Halitosis PT Leaflet BMJ

Patient leaflets from the BMJ Group
Bad breath
Bad breath is a common problem. It can be embarrassing, but there are treatments
that can help.
What happens?
Everyone gets bad-smelling breath occasionally. It’s common first thing in the morning,
and after eating strong-smelling foods. It usually goes away when you clean your teeth.
This information is about bad breath that lasts through the day. It’s sometimes called
halitosis. It’s usually caused by gum disease or bacteria on your tongue.
Gum disease is caused by plaque. Plaque coats your teeth. It’s mainly made of bacteria,
which can infect your gums. Early, mild gum disease is called gingivitis. Advanced gum
disease is called periodontitis.
Bacteria growing on your tongue give off bad-smelling gasses. You’re more likely to get
this if you smoke, don't brush your teeth regularly, or don't produce enough saliva. Saliva
helps keep your mouth clean.
Some people worry that they have bad breath when they don't. They continue to worry
even after they've been examined and reassured. This can be very upsetting.
What are the symptoms?

People may notice an unpleasant smell when you talk or breathe out. It's possible to
have bad breath without knowing. That's because you get used to the smell of your own
body. If you worry you may have bad breath, you could ask a trusted friend, or visit your
dentist.
You can get a rough idea of what your breath smells like. You lick your wrist, wait a
minute for it to dry, then smell your wrist. That tells you how your tongue smells.
Your dentist can probably give you all the help you need with bad breath. As well as
testing your breath, your dentist should check your teeth, gums and tongue. If your dentist
can’t find any problems, but agrees your breath smells bad, he or she may suggest you
see your doctor. Bad breath is sometimes caused by a problem somewhere else in your
body.
What treatments work?

The treatment you need depends on what is causing your bad breath. This information
is about treatments for bad breath caused in the mouth. It doesn't look at treating bad
breath caused by illness elsewhere in your body.
© BMJ Publishing Group Limited 2007. All rights reserved.

page 1 of 3
Bad breath
Things you can do for yourself
There are several things you can do to keep your mouth clean. These can reduce the
number of bacteria in your mouth, which may make your breath fresher. There’s no good
research on these things, but your dentist may suggest:
• Brushing your teeth at least twice a day with a fluoride toothpaste

• Flossing between your teeth once a day
• If you wear dentures, removing them at night and cleaning them thoroughly before
putting them back in
• Having regular dental check-ups.
Many people try things to cure bad breath themselves. We didn’t find any good research
to show if they help. But you may want to try:
• Stopping smoking
• Avoiding strong-smelling food
• Chewing sugar-free gum
• Drinking plenty of water
• Using tablets or a spray designed to fight bad breath
• Chewing fresh parsley, mint or fennel seeds.
Using an anti-bacterial mouthwash
Research shows your breath is likely to improve if you use an antibacterial mouthwash
twice a day. A mouthwash that doesn't kill bacteria is unlikely to help. Antibacterial
mouthwash starts working straight away, but the benefits wear off. You’ll need to use it
for two to four weeks to see a lasting improvement.
You can buy lots of different brands of mouthwash from pharmacists. Look for the active
ingredients. These kill the bacteria.
Some brands (with their active ingredients) are:
• Corsodyl (chlorhexidine gluconate)

• Dentyl pH (cetylpyridinium chloride)
• Peroxyl (hydrogen peroxide).
Some types of mouthwash might make your tongue discolour. If you get a sore mouth
while using mouthwash, you could try diluting it half and half with water.
There are other treatments meant to get rid of bad breath caused by bacteria, but there’s
no good research to say if they work. These include: tongue cleaners to scrape your
tongue, toothpastes containing zinc, and artificial saliva, which comes as a lozenge, a
spray or a gel.

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Bad breath
Treating gum disease
If you have mild gum disease (gingivitis) your dentist will advise you to clean and floss
your teeth thoroughly every day. He or she may also scrape the plaque from your teeth.
This is called scaling.
If your gum disease is more advanced (periodontitis) you may need more complicated
treatments, like scaling below the gum, root planing or flap surgery. These remove
plaque from the parts of your teeth covered by the gums. You’ll have a local anaesthetic
to numb your gums first.
Some medicines can be used to treat gum disease. They're normally used after scaling
and root planing. You may need to use a mouthwash containing chlorhexidine. It helps
to kill bacteria. Your dentist may suggest a low dose of an antibiotic called doxycycline
(brand name Vibramycin).
If you have really bad breath that doesn't improve with treatment, your dentist may
prescribe an antibiotic called metronidazole (Flagyl). You mustn’t drink alcohol when
taking metronidazole, because using the two together can make you vomit.
What will happen to me?

Most people can cure bad breath themselves by keeping their mouth clean. But if your
breath doesn't get any better, your dentist will probably be able to help.
If your dentist can't find any sign of bad breath, he or she will reassure you that your
breath is perfectly acceptable.
If you're still worried about having bad breath, even after you've been reassured by your
dentist, you may have a condition called halitophobia. This is a strong fear of having bad
breath, even though your breath actually smells fine. As with any kind of phobia, a
psychologist or psychiatrist will be able to help you.

This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content
http://besttreatments.bmj.com/btuk/about/12.html.

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Patient leaflets from the BMJ Group

What are the symptoms?

What treatments work?

© BMJ Publishing Group Limited 2007. All rights reserved.

Things you can do for yourself

• Brushing your teeth at least twice a day with a fluoride toothpaste

Using an anti-bacterial mouthwash

Some brands (with their active ingredients) are:

• Corsodyl (chlorhexidine gluconate)

© BMJ Publishing Group Limited 2007. All rights reserved.

Treating gum disease

What will happen to me?

© BMJ Publishing Group Limited 2007. All rights reserved.

© BMJ Publishing Group Limited 2007. All rights reserved.

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