Bad Breath: What causes it and how do you cure it?

Bad breath isn’t just unpleasant; it could also be a red flag for something more serious. Here are the basics of what causes bad breath and how to cure it.
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Let’s get one thing straight before we begin: Bad breath is never something to be ashamed of. Don’t ever let a commercial convince you otherwise. A lot of money is made by corporations convincing people that halitosis is shameful—if you’re ashamed, you’ll never bring it up with your doctor, and you’ll be more inclined to hand over your money for a quick fix.
In this article, we’re going to talk about where bad breath comes from and what to do about it. We’ll also cover some natural remedies for bad breath.
Let’s dig in!
What NOT to do if you have bad breath
I strongly discourage masking the odor with mouthwash, gum, or those bad breath strips. These products have strong antibacterial ingredients that disrupt the delicate balance of bacteria in the mouth, causing more and worse bad breath.
Most bad breath comes from an imbalance in the oral microbiome, the community of organisms that reside inside your mouth. Just like the gut, vaginal, and skin microbiome, the oral microbiome is incredibly diverse and consists of hundreds of different species of bacteria.
Not all this bacteria is bad—in fact, much of it is good. We’ve been told that the way to tackle bad breath is to kill all of these bacteria; however, this is not the right approach.

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How oral microbiome disruptors cause bad breath
When the oral microbiome is out of balance, not only do we see bad breath, but we also see disruption to gut health, an increase in cavities, and even an impact to mental health such as depression and anxiety.
I recommend discontinuing the use of any antibacterial oral care products, including mouthwash and antibacterial toothpaste. And remember that essential oils can have a strong antibacterial effect in the mouth.
How to know if you have bad breath
The best way to know is to test. I love Bristle’s halitosis indicator for this. Bristle is an oral microbiome test you can do via the mail and gives you a personalized plan based on the microbes in your mouth to understand which microbes are driving your bad breath. I highly recommend testing your oral microbiome—not just for bad breath but for your overall health. Oral microbiome testing with Bristle has become an integral part of how I treat my patients now.
Some other (less precise) ways to tell if you have bad breath:

Lick the inside of your wrist and sniff. If it smells bad, chances are your breath does too.
Look in the mirror at your tongue. A yellow or white-coated tongue can indicate you might have bad breath.
Ask a third party like a friend or loved one—but be aware that we often grow accustomed to the body odors of our roommates and loved ones, so this isn’t the most objective.

Which mouthwash should I use to get rid of bad breath?
The best mouthwash to get rid of bad breath is no mouthwash. Mouthwash dries out the mouth, which is the opposite of what you want to get rid of bad breath – lots of saliva is what disorganizes plaque and keeps bacteria from growing out of control in your mouth. Mouthwash can also upset the normal ratio of good and bad bugs in your mouth, thus making things smell bad. I don’t care how minty your mouthwash is or how much it makes your mouth tingle – these are masking agents that do nothing to help, if not exacerbate, your bad breath. Ditch the mouthwash and swish with water after you brush instead.
Embarrassed to talk to your dentist about bad breath?
Please don’t be. Trust me, we want to know, and we want to help—in fact, it’s our job to know because halitosis can be an indicator of something wrong elsewhere in the body, like an infection, nasal polyps, kidney problems, diabetes, liver disease, malnutrition, or even cancer.
Causes of Bad Breath

Dry mouth: Dry mouth is enemy number one with bad breath! A dry mouth is a stinky mouth. Getting dehydrated impedes saliva production.
Gingivitis and periodontal disease: This is the number one cause of bad breath that I see. This type of bad breath is often described as a bad taste in the mouth.
Inadequate oral hygiene: Bad breath can be caused by inadequate oral hygiene —that is, not flossing daily and brushing at least twice per day, or improper technique. (If you’re wondering what good technique looks like, check out my videos on proper flossing technique and proper brushing technique.) I also highly recommend this electric flosser which dramatically improves plaque disruption.
Garlic and onions: There are lots of stinky foods like kombucha, onions, garlic, and grass-fed beef sticks that are fantastic for oral health even if they are also the cause of bad breath. The oils from stinky foods like onions and garlic can be detected on the breath up to three days after consumption.
Bad breath from the sinuses, mouth, or throat: Bad breath can be an indicator of an infection.
Bad breath from the stomach: GERD, SIBO, Crohn’s Disease, and Celiac Disease can all be major players in causing bad breath.

Here’s what I recommend for treating bad breath:

Remember there are no quick fixes.
Start with the oral microbiome: adopt a new mantra of “feed your good guys.” We’ve been conditioned to think we need to sterilize the mouth when this is actually counterproductive for not just curing bad breath but oral health overall! Discontinue anything you’re using that’s antibacterial, such as antibacterial mouthwash, or toothpaste.
Mouth tape at night. Dry mouth is enemy number one when it comes to bad breath. When we mouth breathe, the mouth dries out, saliva flow stalls, and the oral microbiome is disrupted because we get the wrong kinds of microbes growing in that dried-out, anaerobic environment.
Add prebiotic and probiotic foods to your diet: A common mistake I see is taking only probiotics but no prebiotics. We need both; probiotics are the “seed” and prebiotics are the “feed.”
Add fermented products to your diet: Kimchi, kefir, and sauerkraut are fantastic.
Take prebiotic and probiotic supplements: Again, see above—we need both! Taking all the probiotic supplements in the world without the proper prebiotics there to ensure their survival won’t help improve oral dysbiosis in the mouth.
Tongue scrape: you’ll be amazed at how much gunk you scrape off your tongue. First-time tongue scrapers may even see some blood come off the scraper and then later a yellow fluid. It may take 6 months of proper tongue scraping to stop seeing any of this debris on your scraper, which is normal if you’ve never tongue scraped before
Stay hydrated: Hydration allows your mouth to produce saliva, maintain a moist environment in the mouth and maintain that critical balance of bacteria in the mouth for not just good breath but also good oral health overall.
Become a green tea drinker:
Supplement with digestive enzymes: Bad breath can come from the stomach and taking digestive enzymes can help with this.
Brush up on your flossing technique: If you aren’t flossing, you’re not removing bad breath causing plaque and bacteria from 30% of the surfaces of the teeth—and that 30% will easily cause bad breath!
Don’t give up on onions and garlic: I recommend eating an apple or chewing on gum to increase saliva production in the mouth. Use an electric flosser, swish with water and baking soda, or eat an apple afterward to neutralize the odorous compounds.

If your bad breath persists despite following these suggestions and, most importantly, flossing daily and brushing after meals, see your dentist. Having great oral hygiene, drinking plenty of water, and not smoking – but still having bad breath – could indicate that you have a more serious underlying condition.
Mark Burhenne DDS

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