What Causes Bad Breath That Won’t Go Away?

Everyone experiences morning breath, but some have chronic halitosis (bad breath) that remains after brushing and flossing. Around 65 million Americans experience halitosis at least once in their life.

When your breath is unpleasant, it can impact your daily life. You may feel self-conscious, embarrassed, and even anxious in social settings, including work or school. It destroys your confidence.

It’s not always poor brushing habits. Sometimes, bad breath is caused by health issues you may not realize you have. Our guide takes a deep dive into halitosis and how you can stop bad breath.

Understanding the Two Issues Behind Halitosis

Two specific problems lead to bad breath.

1. Anaerobic Microenvironments: Bacteria in the mouth or throat thrive in low-oxygen environments and create volatile sulfur compounds when they break down protein.
2. Volatile Sulfur Compounds (VSCs): Dimethyl sulfide (smells like sugary rotten cabbage) is linked to systemic issues; hydrogen sulfide (the most common and smells like rotten eggs) is linked to tongue bacteria; and methyl mercaptan (smells like garbage or rotten cabbage) is linked to gum disease. 

Bacteria and VSCs must meet for odor to develop. Sometimes, bacteria are already in the mouth, and low saliva flow worsens the issue. It can also be caused by trapped bacteria in areas normal oral care doesn’t reach, or by health conditions that allow VSCs to travel up from the stomach.

12 Common Causes of Bad Breath

Bad breath is usually tied to one of 12 causes. Some are linked to your mouth and tongue, while others are triggered by issues in the respiratory or digestive systems.

ENT and Airway

• Chronic Sinusitis: Mucus builds up and creates a protein-rich environment.
• Mouth Breathing and Airway Issues: Mouth breathing from congestion, a deviated septum, or sleep apnea dries out the mouth and reduces saliva, which usually flushes away food particles and bacteria.

GI and Systemic Health

• Diabetes: Blood sugar levels need to be carefully managed. If they get too high or too low, it can lead to bad breath.
• GERD and Acid Reflux: Stomach acid that backs up into the esophagus makes your breath smell.
• High-Protein or Poor Diets: For years, people switched to high-protein diets like Atkins. Resulting ketones make your breath smell like nail polish remover (acetone). A sick child who hasn’t eaten much for a couple of days can also get acetone breath.
• Liver or Kidney Disease: Kidney and liver issues often trigger bad breath that might smell of ammonia, freshly mowed grass, raw fish, or urine.
• Stomach Infection: H. pylori infections don’t always have symptoms, but bad breath is common with this infection.
• Tonsil Stones: Debris gets stuck in spaces within the tonsils and builds VSCs.

Oral and Dental

• Aging or Failing Dental Work: Cracks or gaps around fillings and other dental work allow bacteria to get into places your toothbrush can’t reach.
• Dry Mouth: Less saliva reduces the mouth’s ability to rinse away food particles and protect the gums.
• Gum Disease: Hidden plaque establishes areas for bacteria to thrive and increases the risk of gum disease.
• Poor Oral Care Habits: Failing to brush and floss properly, and skipping twice-yearly dental cleanings and exams, can lead to tooth decay and gum disease that trigger bad breath.
• Tongue Coating: The tiny papillae on the back of your tongue are a prime spot for VSC-producing bacteria, which is why scraping your tongue is important.

Four Tests Dentists Use to Diagnose the Cause of Bad Breath

When you don’t have an underlying health condition that’s triggering your bad breath, a dentist can help you pinpoint the cause. Four tests can provide answers.

• Gas Chromatography/Halimeter Testing: Measures VSC concentration in your mouth, providing a parts-per-billion measurement; 80 to 150 ppb is normal.
• Oral Microbiome Profiling: A saliva test determines the exact microbes in your mouth.
• pH Testing: A saliva sample is tested to determine pH, as acidic saliva is often linked to bad breath.
• Saliva Flow: This test measures how much saliva you produce and whether you may be dealing with dry mouth.

How Do You Get Rid of Bad Breath?

We advise talking to your primary care physician and getting a full checkup if it’s been a while. If you have an underlying health issue, addressing it sooner rather than later is always best for treating whatever is going on.

Stay Hydrated

One of the most important things you can do is drink plenty of water throughout the day. When you’re well hydrated, your saliva flows and can help clear bacteria and food particles from your mouth.

Upgrade Your Oral Hygiene

Make sure to brush twice a day and floss once. Invest in additional dental cleaning tools like a tongue scraper. Try to remove as much bacteria as possible from the back of your tongue. A water flosser helps flush food particles from between the teeth and around the gumline.

Brush your teeth about an hour after you last ate. Avoid using a mouthwash right after brushing. When you brush too soon after a meal, the enamel is softer, so brushing can damage it. When you use mouthwash right away, you rinse off any fluoride that remains on your teeth from brushing.

Use the Best Mouth Rinse

Alcohol-based mouthwashes worsen dry mouth. If you insist on using mouthwash, make sure you’re using a chlorine dioxide or zinc formula designed for dry mouth. Otherwise, use an alcohol-free fluoride mouthwash.

When Is It Time to Contact a Dental Specialist?

Trust yourself. If bad breath affects your confidence or daily routine, see your doctor or dentist. It might be nothing more than what you ate last night. If it is, the sooner you seek treatment, the sooner you’ll feel comfortable around others again.

Expect the dentist to examine your teeth and take oral X-rays to check for cavities or tooth decay. A small tool is used to measure the gaps between your teeth and gums, which indicates whether you have gum disease or not. If they don’t find any concerns, tests like those mentioned above are often recommended.

If you brush and floss your teeth and cannot get chronic bad breath to go away, it’s time to make an appointment at Sage Dental. Many things can cause bad breath, and a medical professional can help you determine what’s causing it and how to address it.

With dental offices located throughout many states, it’s easy to find a convenient location. Our dental team includes dentists, dental hygienists, and dental specialists. Make an appointment online and put an end to your bad breath.