Bad breath that will not go away, and what is actually causing it

You cannot smell your own breath, so start with a test

Nobody can reliably smell their own breath. The nerve endings in your nose stop reporting a smell they have been sitting in continuously, which is why somebody else’s house has a smell and your own does not. It is called olfactory adaptation, and it is the reason bad breath is usually something you find out about from another person, late, and awkwardly.

So before you change anything, get an answer that is not coming from your own nose.

• The wrist test. Lick the back of your wrist, wait ten seconds for it to dry, then smell it. That is approximately what the front of your mouth smells like.
• The spoon test. Scrape the back of your tongue with the bowl of a teaspoon, wait a moment, and smell what came off. That is what the back of your mouth smells like, and it is usually a good deal worse.
• The floss test. Floss between two back teeth and smell the floss. This is the one that tells you something useful, because if the floss smells, the source is under the gum or inside a tooth, and brushing was never going to reach it.

The back of your tongue is the most likely answer

The large majority of lasting bad breath is manufactured in the mouth rather than the stomach, and most of what is manufactured in the mouth comes off the back third of the tongue.

That surface is not smooth. It is a field of small papillae with grooves between them, and those grooves hold dead cells, food debris and bacteria that work without oxygen. Those bacteria break down protein and release sulphur compounds as waste. The sulphur is the smell, and it is the same family of chemistry as rotten eggs.

Brushing your teeth does nothing to it. Running a toothbrush over the front of the tongue does very little either, because the reservoir sits further back than most people are willing to go.

What works is a scraper, drawn from as far back as you can tolerate to the tip, with light pressure, rinsed and repeated four or five times, once a day. You will see what comes off it. If you gag, start slightly further forward and move back over a week, and do it before eating rather than after.

Give that two weeks. If the smell goes, it was your tongue, and you are finished. If it does not, it is one of the next three.

If the floss smells, it is your gums

Gum disease is the second big source, and it is the one people miss, because it does not hurt.

When plaque is left along the gum line it hardens into tartar, the gum pulls away from the tooth slightly, and a pocket forms. That pocket is a sealed, warm, oxygen-free space with a food supply, which is an excellent place to be an anaerobic bacterium and a terrible thing to have in your mouth. No toothbrush reaches into it. The smell is continuous because the process is continuous.

The tells are easy to check. Gums that bleed when you brush or floss. Gums that look puffy or have receded so a tooth looks longer than it used to. A taste you cannot rinse away. If any of those are true alongside the breath, the answer is gum disease treatment, not another tube of toothpaste.

Mouthwash is often making it worse

Mouthwash is the first thing almost everybody reaches for and it is close to the least useful.

A mint mouthwash masks the smell for about twenty minutes. Then the alcohol in most of them dries the mouth out, saliva drops, and saliva was the thing keeping the bacteria in check. The smell comes back stronger than before, so you use more, and the cycle tightens. Mints and chewing gum do the same thing with sugar added.

None of that is a reason to feel foolish. It is a reason to treat a mouthwash as what it is, which is a cover, and go and find the source.

Dry mouth, and the medicines nobody connects to it

Saliva washes the mouth continuously and is mildly antibacterial. Anything that reduces it makes breath worse.

The common causes are ordinary and easy to overlook. Antihistamines for allergies. Many blood pressure tablets. Antidepressants. Breathing through your mouth at night, particularly with a blocked nose. Simply not drinking enough water across a Bengaluru working day in an air-conditioned office.

If your mouth feels dry and sticky by mid-afternoon, that is worth saying out loud at the appointment, because it changes the advice. Nobody is going to tell you to stop your blood pressure medication. There are other ways to manage it.

A decayed tooth, an old filling, a wisdom tooth

Decay has a smell of its own, and a cavity that has been quietly working for a year has plenty of space in it for food and bacteria. So does the gap around a filling that has started to leak at its edge, or a crown that no longer seals.

The most common single culprit at the back is a partly erupted wisdom tooth with a flap of gum over it. Food goes under the flap, nothing gets it out, and the result is a low-grade infection that smells and comes back every few months. That one is dealt with on the wisdom tooth removal page.

You will not find any of these by looking in a mirror. They are found on an examination and, where needed, an X-ray.

When it is genuinely not your mouth

A smaller number of cases are not dental at all, and they are worth knowing about so you are not scaled twice for nothing.

Tonsil stones are small white lumps of debris in the tonsil crypts and they smell strongly. Post-nasal drip from sinus trouble feeds bacteria at the back of the throat. Acid reflux can carry a smell up. Uncontrolled diabetes gives breath a distinctly sweet or acetone note, and that one is a reason to see a doctor rather than a dentist.

The honest order is still mouth first. Roughly nine in ten cases end there, and it is far quicker to rule the mouth in or out than to work backwards from the stomach.

What the appointment in Koramangala actually involves

At Tooth District in S.T Bed Layout, Koramangala 4th Block, this is an examination before it is a treatment, and it is deliberately not sold as a package.

Dr. Chaitanya K looks at the tongue, checks the gum margins, measures pocket depths where they look suspect, and takes a digital X-ray if there is any sign of decay or a leaking restoration. You are shown the X-ray. That takes one short visit and it ends with you knowing which of the causes above is yours.

Most people then need a scaling and polishing, which is a single visit. Where the pockets are deeper than a surface clean can reach, the cleaning goes below the gum line and that work is done by Dr. Vinay or Dr. Ashwin, the clinic’s periodontists. Where a tooth is decayed, it gets filled. Where it is a wisdom tooth, it is assessed on the film first.

What you will not be told is that you need everything. The point of looking properly is to find the one thing that is causing it.

The clinic is open on Sunday and closed on Wednesday, which for most people means this does not need a day off work.