How to Get Rid of the Causes of Bad Breath

Tagged in: Digestive Health Oral Health

by Dr. Bryan Do, D.O. Last Updated: April 18, 2019

While it can be a considerable bother to you and those around you, bad breath on its own isn’t life threatening. However, persistent bad breath (medically known as halitosis) may point to some serious underlying problems. Learn more about what causes bad breath and how you can take care of it with some simple home remedies below.

Bad Breath Causes

Oral malodor, halitosis, or bad breath, it goes by many names, but most people don’t know where it originates. The vast majority of bad breath cases (about 85 percent) are intraoral in origin.¹

Microbial degradation in your mouth that is caused by anaerobic oral bacteria. Essentially these bacteria feed on decaying food matter trapped between your teeth and in the process release volatile organic sulfur compounds. The top surface of the tongue happens to be the ideal spot for these oral bacteria, and it’s where most of your bad breath will come from.

Tongue coating is the most common origination of bad breath, comprising 43 percent of all cases, while periodontitis and gingivitis (both forms of gum disease) account for 11 percent of bad breath cases. About 18 percent of cases are caused by a combination of both tongue coating and gum disease.¹

Dry mouth also contributes to bad breath. Saliva naturally has an antimicrobial effect that can help to keep anaerobic bacteria under control. Without enough of it, the bacteria can run wild, increasing the rate of putrefaction. This is also why morning breath exists. You naturally produce less saliva at night.¹

Home Remedies for Bad Breath

The good news about bad breath is that you can usually remedy it at home without the need for any prescriptions or medical procedures. The following home remedies for bad breath all aim to reduce the amount of odor-causing bacteria in the mouth.

Probiotics For Bad Breath: Can they Cure Bad Breath?

Promote Saliva Production

As mentioned, saliva is part of what helps to keep anaerobic bacteria under control, so maintaining saliva production throughout your day can keep bad breath at bay. Stay hydrated with water, especially after meals. Consider chewing gum, which will aid in saliva promotion. Most chewing gums also contain some form of xylitol, which possesses antibacterial properties to eliminate anaerobic bacteria and keep your breath fresh.²

Clean Your Tongue

Your tongue is where most of the halitosis-causing bacteria live and thrive. Cleaning your tongue with a tongue scraper can help to keep your breath fresh and promote good oral hygiene in general.

In one study, 60 male patients (88 percent of whom showed signs of early to moderate periodontitis) were advised to use a tongue scraper for two minutes twice a day for seven days. There were no changes to dietary or toothbrushing habits.

By the end of the study, self-perceived bad breath was significantly lower after using the tongue scraper. Furthermore, the saliva of each subject showed a significant decrease in odor causing bacteria counts.³

Use Chewable Probiotics with Xylitol

While probiotics are most often associated with gut health, they can play an integral role in reducing bad breath and promoting oral health. Probiotics residing in the mouth can compete against and overwhelm bad bacteria that produce bad breath. Xylitol possesses antibacterial properties to reduce odor causing anaerobic bacteria and keep your breath fresh.

In an open-label pilot study, 20 patients with halitosis were given 2 billion CFUs of Lactobacillus salivarius and xylitol. These were provided in the form of chewable probiotics and administered once a day with a clinical evaluation performed at two weeks and four weeks into the study. By two weeks, all 20 subjects were positive for the presence of L. salivarius in their saliva, even though 12 of the subjects didn’t have this bacterial strain prior to the study.

Clinical parameters for bad breath showed a significant reduction after two weeks. By four weeks, the subjects showed further reductions in parameters for oral malodor along with a decrease in bleeding on probing. This suggests that chewable oral probiotics with xylitol can help to improve halitosis and potentially support overall gum health.⁵

Maintain Dental Hygiene

Brushing and flossing aren’t just your first line of defense against bad breath. They also protect your teeth and gums, prevent infections, and ultimately contribute to better health overall. In a two-treatment, randomized, single-blind study, 51 pairs of twins were randomized into two groups that either performed daily tooth brushing and tongue brushing or daily toothbrushing, tongue brushing, and flossing. Groups were both supervised and unsupervised throughout their individual treatment regimens. Subjects performed these regimens for two weeks, during which time the researchers recorded gingival bleeding and bad breath (by way of measuring volatile sulfur compound levels).

Results of the study found that the group that brushed their tongues and teeth and flossed showed a significant decrease in gingival bleeding, while the group that only brushed their teeth and tongues showed no changes. Both groups showed statistically significant reductions in intraoral breath values, meaning they all had better breath.⁴

Floss at least once per day, and brush your teeth twice a day for at least two minutes each time. You’re saving your breath and your oral health.

Use Mouthwash

Mouthwash can help to improve bad breath by neutralizing offending bacteria and reducing the production of volatile sulfur compounds. Researchers have investigated many active ingredients of mouthwashes including:

Hydrogen peroxide – A 3 percent concentration of hydrogen peroxide can lead to a 90 percent reduction in VSCs after eight hours. Hydrogen peroxide is available over the counter.¹
Chlorhexidine – As the most efficient molecule for reducing plaque, chlorhexidine can significantly reduce VSC production. Rinsing with a 0.2 % concentration of chlorhexidine can reduce 43 percent of VSCs over the course of the day.¹ This product can only be obtained with a prescription.
Chlorine dioxide – Chlorine dioxide can reduce bad breath by oxidizing methionine, cysteine, and other compounds. Using chlorine dioxide was found to reduce bad breath by 29 percent after four hours.¹
Fluoride – Fluoride mouthwash has been found to reduce morning breath by 83 percent.¹Fluoride mouthwashes are available over the counter.
Essential oils – Essential oils such as peppermint can be effective mouthwashes, especially when mixed with olive oil and combined with over the counter cetylpyridinium chloride mouthwash. One study found that this combination led to an 80% reduction in sulfide at 3.5 hours compared to a 30% reduction with commercially-available mouthwashes.⁷
Mouthwashes with alcohol - Alcohol is known to have great antibacterial properties. However, the risk of acquiring oral cancer is 5x higher amongst drinkers. A recent literature review advised against the long term use of mouthwashes that contain alcohol.⁶

While mouthwash can be effective in reducing bad breath, it’s not a replacement for brushing and flossing. You’re likely to see the best results when using mouthwash in conjunction with a regular dental regimen.

Bad breath can be embarrassing and negatively impact how you communicate and your quality of life. More importantly, it could be sign of a more serious underlying problem. Thankfully, the home remedies above can help to keep your breath fresh and support your oral health.

Staying hydrated, careful brushing, flossing, tongue cleaning, using chewable probiotics with xylitol, chewing xylitol gum after meals, and using mouthwash occasionally can all help reduce bad breath. If your bad breath persists despite using these home remedies for bad breath, consult your physician or dentist to determine if there is a more pervasive issue.

The Research Behind Probioitcs for Bad Breath

Several studies suggest that chewable probiotics with xylitol may be the key to eliminating bad breath. Chewing xylitol helps to stimulate saliva production, which can help to reduce bad breath, while the introduction of chewable probiotics can help to compete against the bad bacteria that cause halitosis.

In one study, 20 patients experiencing halitosis were given 2 billion CFUs (colony forming units) of Lactobacillus salivarius and xylitol. Researchers then recorded oral malodor and general clinical parameters for each patient at two and four weeks into the study. Results of the study showed that all 20 patients tested positive for L. salivarius in their saliva within two weeks, even though 12 of the subjects had no signs of this probiotic strain prior to the study.

After 2 weeks all subjects showed statistically significant decreases in oral malodor parameters. By the end of the 4-week study, halitosis parameters saw a further reduction, along with a decrease in bleeding gums on probing (a common sign of gum disease).⁸

In another study, Streptococcus salivarius was found to be a common bacterial strain found in the saliva of those who do not have bad breath and halitosis. Research suggests that S. salivarius oral probiotic produces bacteriocins, which may help to combat the bacteria responsible for producing volatile sulfur compounds. These compounds are responsible for the bad smells associated with halitosis. Using lozenges or gum containing S. salivarius was found to significantly reduce volatile sulfur compounds among patients diagnosed with bad breath and halitosis.⁹

In another study, researchers isolated three strains of Lactobacilli oral probiotics that produced hydrogen peroxide in children’s saliva and their effects on the production of volatile sulfur compounds. These strains were identified as Weisella cibaria and were found to effectively inhibit the production of volatile sulfur compounds created by Fusobacterium nucleatum.¹⁰

Note – Bad Does Usually Doesn’t Come from the Stomach

It’s easy to assume that it comes from the stomach as the gasses released by belching tends to be odorous. A majority of patients and physicians still believe that bad breath originates from the gastrointestinal tract. However, the contents of your stomach are naturally separated from your mouth by the esophagus, specifically a one-way valve known as the lower esophageal sphincter. This valve prevents food and gasses from refluxing back up through the esophagus.

In reality, less than 0.5% of cases of halitosis have any basis in the gastrointestinal tract. In less than 0.1% of cases, bad breath may come from a condition called Zenker’s diverticulum.¹ This is a rare anatomical abnormality that results in an outpouching of the esophagus. This pouch traps decaying food in the throat and causes bad breath.

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About the Author:

Dr. Bryan Do, D.O.

Dr. Bryan Do, D.O. is an osteopathic physician whose research interests include gastroenterology, immunology, and dermatology. He is particularly interested in the role of probiotics in the gut-brain-skin axis and has written many articles on the topic. He graduated from University of California, Los Angeles (UCLA) before graduating from Marian University College of Osteopathic Medicine in Indianapolis, Indiana and becoming a Doctor of Osteopathic Medicine. Osteopathic physicians are taught to take a holistic approach to medicine and to consider mind, body, and spirit when treating a patient. Osteopathic physicians receive training in Osteopathic Manipulative Medicine (OMM) in addition to the standard rigorous medical school curriculum. Both physicians with a Doctor of Osteopathic Medicine (D.O.) degree as well as a Doctor of Medicine (M.D.) can practice medicine.

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