Bad breath, also known as halitosis, is a dental malady that is stressful and often embarrassing to deal with. We typically associate chronic bad breath with poor oral hygiene habits, however, the truth is that even people who brush and floss everyday can still suffer from bad breath. Below are some lesser-known causes of chronic bad breath:

● Buildup of bacteria on the tongue. If you notice a thick, white or yellow paste on the surface of your tongue, this could be contributing to bad breath. Be sure to clean your tongue by brushing with toothbrush and toothpaste or by using a tongue scraper to remove the odorous bacteria buildup on your tongue.

● Tonsiliths (tonsil stones). Tonsiliths are soft, yellowish-white calcifications that can form when bits of food get lodged in the deep crevices of tonsils, attracting odorous bacteria and causing chronic bad breath. They can be as small as half a grain of rice or as big as a marble. Tonsiliths are particularly common in people who have large tonsils or tonsils with deep crevices. Some remedies for tonsiliths include warm salt-water rinses, but in severe cases, a tonsillectomy may be necessary. If you are curious whether you suffer from tonsil stones, talk to your dentist at your next appointment!

● Dry mouth. Saliva has antibacterial properties, so any condition or behavior that leads to decreased saliva production (i.e. dry mouth) can increase the risk of bad breath. Dry mouth can be caused by health conditions (Sjogren’s disease, diabetes, and other autoimmune disorders), certain medications (antihistamines, antidepressants, blood pressure medications, etc.), and behaviors like smoking, alcohol consumption, or mouth breathing. Certain beverages, like coffee and alcohol, have a dehydrating effect on the body, which reduces saliva flow and creates a favorable environment for odorous bacteria to propagate. To alleviate dry mouth, try to sip water regularly throughout the day, chew sugar-free gum, limit consumption of dehydrating beverages like alcohol or coffee, breathe through your nose rather than your mouth, use over-the-counter saliva substitutes containing xylitol, and use a non-alcohol-based mouthwash (such as a salt-water rinse or a hydrogen-peroxide-based wash).

● Diet. A diet high in sulfuric foods, such as garlic and onions, can lead to bad breath. This is because the sulfur in these foods is absorbed into the bloodstream and expelled when you exhale. To alleviate diet-induced bad breath, it is imperative to brush and floss after each meal and drink lots of water to increase saliva production. Saliva, not alcohol-based mouthwash, is your best ally when it comes to fighting bad breath.

● Periodontitis. Bacteria that cause periodontal diseases putrefy glycoproteins and proteins in the oral cavity, resulting in volatile sulfur compounds which are responsible for the characteristic bad breath. Unlike halitosis caused by diet or poor oral hygiene, halitosis caused by periodontitis seems to be persistent independent of one’s dietary pattern and quality of oral hygiene. A detailed  periodontal exam by your dentist and specialized periodontal scalings to reduce bacterial load are necessary to resolve the malodor.