Bad breath coming from within the mouth
In most people who have bad breath (halitosis), the bad smell is thought to come from germs (bacteria) and debris within the mouth. As the bacteria break down proteins and other debris in the mouth, they release foul-smelling gases. One or more of the following may contribute to the build-up of bacteria, debris and bad breath:
- Food stuck between teeth. Normal teeth brushing may not clear bits of food which can get stuck between teeth. The food then rots and becomes riddled with bacteria. Regular cleaning between the teeth can clear and prevent this problem.
- Plaque, tartar (calculus) and gum disease. Dental plaque is a soft whitish deposit that forms on the surface of teeth. It forms when bacteria combine with food and saliva. Plaque contains many types of bacteria. Calculus is hardened calcified plaque. It sticks firmly to teeth. Gum disease means infection or inflammation of the tissues that surround the teeth. If your gums look inflamed, or regularly bleed when you clean your teeth, you are likely to have gum disease. The severity can range from mild to severe.
- Coating on the back of the tongue. In some people, a coating develops on the back part of the tongue. It is not clear why this occurs. It may be from mucus that drips down from the back of the nose (postnasal drip). The coating can contain many bacteria. This explains why bad breath can sometimes occur in people with otherwise good oral hygiene.
- Tonsil stones (tonsilloliths). These are clusters of calcified material that form in the tonsillar crypts, or crevices of the tonsils. They are made up mostly of calcium but can contain other ingredients such as magnesium and phosphorus, and can feel like a small lump in the tonsils. Rarely harmful, they can be a nuisance and hard to remove and can often cause bad breath.
Further reading and references
Kapoor U, Sharma G, Juneja M, et al; Halitosis: Current concepts on etiology, diagnosis and management. Eur J Dent. 2016 Apr-Jun10(2):292-300. doi: 10.4103/1305-7456.178294.
Halitosis; NICE CKS, November 2014 (UK access only)
Bollen CM, Beikler T; Halitosis: the multidisciplinary approach. Int J Oral Sci. 2012 Jun4(2):55-63.
Yaacob M, Worthington HV, Deacon SA, et al; Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014 Jun 17(6):CD002281. doi: 10.1002/14651858.CD002281.pub3.
Poklepovic T, Worthington HV, Johnson TM, et al; Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev. 2013 Dec 18(12):CD009857. doi: 10.1002/14651858.CD009857.pub2.
Kuo YW, Yen M, Fetzer S, et al; Toothbrushing versus toothbrushing plus tongue cleaning in reducing halitosis and tongue coating: a systematic review and meta-analysis. Nurs Res. 2013 Nov-Dec62(6):422-9. doi: 10.1097/NNR.0b013e3182a53b3a.
Porter SR, Scully C; Oral malodour (halitosis). BMJ. 2006 Sep 23333(7569):632-5.
Fedorowicz Z, Aljufairi H, Nasser M, et al; Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev. 2008 Oct 8(4):CD006701.
Phillips IR, Shephard EA; Trimethylaminuria, University of Washington, 2007 (updated 2011)
Reidy JT, McHugh EE, Stassen LF; A review of the role of alcohol in the pathogenesis of oral cancer and the link between alcohol-containing mouthrinses and oral cancer. J Ir Dent Assoc. 2011 Aug-Sep57(4):200-2.
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