We have had several patients in recently who complained of bad breath.  We hear all kinds of different descriptions of the taste, "metallic taste", "ammonia", "stale garlic", you name it!  We try our best to help determine what is causing the problem.  I thought I would send out a quick note on common causes.

What causes bad breath?
Types of Food: In most cases, it is caused by bacteria that forms on your teeth and tongue and releases a sulfur compound that gives your breath an unpleasant odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is exhaled. Brushing, flossing and mouthwash only mask the odor.

Types of Medications: Specifically, those that include central nervous system agents, anti-Parkinson drugs, antihistamines/decongestants, anti-psychotics, anti-cholinergics, narcotics, anti-hypertensives, and anti-depressants.

Periodontal (gum) disease often causes persistent bad breath or a bad taste in the mouth, and persistent bad breath may mean a sign that you have gum disease.

Dry mouth (xerostomia) may also cause bad breath due to decreased salivary flow. Saliva cleans your mouth and removes particles that may cause odor.

Tobacco products cause bad breath, stain teeth, reduce your ability to taste foods and irritate your gum tissues.

In rare cases, bad breath may also be a sign that you have a serious health problem, such as a respiratory tract infection, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.

Here are characteristic bad breath odors associated with some of these illnesses:

• Diabetes - acetone, fruity
• Liver failure - sweetish, musty
• Acute rheumatic fever - acid, sweet
• Lung abscess - foul, putrefactive
• Blood dyscrasias - resembling decomposed blood
• Liver cirrhosis - resembling decayed blood
• Uremia - ammonia or urine
• Hand-Schuller-Christian disease - fetid breath and unpleasant taste
• Scurvy - foul breath from stomach inflammation
• Wegner`s granulomatosis - Necrotic, putrefactive
• Kidney failure - ammonia or urine
• Diphtheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis - extremely foul, fetid odor
• Syphilis - fetid

Caring for bad breath
Daily brushing and flossing, and regular professional cleanings, will normally take care of unpleasant breath. And don't forget your often overlooked tongue as a culprit for bad breath. Bacterial plaque and food debris also can accumulate on the back of the tongue. The tongue's surface is extremely rough and bacteria can accumulate easily in the cracks and crevices - be sure to scrape your tongue!

Eliminating periodontal disease and maintaining good oral health helps to reduce bad breath. If you have constant bad breath, make a list of the foods you eat and any medications you take. Some medications may contribute to bad breath.

If your mouth is healthy and the odor is not oral in nature, you may be referred to your family physician or to a specialist to determine the cause of the odor and possible treatment.