What causes bad breath?
Most people suffer from bad breath occasionally. However, if it becomes permanent you should consult your dentist. Bad breath is usually due to the breakdown of proteins by bacteria somewhere in the mouth. However, there are several other possible causes in the airways, oesophagus and stomach that can also lead to bad breath.

1. What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odour. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. Brushing, flossing and mouthwash will only mask the odour temporarily. Odours continue until the body eliminates the food. People on a diet may develop unpleasant breath from infrequent eating.

2. If you do not brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odour. Dentures that are not cleaned properly can also harbour odour causing bacteria and food particles.

3. One of the warning signs of periodontal (gum) disease is persistent bad breath or a bad taste in the mouth. Periodontal disease is caused by plaque, the sticky, colourless film of bacteria that constantly forms on teeth. The bacteria create toxins that irritate the gums. In the advanced stage of the disease, the gums, bone and other structures that support the teeth become damaged.

4. Bad breath is also caused by dry mouth (xerostomia), which occurs when the flow of saliva decreases.

5. Tobacco products cause bad breath, stain teeth, reduce one's ability to taste foods and irritate gum tissues. Tobacco users are more likely to suffer from periodontal disease and are at greater risk for developing oral cancer.

6. Bad breath may be the sign of a medical disorder, such as a local infection in the respiratory tract (nose, throat, windpipe, lungs), chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Factors in the mouth that cause bad breath:

* Dental decay
* Gum disease
* Food stagnation between the teeth
* Dry mouth
* Excessive bacterial activity on the tongue, possibly due to postnasal drip (catarrh coming down the back of the throat from the sinuses and nasal passages)
* Throat or tonsil infection

Factors in the airways that cause bad breath:

* Sinusitis
* Polyps
* Dryness
* Foreign body
* Hindered air or mucus flow
* Bronchitis
* Pneumonia

Factors in the oesophagus and stomach that cause bad breath:

* Gastritis and food reflux
* Food stagnation
* In rare cases, bad breath can be a sign of a significant general health problem, so it should not be ignored. However, the usual cause is oral, which can often be treated to resolve the problem

How is the diagnosis made?
Regular checkups will allow your dentist to detect any problems such as gum disease, a dry mouth or other disorders that may be the cause. Schedule regular dental visits for a professional cleaning and checkup. If you think you have constant bad breath, keep a log of the foods you eat and make a list of medications you take. Some medications may play a role in creating mouth odours. Let your dentist know if you have had any surgery or illness since your last appointment. If your dentist determines that your mouth is healthy and that the odour is not of oral origin, you may be referred to a specialist to determine the cause of the odour and for treatment. With regular dental checkups, your dentist can detect and treat periodontal disease early.

What is the treatment?
Maintaining good oral hygiene, eliminating gum disease and scheduling regular professional cleanings are essential to reducing bad breath. Brush twice a day with a fluoride toothpaste to remove food debris and plaque. Brush your tongue, too. Once a day, use floss or an interdental cleaner to clean between teeth. If you wear removable dentures, take them out at night. Clean them thoroughly before replacing them the next morning.

Mouthwashes are generally cosmetic and do not have a long-lasting effect on bad breath. If you must constantly use a breath freshener to hide unpleasant mouth odour, see your dentist. If you need extra help in controlling plaque, your dentist may recommend using a special antimicrobial mouthrinse. A fluoride mouth rinse, used along with brushing and flossing, can help prevent tooth decay. If you suffer from dry mouth, your dentist may prescribe an artificial saliva, or suggest using sugarless candy and increasing your fluid intake.
What can you do for yourself?

* Maintain a high level of oral and dental hygiene. In addition to brushing, it is important to clean between the teeth using dental floss.
* Use a tongue cleaner and clean right to the back of the tongue.
* Use a mouthwash recommended by your dentist or pharmacist. The best time to use it is just before sleeping
* Drink plenty of fluids, avoiding too much coffee
* Clean your mouth after eating milk products, fish and meat
* Chew sugar-free gum, especially if your mouth feels dry
* Eat fresh, fibrous vegetables
* Visit your dentist regularly and have your teeth professionally cleaned as required.
 

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