What makes your breath smell bad

Oral hygiene - When bad breath becomes a problem

Nobody has probably woken up with fresh breath. But why do some people - and sometimes those around them - suffer from bad breath? It usually has nothing to do with poor hygiene, says Prof. Dr. Rainer Seemann.

Prof. Dr. Rainer Seemann is chairman of the working group for halitosis (bad breath) of the German Society for Dentistry, Oral and Maxillofacial Medicine. At the end of the nineties, he founded the first special consultation hour for bad breath in Germany at the Charité in Berlin. The halitosis expert has been working at the University Dental Clinic in Bern since 2008. Source: private

Allegedly every fourth person has bad breath at times. Is that number realistic?

Yes. Almost everyone has to do with bad breath, at least occasionally. But it is always somewhat subjective what is perceived as unpleasant. In a representative survey that we carried out here in Bern, we found slightly higher values ​​in 11 percent of the participants. Really massive bad breath was only present in about 2 percent of the cases.

Can you measure bad breath?

Yes, namely with the organoleptic method. That means nothing else than sniffing a person. As a rule, the doctor assesses the severity of the odor on a five-point scale. But here in Bern we advocate the distance scale. That means: the closer you have to get to a patient to smell something, the lower the bad breath. This is more meaningful for the person concerned. There are also measuring devices with which the sulfur compounds in the air we breathe are measured. It is best if you can ask someone you trust at home.

You don't notice anything of your own smell?

Indeed, it is difficult to judge bad breath for yourself as you get used to your own odors. We experience this regularly in our consultation hours. There we first ask the patients to assess how severely affected they are on a scale. Then we take our measurements. Very often these details differ greatly. In other words, someone who smells extremely may mean that it isn't bad right now. And vice versa.

Does it often happen that people mistakenly believe that they are smelling out of their mouth?

There are no studies on this. In fact, this often happens in special consultation hours like ours. Every fourth person who comes to us has no bad breath.

How can that be?

Some patients got into it. I had a patient who heard from her boyfriend during the breakup: 'You stink anyway'. Since then, she believed she had massive bad breath. But there are also mentally ill people who are disgusted with themselves and project that onto their mouths. You need psychiatric treatment.

How does bad breath come about?

In most cases it is caused by the metabolism of microorganisms. They live in appropriate hiding places, mainly in the oral cavity. For example, bacteria can easily lodge on the tongue with its rough surface, but also in the gum pockets or interdental spaces. However, unpleasant-smelling putrefactive products also arise when the almonds are heavily colonized with microorganisms. The second most common cause is bacterial foci in the throat and nose area.

Can the smell also indicate internal illnesses?

Yes, there are a number of diseases in which there are special smells due to metabolic changes. For example, poorly controlled diabetes creates a sweet smell that is reminiscent of fermented fruit. This is due to the ketone bodies that are produced when fatty acids are broken down. They travel through the bloodstream to the lungs and are exhaled. Something similar happens with liver or kidney failure. Certain metabolic products cannot be filtered out.

When should you go to the doctor?

Especially when the bad breath occurs suddenly and then persists. This is especially true with children. It cannot be ruled out that foreign bodies, such as pearls, could then stick in the nose. Anything that develops slowly, on the other hand, is less dangerous, but should be clarified.

Is it true that fasting also creates bad breath?

Yes, there can also be changes in the air we breathe because of a change in metabolism. Bad breath can also have very simple mechanistic causes. If you don't eat or drink enough all day, bacteria will build up in the throat and oral cavity. Self-cleaning is missing. It's like when you come back from vacation and there is a smell in the bathroom because the siphons have dried out. That's why you're more likely to have bad breath when you get out of bed in the morning.

Is diet an important factor?

It certainly plays a role, but not as big as you'd like it to be. So you can't say: vegetarians have bad breath or vice versa. But I would always recommend eating a healthy, balanced diet. Those who only drink and smoke coffee have unpleasant breaths faster.

So is coffee drinking bad?