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Checking your breath on a night out or before an important meeting isn’t anything to be ashamed of. Chances are, you’re not the only person in the room self-conscious about the smells that may come from their mouth. According to the American Dental Association, 50% of adults have bad breath, or halitosis, at some point in their lives.

But, bad breath doesn’t always mean bad dental hygiene. Dr. Margaret Richards Frankel, dentist and owner at Richards Frankel Dentistry in Lyndhurst, and Dr. Sam Glick, dentist at Cleveland Smile Center in Aurora and Cuyahoga Falls, said bad breath can be caused by many things.

“The cause of bad breath is often multi-factorial, but is most likely tied to bacterial build-up and an imbalance in the pH of the mouth, and can mean the oral environment is not healthy,” Frankel said. “Major causes of bad breath include peridontal disease, or gum disease, acid reflux, or heart burn or GERD, poor oral hygiene, strong smelling food, dry mouth, smoking and vaping. Often times, bad breath is an indication that there is an imbalance in the mouth and that bad bacteria are overgrowing.”

Glick said bad breath can simply be caused by diet.

“A lot of the foods we eat, like garlic and onions can cause bad breath,” he said. “What bad breath means for someone really depends on the cause behind it. If they ate garlic knots for lunch, we know it’s the food. But if it’s dehydration or their medications, it could be a deeper problem.”

Bad breath can also progress in very different ways depending on the cause.

“When systemic health issues that contribute to bad breath like acid reflux and causes of dry mouth aren’t controlled, it will get worse,” Frankel said. “If good oral hygiene isn’t practiced at home and regular visits to the dentist are ignored, bad breath will worsen.”

In order to combat bad breath, and conditions associated with it, Glick suggested individuals set a routine and stick to it.

“Obviously, oral hygiene is key, like brushing and flossing regularly,” he said. “If someone isn’t brushing twice a day and flossing once, that’s a contributing factor to progression. But another thing is people don’t realize the importance of a tongue scraper. Most things that cause bad breath sits in the crevices on your tongue. You’re going to get away from so much bad breath from doing just that.”

Most times, bad breath is an isolated event. But, there are conditions where bad breath is a symptom itself.

“A good example is people who have acid reflux because they are getting that reflux from their stomach up the esophagus,” Glick said. “People with that tend to have bad breath. This can also be a sign that someone is struggling with an eating disorder like bulimia. Another one is if a person has a fruity odor to their breath, it’s a sign of ketoacidosis, which occurs in diabetics. We see that as almost a first symptom at times.”

Frankel said, “While most often bacteria and acid are the cause of the smell, diseases and medications that make acid reflux worse, or cause dry mouth, will contribute to bad breath. Bad breath, outside of having just eaten a pungent food, is often a sign of disease.”

If one is struggling with bad breath, Frankel said it’s always good to consult their dentist.

“Bad breath should always be discussed with one’s dentist,” Frankel noted. “If the cause is not known, then there is no way to properly treat the bad breath. A dentist can help determine the cause and target treatment to improve the condition.”

Both professionals suggested individuals keep up on their oral care as a means to combat bad breath, as it could also mean tooth decay.

“Come in for regular cleanings and taking care of any cavities or decay, as well as regular daily activities like brushing, flossing and tongue scraping,” he noted.

Frankel said, “Over the counter therapies often just mask the smell temporarily, but don’t do anything to treat the cause of it. Working closely with your dentist to discover why one has bad breath and to then tailor treatment to the individual’s needs is best practice.”

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