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It is one thing to have a temporary problem of a garlic odor on your breath and quite another to be plagued with an offensive breath much of the time. There are many causes for bad breath. When the cause can be identified it can usually be treated satisfactorily. Unfortunately, the cause may not be found and in those cases treatment may not be successful. It is certainly true that a person may have bad breath and not know it. Since bad breath is often a symptom of a dental or medical problem, you are not always doing a person a favor by not mentioning it. In some cases a person may imagine he has bad breath when, in fact, he does not. Again, an unbiased observer can be very helpful. The "imagined" bad breath often stems from a psychological need to avoid social contact. Bad breath can indeed have unfortunate social consequences. No matter how attractive a person may be physically and personality-wise, bad breath is a turn-off.

Despite the frequency of bad breath and its significance, it has been largely neglected by the medical profession. Interest has centered on the obvious causes that can be readily treated. Worse still, is the general apathy about the problem. Halitosis, or bad breath, is often not even mentioned in leading complete texts of medicine or appropriate specialty texts such as otorhinolaryngolgy (ear, nose and throat). With this lack of interest, it is little wonder that many physicians are at a loss in treating the patient with bad breath of unknown cause.

A good place to start to look for the cause of bad breath is your mouth. A visit to the dentist is appropriate and you must tell him that you have a problem with bad breath. Of course, you must use ordinary daily dental hygiene to avoid an unpleasant odor. Any food particles around the teeth or between the teeth can be a source of bad breath. Tiny food particles wedged between the teeth may not be removed by brushing. Plaque, that creamy soft material, may collect along the gingival (gum) line at the base of the teeth and between the teeth. Proper use of dental floss between the teeth will help to remove food particles and plaque that the brush does not remove. You may also find that special devices, from cotton swabs, toothpicks, wood stimulators or a rubber tip on the handle of the tooth brush, will help you remove material. A water jet may be helpful in dislodging material between the teeth. Of course, dentures require special care and if you have a problem with denture odor you should review your denture care with your dentist.

Even with the best efforts, if there are infected areas around the tooth or just under the edge of the gingiva, you cannot remove the odor they cause. These areas often contain bacteria that release particularly unpleasant odors. This condition is called pyorrhea or periodontal disease. You must have this treated by your dentist. He will need to do the kind of cleaning required to clear infected pockets that home hygiene cannot accomplish. He may need to remove excess gingival tissue and will certainly have to remove infected pockets that have developed. That is essential to restore health to the gingiva. Proper dental treatment in such cases is not only essential to eliminating bad breath but it is essential to prevent the early loss of your teeth. This is an excellent example of bad breath being a sign that you need some professional attention for your health, in this case your teeth. Any dental problem can cause bad breath. An abscessed tooth may be the cause or any other infection. These are usually painful and self-limiting disorders.

Too often, only the teeth are considered as a possible source of bad breath. The cause may actually be the tongue. The tongue sheds cells daily. These and food particles accumulate on the surface of the tongue. This is a rich media to grow bacteria and bacteria often produce bad smelling odors. The tongue is partially cleaned by the saliva but often much more is required. It is a good idea to brush you tongue at the same time you brush your teeth. Look in the mirror and be sure your tongue is clean. It will not hurt your tongue to brush it unless you are exceptionally rough. You will find that your sense of taste is better if your tongue is clean. That may also improve a person’s sense of smell. When tastes and odors from bacteria are strong, they overpower the sensitivity to both taste and smell from other sources. Mouth breathing allows the mouth to dry and this promotes a coated tongue with increase bacterial growth. That is one reason why some people wake up in the morning with a foul breath.

Of course, the odors from food and beverages are in the mouth. You can usually tell if a person has already had a cup of coffee. Smokers seldom realize that their breath really smell’s from their habit. The smoker is so accustomed to the smell of his breath that he is unaware of it and the odor of his breath dulls his sensitivity to other odors. Usually a nonsmoker has a much keener sense of smell than a smoker. A smoker can benefit from good dental hygiene but to really be free from that bad odor he will need to eliminate smoking entirely. Smokers are sometimes startled at how quickly a nonsmoker can tell they have been smoking.

Infected sinuses may be a source of bad breath. As the air is exhaled from your nose it will pass over the infected areas or over the opening of the infected sinuses. The vapors from the infection caused by secretions and the bacteria will impart an unpleasant odor to your breath. Any problem that affects normal drainage of the natural secretions from the sinuses can cause an odor. At the back of the throat, behind the soft upper part of the roof of your mouth, are specialized lymph glands called the adenoids. When they are large and obstruct the nasal passage, they may cause mouth breathing. By obstructing the normal flow of air and also by causing mouth breathing, they set the state for bad breath. They may become infected and like any chronic infection, may cause bad breath. Infected tonsils are a more common cause of bad breath. The enlarged tonsils, full of cheesy material from chronic infection, smell bad. As air passes over the smelling tonsils, the odor is wafted out of the nose or mouth and creates the problem. The solution here is removal of infected tonsils and abnormal adenoids. If the tonsils are not chronically infection, their remove will not do a thing to eliminate bad breath.

You may be surprised to learn that a common source of odors are chemicals from you internal body that are eliminated through your lungs. Just as carbon dioxide produced from metabolism is eliminated through the lungs in the exhaled air, so are other chemicals. Those that have an odor cause the breath to have the same odor. A good example is alcohol. This also explains why mints and mouthwash often do not cover up the fact that a person has had an alcoholic beverage. The alcohol and associated volatile components of the beverage are absorbed through the digestive system into the bloodstream. They are carried to the lungs and exhaled. This fundamental relationship is the basis for a breath analysis to see whether or not a person is sober. The breath alcohol content is closely related to the level of alcohol in the bloodstream.

There is no way that cleaning the mouth can remove the alcohol odor. The odor will disappear when all the alcohol has been eliminated from the bloodstream. That depends upon how fast the body metabolizes alcohol. Obviously the more alcohol that a person ingests the long it will take for the alcohol to be cleared. Mints and mouthwash may temporarily mask the odor only by creating a contrasting strong odor that is usually of short duration.

The concept of chemical vapors from the lungs is essential to understanding of causes of bad breath. This is exactly how you develop a bad breath from garlic, onions or any number of spices. The spices are absorbed into the blood and are released from the blood into the lungs. After consuming spices or odorous chemicals a person becomes a walking "incense" dispenser.

Severe dieting, particularly if you are on a severe carbohydrate restricted diet, can cause bad breath from the lungs. How? The body forms excess amounts of the chemical called acetone because the chemical balance of the body is disturbed. The acetone has an alcohol-like smell that is exhaled. The characteristic odor of the breath disappears when the individual starts eating enough carbohydrates again and the chemical balance of the body is corrected.

A diabetic who is out of control will also have excess acetone formation. This is often a prelude to or an accompaniment to diabetic coma. If the individual is unfortunate he will be found confused or semi-conscious from coma with an odor to his breath similar to alcohol. The police may take him to jail rather than to a hospital where he belongs.

Liver disease may be associated with a disturbance in chemical balance and can cause odors. Bacteria in the intestine may act on sulfur containing compounds to produce mercaptans. These are absorbed into the circulation and exhaled through the lungs imparting a fruity-fecal odor.

A number of medicines or drugs will impart an odor to the breath. These too are a direct result of the chemical vapor action and come from the lungs. With this long list of ways that vapors from the lungs can affect your breath it is no wonder that the lungs are a common source of bad breath. Even an emotional upset, digestive disorders, and, in some women, the chemical changes associated with menstruation can result in halitosis.

Rarely the odor is produced within the lungs. One of the worst and the most rare causes is gangrene of the lungs. A lung abscess will cause an odor and so will bronchiectasis. This condition is associated with large dilated bronchi. They may become filled with bad smelling secretions. Some complications of tuberculosis and pneumonia or other lung infections may also cause bad breath.

In the past, many doctors have thought that the digestive system seldom played a role in causing bad breath. The mistake was made because of overemphasis on smelling odors because the digestive "tube" was open. You can smell odors from the esophagus. When food is trapped in the lower esophagus, as it can be with spasm of the lower esophagus or because of a complication of a hiatal hernia through the diaphragm, the food can be smelled.

The stomach is normally closed and the odors of foods being digested do not affect your breath. The outlet of the stomach is also closed so there is no mechanical opening to the intestines, hence the thought was, no odors from the intestines. The mistake was in not recognizing that gases produced in the colon are absorbed into the bloodstream. Since bacteria can cause mercaptans in the presence of liver disease that are exhaled, it is obvious that other gases produced in the intestine, from whatever means, can also be carried by the circulation and exhaled through the lungs. In that way what happens in a person’s colon can certainly affect his breath. Undigested food that is fermented by bacteria may be a factor. Many cases of unexplained bad breath may in fact be caused by the formation of malodorous gases in the intestine that are absorbed into the circulation. Both hydrogen and carbon dioxide from food fermentation are absorbed from the colon into the circulation. Breath analysis of hydrogen is one way of measuring food fermentation in the colon. It is used in detecting lactose intolerance (inability to digest the milk sugar, lactose).

The typical mouthwash contains one or more agents, which have some antiseptic action. One of these is often alcohol. They also contain flavoring agents and chemical scents. The germicidal action, if any, of a given mouthwash is of limited use. It will not eliminate the odor source of food and debris between the teeth and the odor of pyorrhea – only cleaning the teeth properly and adequate dental treatment will do that.

If the odor comes from the mouth, the mouthwash may have about the same effect as a sweaty laborer using cologne rather than taking a bath. It may mask the odor for a short time but the underlying cause is still there. If the individual has a sore throat, gargling such preparations usually does not apply any significant quantity of the mouthwash or gargle to the infected area at the back of the throat.

There is no way that mouthwash, even if it cleaned the mouth perfectly, can obscure an odor that comes from your lungs. Those vapors in the exhaled air will still be there as long as there are vapors of alcohol, spice or bodily produced chemicals to be exhaled. You need to rid the body of the chemical producing the smell, not swish mouthwash between the teeth.

Does this mean you should never use mouthwash? No. If you understand that it has a very temporary action and will not cure the underlying cause of bad breath, you can use it. Or if you want a pleasant fresh taste to your mouth, it is fine. It is not harmful. If you want to gargle for a throat infection you would be as well off, or better off, to use warm salt water.. A warm, salt water gargle will impart moisture to the area and may make your throat feel a little better.

If it is just an occasional event, bad breath can usually be prevented by eliminating the cause, which is usually known. That can be cigarette smoking. Remember that cigarette smoking increases dental problems. It seems to interfere with the health of the gingiva and may predispose to pyorrhea problems. Cigarettes and alcohol both interfere with bone formation throughout the body. They can contribute to, or accelerate, osteoporosis (dissolving bones). Loss of bone tissue around the roots of the teeth may contribute to infected pockets or pyorrhea. Anyone with bone loss around the roots of the teeth should also see a physician for an evaluation of underlying and unrecognized osteoporosis. Alcohol alone can cause bad breath. Any sore throat or upper respiratory infection may cause a temporary problem of bad breath.

You should do first things first. That means clean your teeth thoroughly every day and keep them clean. Dental hygiene is the first step in eliminating many cases of bad breath. Don’t forget your tongue. If you still have problems the first step should be to see your dentist. You may have areas around your teeth that you can’t clean. If you have a chronic dental problem such as pyorrhea you need dental treatment anyway.

If you have perfect teeth and gingiva and have no dental reason for bad breath, the next step is to see an ear, nose and throat specialist. He may find that you have infected sinuses that can be treated. Or if you have chronically diseased tonsils that could be your problem. Again, remember that if you do not have disease of your tonsils with a chronic infection that emits an odor, taking out the tonsils will not solve the problem. But if they are chronically infected, removing them may be the answer.

If you have no ear or throat problems and the dentist says your teeth are fine, what then? You should see your family doctor or a specialist in internal medicine. Let him examine you for possible medical causes for bad breath. If you have a hiatal hernia that is causing you difficulties it may also be causing you to have bad breath. Your doctor will want to review your dietary habits. If you are not eating properly, particularly if you are a fad diet and not eating carbohydrates, you can expect to have bad breath. He will need to look for underlying problems that cause chemical changes in the body.

After seeing your dentist, a specialist in ear, nose and throat problems and your family doctor, what if they can find no cause for your bad breath? That happens all too often. The first thing you need is a reliable friend who will tell you whether or not you have bad breath. If your friend is a good observer and willing to cooperate you are then justified in making some efforts to solve the problem yourself. Keep a diary of the days and times you have bad breath. Also keep in your diary a list of everything you eat or drink and the time. Note any symptoms you may have such as gaseous distention or any abnormality in bowel function, such as loose stools, diarrhea or constipation and passing gas.

After a baseline period of a week of observations you can try an elimination diet to find out if any food or drink you are using is causing your bad breath. This is not a healthy, balanced diet. Take nothing by mouth except lean beef or chicken that is broiled, baked or boiled, steamed rice and distilled water. You will need a reasonable amount of rice each day to avoid carbohydrate depletion which will make you lose salt and water, leading to weakness and faintness. Eat as much as you like but do not use any seasoning except ordinary salt if you desire. After a few days if you have no bad breath you may suspect that what you were eating may affect your breath. Now you need to find out what items are a factor. You can add one food or drink at a time to your diet and use it a few days to see if your breath problem returns. If it doesn’t you can add that item to your diet list of acceptable items. If you have bad breath, eliminate the item and put it on the suspect list. See if your breath clears again before proceeding. Gradually you will develop a list of items that you know are not associated with bad breath and a list that is. You can use your good-items list to construct a balanced diet for yourself.

While you are testing yourself, do not take vitamin pills or other medicines unless your doctor has prescribed them. If you take vitamins, when you resume taking them, check for several days to be sure they are not a factor in causing your bad breath.

You may learn that bad breath is associated with increased gas problems. That may be a clue that bacterial action on undigested food items is producing noxious gases that are then absorbed into your blood and exhaled through your lungs. If you identify a list of items that cause bad breath, it may be worth checking with your doctor to see if these are of other medical importance to you.

While you are keeping your diary also note periods of stress and any associated symptoms. If stress affects your digestive function that can be a clue to how you develop periods of bad breath. Don’t forget that bad breath is often an indication of what is happening chemically inside your body and is not limited to dental hygiene or the ear, nose and throat area. Your whole body and state of health can affect how your breath smells.