Bad breath: Risk factors and contributing conditions.

- This page outlines issues, circumstances and conditions that can place a person at greater risk for having halitosis.

Page Graphics | Animations.
Link to gum disease section.
Link to sinus conditions section.

FYI: When reading this information, take notice of the fact that many of the factors we explain directly relate to:

  • Conditions which promote the growth of oral bacteria.
  • Situations that make it difficult clean those areas where oral bacteria reside.

(We have other pages that explain how bacteria cause mouth odors and outline methods for cleaning these bacteria away. As background for this page, you just need to understand that anything that promotes the growth of oral bacterial will most likely heighten a person's problems with breath odors too.)

Contributing factors -

A) Smoking.

You're probably familiar with the odor of people who have "smoker's breath." Much of this smell is caused by tar, nicotine, and other stinky compounds found in tobacco smoke that accumulate on a person's teeth and oral soft tissues (tongue, cheeks, gums,...).

No smoking sign.

Smoking can aggravate breath problems.

Short of quitting smoking, there's no way to eliminate smoker's breath, although practicing immaculate oral hygiene can help to minimize it.

How smoking compounds a person's breath problems.

Smoking creates other risk factors. For example, tends to dry out oral tissues.

A decrease in oral moisture diminishes the beneficial washing, diluting and buffering effect of saliva on oral bacteria and the waste products they create. This topic is discussed in greater detail below.

It's also known that people who smoke are at greater risk for having problems with periodontal disease (gum disease). We discuss the role this condition plays in causing bad breath below too.

B) Dry mouth / Xerostomia.

Even if you don't really have a breath problem, you've probably noticed that yours least pleasant in the morning when you first wake up.

That's because during the night a person's mouth tends to dry out. This is due to the human body's natural tendency to reduce its salivary flow when a person sleeps.

  • This same souring effect is sometimes noticed by teachers, lawyers, and anyone else who must speak for extended periods of time.
  • People who breathe through their mouth, are fasting, or else are under stress may find they have a chronically dry mouth and subsequently persistent problems with breath odors.

1) Why oral moisture is so important.

One explanation for this phenomenon is that the moisture found in our mouth helps to keep it clean.

  • The presence of oral fluids encourages us to swallow. With each swallow we take we expel from our mouth bacteria, as well as the food and debris on which they feed.
  • Oral moisture dilutes and washes away the smelly waste products that oral bacteria produce.
  • Saliva is the body's natural mouth rinse. It contains compounds that kill bacteria and can buffer their odiferous waste products.

So, when our mouth dries out, all of these mechanisms are inhibited. The net result is one where the conditions for bacterial growth are enhanced while the neutralization of stinky bacterial waste products is reduced.

2) Xerostomia.

Some people have a chronically dry mouth. This condition is termed "xerostomia."

Medications - Having it can be a side effect of taking certain types of medications. Antihistamines (allergy and cold medications), antidepressants, blood pressure agents, diuretics, narcotics, or anti-anxiety medications may all be contributing factors for this condition.

Age - A person's age can also be at issue. For most people, as they get older, chronic mouth dryness becomes more and more of a problem. That's because their salivary glands tend to work less effectively and the composition of the saliva they produce changes too.

Gum disease - As complicating factor, people who have xerostomia are at greater risk for developing gum disease and the breath issues that come with it (see our next section).

C) Periodontal disease (Gum disease).

Periodontal disease frequently lies at the source of a person's breath odor. It's the second most common cause.

Periodontal pockets can harbor bacteria.

Gum disease pocketing makes it hard to remove bacteria.

Ask any dentist, the odor coming from the mouth of a person with active gum disease can be so distinctive that a dentist can correctly diagnose their condition even before they begin their examination.

Who's at greatest risk for gum disease?

Periodontal disease is typically more of a problem for people over the age of 35 and beyond. So, the older we get the more likely it is that our breath issues are related to the health of our gums.

What type of damage does periodontal disease cause?

Periodontal disease is a type of bacterial infection located in the tissues that surround a person's teeth.

As our animation illustrates, advanced forms of this condition typically result in serious damage to the bone that holds teeth in place. As it occurs, deep spaces form between the teeth and gums (termed "periodontal pockets"). They provide an ideal location for the bacteria that cause bad breath to live in.

How gum disease can affect your breath.

  • In many cases, it's waste products coming from bacteria harbored in periodontal pockets (some so deep that they're impossible to clean) that cause a person's bad breath.

    Most of the species of bacteria that live in these locations produce volatile sulfur compounds as waste.

  • Researchers have found that the amount of odor-causing coating (as measured by weight) that's present on the tongue of people with periodontitis is greater than those in control groups.
  • Studies have determined that the level of volatile sulfur compounds coming from this tongue coating is four times greater than in people who do not have periodontal disease.

(Suzuki 2012, Sanz 2001) [reference sources]

The source of post-nasal drip.

Sinus conditions can aggravate breath problems.

D) Sinus conditions.

Sinus conditions can cause breath problems.

1) Postnasal drip.

Upper respiratory infections and allergies can create a postnasal drip that falls onto the back portion of a person's tongue. (Via the opening behind the soft palate. See graphic.)

This discharge often has a foul taste and smell. What's worse, the bacteria that cause bad breath can use it as a food supply.

2) Dry mouth.

As a compounding factor, people who have a sinus condition will often have a stuffed up nose and will need to breathe through their mouth.

This drying effect can create an environment that promotes bad breath. Additionally, sinus sufferers are likely to take antihistamines, a type of medicine that's known to cause mouth dryness (see above).

E) Foods.

Everyone knows that certain foods have a reputation for causing bad breath. Two of the most notorious are garlic and onions.

How foods can cause bad breath.

  • When we eat, our digestive system breaks down the food we have consumed into its component molecules. Some of them have a very unpleasant odor.
  • As these molecules are created, they are absorbed into our blood stream so they can be distributed throughout our body as nourishment.
  • As our blood travels through our lungs, some of these molecules are released into them. As a result, as we exhale, they get expelled with our breath too.

While this type of bad breath can be annoying and embarrassing, it's not the main concern of the pages of our topic.

Halitosis caused by the consumption of foods will resolve on its own in a day or so as your body completes the process of breaking down and utilizing, or else excreting, the offending compounds. You can control this type of problem simply by avoiding or minimizing your consumption of certain types of foods.

F) Medical conditions.

Some medical issues are known to be associated with the presence of mouth odors. If a person's bad breath persists after they have consulted with their dentist and tried the usual simple solutions, then a consultation with their medical doctor may be indicated.

Your doctor will of course know what types of conditions to look for. But, in general, they will evaluate you for problems associated with your respiratory (pulmonary or bronchial), hepatic (liver), renal (kidney), and gastrointestinal (stomach and intestine) systems.

X-ray of a decayed tooth with an abscess.

Infected teeth can be the source of breath odors.

G) Dental conditions.

Untreated dental conditions can be the cause of or contribute to a person's breath problems.

  • Active infections, such as those associated within abscessed teeth (see graphic) or partially erupted wisdom teeth, can be at fault.
  • Teeth that have large voids (due to decay or fracture) can trap enough debris and bacteria that they become the source of foul odors.

H) Dentures.

Dentures (complete dentures, full dentures, partial dentures, etc...) can have a big influence on the quality of a person's breath.

How to test for denture breath.

Try this test to see if your dentures might be the source of your breath problems.

  • Remove your dentures and place them in a baggie.
  • Seal the baggie shut and let it sit for about four or five minutes.
  • Now, crack the baggie open and take a whiff.

For better or worse, that's what your breath smells like to others. Use this link for more information bout the causes of denture breath and how to treat it.

Now you know the reasons why you have bad breath. Our next page explains how to cure it.


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