Recognizing Bad Breath Symptoms: Seven Tests You Need to Know
Most of us cannot smell our own breath, and bad breath researchers report that for about 40% of us, this is a good thing. The problem is, how can you possibly know whether you have bad breath if you can’t smell your own breath? It’s a question most of us don’t even want to ask our closest friends. Even family members and spouses may not necessarily tell us.
One way to find out whether you have bad breath is to plunk down your credit card and buy a $30 bad breath meter that doesn’t work or a $300 bad breath meter that does. Or you could walk up to random people on the street and breathe them, asking “Excuse me, does my breath smell bad?” We recommend that you don’t pursue either of these ideas. Instead, we suggest that you go down this checklist of seven bad breath symptoms for signs that you may need to take measures to make your breath sweeter.
1. A grayish, off-white, or yellow coating on the tongue.
It is very common for people who have halitosis to have a visible biofilm on the tongue. This gray or off-white or yellow film on the tongue is really a coating of anaerobic bacteria. Growing in nooks and crannies and not needing oxygen from the atmosphere, these 20 some-odd species of bacteria accumulate in cracks in the tongue.
Bad breath bacteria digest proteins from food particles and from the mouth itself. They break down proteins into amino acids, most of which they use for themselves. The amino acids the bacteria usually don’t use, however, contain sulfur and are converted into sulfur compounds that are literally identical with flatulence, sewer gas, and rotten egg odor.
Sometimes you can see a film on your tongue. Sometimes you may notice dots of color around your taste buds. These dots of slimy color around your taste buds are bad breath bacteria.
The larger your taste buds, the greater the potential of your tongue to house these bad breath factories. And if you have post-nasal drip, the gooey film can build up on your tongue 24/7.
What can you do? A tongue scraper can help and is one of the must-have tools, but so can home sinus irrigators or a neti pot. They can be far more helpful in controlling bad breath than a trip to your dentist and dental hygienist. A bright red color in your gums and bleeding when you brush, however, are symptoms that mean you need to see the dentist right away.
2. Dry mouth.
You don’t have to have some kind of obscure autoimmune disease or to be taking medications for mood disorders or irritable bladder or Parkinson’s disease to have dry mouth. The most common cause of dry mouth is breathing through the mouth.
And the most common cause of breathing through the mouth is nasal congestion or nasal obstruction. If you snore, you can have dry mouth. If you snore, you are at risk for bad breath. Curing nasal congestion or snoring will probably also cure bad breath. But there are also other serious conditions (yes, snoring is a serious medical issue) that can cause dry mouth and its attendant problems.
Known in the medical research literature as xerostomia, dry mouth changes the oral cavity in a number of ways that contribute to bad breath. First of all, as saliva production is decreased, bacteria become more concentrated. They aren’t flushed down the throat. This makes bad breath more noticeable at longer distances and from smaller mouths—children and people of small frame usually don’t have noticeable bad breath because they don’t have as many bad breath bacteria.
Also, as less saliva is produced, bacteria are rinsed off the surface of the tongue and cheeks less frequently. They have more opportunities to form a biofilm that sticks to the surface of the gums and tongue that makes them harder to brush away. The biofilm traps volatile sulfur gases that not only smell bad but kill healthy tissue providing still more food for the bacteria. And as the mouth dries out, tiny cracks and fissures form to provide halitosis bacteria with the perfect home.
Once in a while dry mouth is self-inflicted. Too much coffee, too much hard liquor, and too much alcohol-based mouthwash (like regular Listerine used more than once or twice a day) can dry out the mouth and cause bad breath.
Sometimes dry mouth results from medication. Diuretics, of course, dry the mouth, but so do the medications that control irritable bladder or frequent urination. Many antidepressants and all the drugs for Parkinson’s disease contribute to xerostomia. Less frequently, the contributing condition is diabetes, Sjögren’s syndrome, or radiation treatment of the mouth and neck. These last three conditions usually cause dry skin in addition to dry mouth.
So, what can you do about dry mouth? The simplest approach is to sip water throughout the day. Occasional sips of water rinse away food particles that might stick to gums and teeth. Chewing sugar-free gum also helps, and people who have autoimmune conditions like Sjögren’s syndrome may benefit from taking a daily capsule of fish oil or flaxseed oil. You may also benefit from using Salivart, Saliment, Saliva Substitute, MouthKote, or Xero-Lube, but if you use these saliva replacements, be sure you have removed any sticky films on your tongue first.
3. Bitter, sour, or metallic taste in your mouth.
Diagnosing bad breath by changes in taste perception is difficult. The diseases that cause changes in the way you taste things are often obscure, but altered taste perception is a common side effect of chemotherapy. If you have been taking chemotherapy for cancer and you have a bitter, sour, or metallic taste in your mouth, you can at least rest assured that it it’s due to cancer treatment—but the kinds of mouth dryness and soreness after chemo and radiation also cause really terrible bad breath. Don’t worry about what people think. Or if you do, ask your doctor for a prescription for Dioxirinse mouthwash.
In women, sour or metallic tastes are an occasional component of monthly hormone changes, and men receiving hormone therapies can notice odd tastes too. These likewise do not signal bad breath and don’t mean you don’t have it, either.
In rare instances, nerve damage elsewhere in your body can cause phantom taste perception. This most often happens when diabetes causes the same kind of nerve damage in the mouth that it causes in the hands and feet—but you will have changes in the hands and feet first.
If you have not been taking medications that commonly change taste perception, and you have bitter, sour, or metallic tastes in the mouth, however, chances are you also have bad breath. These tastes are more frequently associated with yeast overgrowth than with the other bacteria that cause bad breath. The underlying problem may be a milder form of dry mouth. The treatments listed for dry mouth also help if you have a bad taste in your mouth.
4. Post-nasal drip
Do you need to clear your throat a lot, night and day? If you do, you don’t need an extensive workup at the clinic to know that chances are you have post-nasal drip, a draining of mucus from your sinuses bypassing your nostrils and going straight to your throat. The mucus can get caught on the cracks and crevices of your mouth and tongue and feed the bacteria that cause bad breath.
Post-nasal drip is often caused by allergies, but what most doctors won’t tell you is that post-nasal drip is often caused by a food allergy. If there is some food you eat every day—tomatoes, for instance—that’s the food that is most likely to be causing the problem. Simply taking a break from an everyday food may be enough to stop both post-nasal drip and halitosis.
Nasal sprays can make bad breath worse by sedating the cilia that move mucus out of the sinuses and the nostrils. The medications open up passages, but but stopping the flow of mucus, they also dry them out. Even worse, the mucus can begin the decay where it is trapped in the sinuses.
Dry nasal passages provide hiding places for sinus bacteria to make the same kinds of odors that cause bad breath in the oral cavity. You are a lot less likely to develop bad breath if you use any method other than a nose spray to open up your sinuses.
5. Lumps on the tonsils
If you feel a lump in the back of your mouth, or the top of your mouth, and you have a history of tonsillitis, strep throat, colds and flu, or sore throat, you may have tonsil stones. These are odor-causing accumulations of bacteria and mucus that grow in cracks in your tonsils. They become covered with a thin, soft, skin-like accumulation of scar tissue.
You could just have your tonsils, removed, of course, but many people find that spraying the back of the mouth with a WaterPik or similar oral irrigation device is a great way to loosen the stones—and when they come loose, bad breath goes with them. Tonsil stones are also a common cause of chronic bad breath in children.
You can also remove tonsil stones by poking with your finger—but take care not to induce vomiting. Don’t use this technique on a child unless a doctor has examined your child first.
6. Brushing really does make a difference. Just not a lot.
About 30% of the bad breath bacteria in your mouth live on the brushable surfaces of your mouth. If you have a mild case of acute bad breath, brushing might make the difference between having noticeable bad breath and not.
Brushing with the wrong kind of toothpaste, however, can cause as many problems as it helps. If your toothpaste contains sodium laureth sulfate or sodium laurel sulfate, the foam from brushing your teeth can dry out your mouth. As you know by now, the drier your mouth, the more places bad breath bacteria can take hold and grow. If you are already brushing three times a day, try some of the remedies for dry mouth for greater confidence in the social acceptability of your breath. A very good sign you are brushing too much is pain when you brush.
Here is another important tip: Flossing is a great tool for oral health, but flossing technique makes all the difference, too. It is essential to wrap the floss around the tooth and floss each individual tooth from side to side to side. Flossing up and down can injure your gums and trap food particles between your teeth. Both the impacted food particles and dying gum tissue can start to stink.
7. Mouthwash doesn’t keep bad breath in check, either.
Many mouthwashes contain alcohol that manufacturers claim will kill the bacteria that cause bad breath. The problem is that the amount of alcohol needed to kill bacteria on contact (46%, or 92 proof) is enough to make your mouth burn. Most mouthwashes contain only 22% to 28% (44 to 56 proof) alcohol so the burning will be noticeable but not unbearable.
That stinging you feel, however, is not alcohol killing bad breath bacteria. It is alcohol killing the lining of your mouth. Dead tissue decays and make bad breath worse.
There are mouthwashes that won’t dry out your mouth, such as Dr. Katz’s or Oxyfresh, among several others. They’ll help control bad breath at least temporarily. So will rinsing your mouth with warm (not hot) green tea.
These seven signs don’t cover one of the most common questions about halitosis:
Was it something I ate?
One thing you shouldn’t worry about too much is what you eat. Yes, it’s true that eating onions and garlic will produce funky breath, but that effect is temporary, about six hours at the max. If you rinse your mouth to remove onion- and garlic-tainted food particles, your sweet breath will return even faster. The seven suggestions above give you good ways to check for bad breath that lead to treatment that really works.
