types of foods.

Q. Why is it that some people don't even realize their breath stinks while everyone around them can smell it easily? 

A. Sometimes people can and can't tell if their breath smells.  It could be that their sense of smell isn't as good as others; smokers usually don't smell smoke on themselves because they are used to the smell. And then, there are those people who just don't care if they offend anyone.

Q. Are there underlying illnesses or health conditions that can be responsible for chronic bad breath?

A. Sure, if your dentist says your mouth is healthy he or she may tell you to see a physician. Some illnesses that may cause bad breath include respiratory tract infections, post nasal drip, chronic sinusitis, bronchitis, G.I. disorders, liver or kidney aliments, reflux, ulcers, or hypoglycemia.

Q. What about tongue scrapers - are these an effective tool and what are the proper ways to use them?

A. Tongue scrapers are great, but you can use a toothbrush as well.  Whichever one you use, start at the back of your tongue and scrape (or move the brush) forward towards the tip of your tongue.  Do this 3-4 times. 

Q. What about chewing gum or eating mints to combat bad breath?

A. Gum, mints and mouthwashes usually mask the odors.  But you need to manually remove the bacteria (plaque) from your mouth.  If you are doing this and you still have bad breath, you may need to use a special antimicrobial rinse (you can get this from your dentist), or see your gastroenterologist.

Q. Can old fillings or cavities be responsible for bad breath?

A. Cavities and old fillings with cavities (decay) underneath them can certainly cause bad breath.  But remember: just because you have fillings in your mouth doesn't mean that they will cause bad breath.

Q. Finally, if there is someone with chronic bad breath, what's a nice way (or is there a nice way) of telling them?

A. Tough...if it's a loved one- just be honest and say it- they'll appreciate it.  If it's a friend or a co-worker- offer them a piece of gum (hopefully you have a pack of gum handy!).


This is good info. I didn't know toothbrushes were as effective as tongue scrapers. I'm not sure just offering a coworker a piece of gum is going to get them the message though!

This is such a tough subject! I had a co-worker with bad breath and I never felt comfortable telling him. But I did make a point of opening up a big tin of Altoids every time he stopped by my desk and offering him one (or two). That helped a little.

I guess that's just about all you can do, short of actually telling a person they stink. I've done that too, myself. I wonder if they actually get the hint or just think I'm being generous by sharing my mints.

Great interview! It's such a hard thing to say to anyone, but I love the idea of offering a mint. Whenever anyone asks me if they have anything in their teeth or whatever, I always respond, no, do I? since I'm always one to assume they're asking because they saw it on me:)

sensitive subject, sure. but i always apply the "i'd want to know" principal. if it's a family member, i'm pretty direct, in my blunt Aussie way, "go brush your teeth."

friends and colleagues...that's a tougher call...i find coffee is a constant culprit...whereas the occasional garlicky meal can be overlooked (or avoided).

having mints or gum may simply mask the odor -- but it buys recipients of stinky breath some smell-free time.

Yes, I guess I'd want to know, too. But why does it always feel so bad when someone actually does tell you??

Oral hygiene is so important. I learned this fact as I grew older. However, at one point in my life, I had bad breath for another reason: I had sludge in my gall bladder. We had a hard time figuring that one out, but the problem did go away as my digestive system learned to function without the removed organ ...

That's interesting, Alexandra. Although I've read about digestive problems/bad breath, I've never really heard it first-hand from anyone. Glad the problem was solved!

Huh--never knew there was a logic to tongue scrapers. Not sure how to break that kind of news to someone. My husband once told me that my breath stank the day he met me. Odd that he still wanted to date me.

I got a good laugh with this one, Alisa. You must have made quite an impression, despite that little problem :)

What if it has nothing to do with oral hygiene and you just don't like the way someone smells because of his pheromones? I think maybe that reader should not consider dating her co-worker. Smells, to me, are very important!

Hygiene issues are always tough to bring up--unless you're telling a smelly teenage boy he stinks and needs to brush his teeth and take a shower! Then you can be blunt.

So true, Nancy. Whenever I'd say anything about stinking and having to take a shower to my sons, they'd be so embarrassed that they'd quickly take my advice. Bad breath? That's a whole other story...

Funny, I was just at the dentist today and he *swears by a chlorine dioxide mouthwash for bad breath. Sounds toxic, but he's a holistic dentist and feels that this is a reasonable solution.

I have a good friend who always has terrible breath. I get the sense that it's not just her mouth, though. Her bad breath seems like it's related to being generally unhealthy. It's a different odor than just halitosis!

Kris, what a funny coincidence with your dentist. I wonder if he's referring to something that is over-the-counter?
As for your friend, that's too bad- and tough to figure out just what to say (if anything!)

I like the idea of offering to coworker some gum. I also keep scented lotion at my desk--if the smell is too bad at least you'll have your own nice scent to mask it!

That's a good tip, yes...at the very least, you can indulge in some hand lotion to surround yourself with your own nice scent! Which gets me thinking - how about lighting a candle, too?

That is a sticky situation! I'd hate to be that person who has no idea about his bad breath, but it's not much easier being on in the awkward position of smelling it and not wanting to bring it up.

True, Susan...either way, it's a tough one! :)

And yet another reason to cut down on sugar intake! I'm not much of a coffee drinker but there are a lot of coffee drinkers at one of my clients and - oh boy - it's best to keep a certain degree of distance.

Oh, yes, that's right- coffee breath. Always a tough one.

Never assume that you know what's wrong with a person that has bad breath. I brush constantly and still suffer from bad breath. I've tried hundreds and hundreds of dollars with products and procedures. I finally found a doctor who will listen to me. He is working with me to help me solve this problem. For those of you who feel you have the right to offer mints and gum, please know that that makes the breath even worse. Sugar feeds bad breath.

What type of doctor did you go to that would finally help you. I am so frustrated with the bad breath that I truly donot know what to do anymore. I have tried everything and I am exhausted. My primary care doctor will not help me and I try to read things on the internet that could possibly help but no luck yet. Please help me!! thanks!!

I am really shocked to what degree people are uneducated about the bad breath issue. I suffer 50 years from foul breath not just bad and it there as long as I have pain in my GI tract. And I have the GI tract pain 24/7/365 and until today it's still undiagnosed. Numerous endoscopies- negative,mdications don't help, specialists can't figure out the problem. I have recently been diagnosed with big gallstone and was advised to remove the gallblader. I am almost confident this is not the reason for my bad breath because to this size of gallstone won't take 50 years to grow in my body. So what was the reason to my bad breath before the gallstone formed. My dentist said my mouth is treated, gums are fine and suspect internal disorder although not been able to find out. blood tests are fine..

I had foul breath for many years and it really was a huge issue. I cleaned my teeth and flossed and scrapped and mouthwash and nothing would help and I knew it was something else causing it. I had white tongue also. Thought maybe yeast overgrowth. I just had gallbladder removed due to blockage and my breathe is now normal! Gallstones do take many years to form so it is not unfeasible this is the problem. I am so happy I am now normal and my tongue is no longer white.


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