The Causes of Halitosis and How to Remedy Bad Breath

By Hubert Vigilla

Published on April 07, 2008

Bad breath is a real deal killer. Also referred to as halitosis, bad breath can ruin first impressions, leave you feeling self-conscious, and harm social and professional interactions. Bad breath, among other things, even ruined a movie for Ignatius Reilly, the bizarre protagonist of John Kennedy Toole's novel A Confederacy of Dunces. Ignatius would go on to ruin the movie for others. Bad breath can make you the source of ridicule, branding you as "dragon breath" or "dog breath." Come to think of it, almost any noun paired with the word "breath" is a potential bad breath insult.

Americans spend an estimated $10 billion each year on toothpastes, chewing gums, mouthwashes, specialized rinses, and other remedies for bad breath. Studies show that bad breath is the third most frequent reason patients visit a dentist behind tooth decay and gum disease. Thankfully, there are a number of remedies available to treat bad breath, some of which are as simple as proper dental hygiene.

Causes of Bad Breath

In a majority of cases (approximately 85 to 90 percent), bad breath is caused by oral bacteria that break down proteins in the mouth, resulting in volatile sulfur compounds. More than 200 different types of bacteria live in the mouth, though some sources place the number as high as 700. In any case, that still makes the human mouth more sanitary than your average office desk or cell phone, or a Southern California restaurant with a "B" safety rating.

One of the most common locations for mouth-based bad breath is the posterior dorsum (the back of the upper surface) of the tongue, which is usually not cleaned as well as other parts of the mouth and is relatively dry, creating an ideal environment for bacteria to thrive. Dental problems such as tooth decay, dry mouth, gingivitis, and advanced gum disease have been shown to cause bad breath since such problems are also beneficial to oral bacteria.

Smoking, alcohol, and certain foods that contain volatile oils (e.g., garlic, onions, etc.) have also been shown to contribute to bad breath. In addition, the potency of bad breath may vary throughout the course of the day, subject to changes in oral dryness and other factors. Interestingly enough, a study by Tel Aviv University also found that obese people are more likely to have bad breath.

While in many cases bad breath disappears after brushing, rinsing, or eating, an estimated 25 percent of the population suffers from persistent or chronic bad breath - that is to say, bad breath that just won't quit.

Bad Breath and Health Problems

Certain serious health problems and systemic disorders have been known to cause bad breath. These health problems include:

• Kidney infection or kidney failure
• Lung infections
• Chronic liver failure
• Carcinoma (a type of malignant cancer)
• Diabetes
• Trimethylaminuria (also known as "fish odor syndrome")

Should you notice any bad breath that persists even after brushing and rinsing, it is important to locate a dentist in your area to discuss treatments and to find out whether your bad breath is the result of a systemic disorder.

The Terror of Tonsillolith

One of the joys of research is discovering new words and new objects, which is why it pleases me to mention tonsilloliths, another potential cause of bad breath. Sometimes referred to as tonsil stones, tonsilloliths are calcified growths found in the creases of the tonsils and towards the back of the mouth. Possible causes of tonsilloliths include the accumulation of food particles and dead white blood cells, overactive salivary glands, and oral bacteria.

Tonsil stones can be carefully removed on one's own or by a dentist. It's probably best to contact a dental professional to remove any tonsilloliths, though, due to the soft tissues of the mouth and tonsils.

Bad Breath Remedies

There are a number of bad breath remedies on the market. Some of them are more effective than others, especially since mints and chewing gum sometimes only mask the problem rather than eliminate the oral bacteria. Below is a partial list of bad breath remedies that you can use, though it's important to also visit a dentist twice a year for regular dental checkups.

Mouthwash

In a scene from Gone with the Wind, Scarlett O'Hara gargles with cologne to hide the scent of alcohol on her breath. As odd as it sounds, this practice was apparently not uncommon up through the early 20th century. As a child, I seem to recall hearing apocryphal stories of old-time movie stars and theater stars also rinsing their mouths out with perfume.

The first mouthwashes are attributed to Chinese medicine in 2700 BCE, when mouth rinses were used to treat gingivitis. The ancient Egyptians had rinses of water and honey that also included cumin, ocher, frankincense, and goose fat. One dental resource site noted the following ancient Greek recipe for mouthwash: "a decoct of the leaves of the olive tree, milk, the juice of pickled olives, gum myrrh with wine and oil, pomegranate peelings, nutgalls, and vinegar."

The Romans, not to be outdone, also developed mouthwashes and made dental hygiene part of religious ceremonies. The Romans' mouthwash had a secret ingredient, however: urine. The fact that Romans gargled with urine may be the reason that they needed vomitoriums. The kicker, of course, is that Romans did not believe their own urine was potent enough to knock out bad breath. Instead, they imported Portuguese urine because it was supposedly much stronger.

While this all may sound senseless and just plain gross, according to one source, urine (which contains ammonia) was an active ingredient in toothpastes and mouthwashes until the 18th century.

And you thought Tom's of Maine tasted bad.

Contemporary mouthwashes are thankfully comprised of different ingredients, though they do have their own interesting quirks. For instance, before becoming one of the leading mouthwashes on the market, Listerine was used as a surgical antiseptic, floor cleaner, and even a cure for gonorrhea.

When looking for a mouthwash, it's important to select one that contains no sugar and ideally no alcohol. Sugar can contribute to tooth decay and alcohol can dry out the mouth, creating an ideal environment for bacteria. It's been suggested that mouthwashes that contain chlorine dioxide (sometimes "stabilized chlorine dioxide") are particularly effective at combating bad breath. Chlorine dioxide can neutralize volatile sulfur compounds and minimize the level of bacteria in the mouth.

Brushing and Flossing

Brushing and flossing are the meat and potatoes of proper dental health. And, fittingly enough, they help remove excess meat and potatoes from the mouth. According to the 2003 Lemelson-MIT Invention Index, the toothbrush is one of the five inventions which Americans could not live without, beating out the car, the personal computer, the cell phone, and the microwave in that order.

While various cultures have been using chewed twigs, branches, bones, and feathers to brush their teeth, the first proper toothbrush is attributed to the Chinese in the 1400s. This ancestor of the modern toothbrush used a hog's stiff neck hairs attached to a bamboo stick. As of this writing, I don't know whether or not a swine's neck hair is more sanitary than a human mouth.

In 1770, William Addis created the first modern toothbrush while in London's Newgate Prison, serving time for inciting a riot. Most people of that period cleaned their teeth using a rag. Addis' toothbrush consisted of stiff bristles attached to a bone he'd saved after a prison meal. Once released from prison, Addis became quite successful marketing his toothbrush.

When selecting a toothbrush, it's important to select one with soft bristles to effectively remove plaque. A small head on a toothbrush may also be ideal since that will allow you to clean harder-to-reach areas of the mouth, such as the molars.

Dental floss has a much more traditional history, free from the fetters of prison and the hair of swine. It was introduced by New Orleans dentist Levi Spear Parmly in the early 1800s. Parmly was a major advocate of flossing to ensure proper dental health. Dental floss was finally made available to consumers toward the end of the 1800s, when Codman and Shurtleft, Johnson & Johnson, and other companies produced and mass marketed dental floss.

Tongue Cleaners and Scrapers

While not used as often as toothbrushes, tongue scrapers are an important part of dental hygiene and can help prevent bad breath. Tongue cleaners are designed to scrape excess food debris, dead cells, and other material from the surface of the tongue. Tongue scrapers are much less abrasive against the tongue than toothbrushes, the latter of which may damage tastebuds if used roughly against the tongue.

There have been a few studies that show the use of tongue scrapers can help prevent bad breath. According to a study in General Dentistry, the peer-reviewed journal of the Academy of General Dentistry, using a tongue scraper to clean the tongue proved more effective in eliminating volatile sulfur compounds than cleaning the tongue with a toothbrush and toothpaste. The study did note, however, that the reduction of volatile sulfur compounds was only short term.

Chewing Gum and Breath Mints

The fact that there are so many chewing gums and breath mints on the market is a testament to these confectionary bad breath remedies. More than $3 billion of chewing gum and breath mints are sold each year in the United States. This may be due to the fact that both are staple impulse buys at grocery stores and corner shops, often situated just below the tabloids and copies of Soap Opera Digest.

Chewing gum is one of the world's oldest candies. The ancient Greeks chewed on a substance they called "mastiche," which was derived from the resin of the mastic tree. The indigenous natives of North America, Central America, and South America similarly chewed on tree resins. For both the ancient Greeks and the early Americans, these resin-based chews were used to clean their teeth and freshen their breath.

It wasn't until the 1800s that chewing gum became a commercially viable product, with several manufacturers using a variety of gum bases, including chicle, spruce resin, paraffin wax, and beeswax. In 1893, the William Wrigley Company introduced the Spearmint brand. While not the first flavored gum--that distinction goes to the black licorice-flavored Black Jack in 1871, a retro favorite still manufactured today--Spearmint is one of the most recognizable mint-flavored gums on the market.

Breath mints evolved out of the breath freshening chews of the past. According to the website How Products Are Made, people used to suck on whole cloves to fight bad breath more than 4,000 years ago. Anise, which smells similar to licorice, was a popular solution to bad breath in the Middle Ages, as were cardamom seeds. The early settlers of North America discovered that chewing on dried orris root and calamus root could stave off buffalo breath.

Though Altoids (those curiously strong mints that come in a tin case) had been around in England since the 19th century, it appears that the American demand for a candy mint was not met until1956, with the debut of Certs. The demand for kitschy candy mints was not met until Mentos started airing commercials on American television in 1991, and the demand for soda explosions caused by Mentos was not met until September 2005, when Steve Spangler drenched a Denver news anchor with soda, harkening the birth of an Internet video phenomenon.

Natural Bad Breath Remedies

Given that so many early forms of chewing gums, breath mints, and even mouthwash were derived from plants, it's only natural that people often return to plants for bad breath remedies.

One of great folk remedies for bad breath is chewing parsley. Chewing mint leaves is another fine folk remedy that, like chewing parsley, has been used for thousands of years. Other herbs that can be chewed to remedy bad breath include basil, sage, rosemary, and thyme. So, in a sense, if it's mentioned in Simon and Garfunkel's "Scarborough Fair," you can probably chew it to alleviate bad breath.

One remedy I found for garlic breath involves sucking a lemon covered in salt. Of course, the only surefire way of beating garlic breath is to avoid garlic. Indeed, the best, if not the easiest, way to prevent bad breath is to abstain from the foods that can cause it, such as garlic, onions, pungent cheeses, spicy meats, and certain fish.

While bad breath will always be around, a combination of good dental care and smart choices should help keep halitosis at bay. And better to keep halitosis at bay than the people around you.