Having a problem shifting that bad breath even cleaning your teeth more than the recommended amount and using various mouthwashes – you could have an underlying health problem
There are a number of diseases which may not have immediate symptoms other than a foul smell coming out of your mouth.
Some metabolic disorders can cause bad breath because of various issues with the intestines, blood, or liver as people with halitosis often have elevated salivary urea and uric acid concentrations compared with those without the issue. Metabolism is the essential process of creating energy from food.
A common condition that can cause a foul odour in your mouth and throat is diabetes. If a person is unable to control their diabetes effectively, high glucose levels can cause harmful bacteria to grow. In combination with food, they produce a sticky film called plaque, which can lead to gum disease and bad breath.
Because people with diabetes have a problem with insulin, cells may not get the required glucose for energy and instead the body begins to burn fat producing compounds called ketones. These may build up in the blood and urine and cause bad breath. One of these ketones is acetone, and it may cause breath that smells similar to nail polish. If a person with diabetes notices the smell, they should seek medical advice, as it could be diabetic ketoacidosis, a potentially life-threatening condition.
Another disease that can be signified by bad breath is liver disease. One of the symptoms of liver disease is the presence of volatile organic compounds in the breath. If a person’s breath has a strong, musty smell, it is a sign that their liver is not filtering out toxic substances, indicating liver disease. Doctors call this distinct smell fetor hepaticus or “breath of the dead” because of its association with severe and potentially fatal liver disease.
Chronic kidney disease is a condition in which the kidneys are damaged and cannot filter blood as well as they should. Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke. People with kidney failure may develop bad breath.
As the kidneys begin to fail, they cannot efficiently excrete the metabolite urea in the urine, and it builds up in the blood and saliva. The body then converts the urea into ammonia, causing a bitter taste in the mouth and bad breath. Around one in three on dialysis say their breath has a urine-like odour.
Hypermethioninemia is an excess of a particular protein building block (amino acid), called methionine, in the blood. People with this condition often don’t show any symptoms, but if their breath, sweat, or urine has a smell resembling boiled cabbage, they should see a doctor. There are other signifiers, such as problems with the intellect, delays in motor skills in standing or walking, sluggishness, muscle weakness, liver problems and unusual facial features.
If there is a fishy small from the mouth, or urine, sweat and reproductive fluids, it could be a condition called TMA – or fish odour syndrome. People with TMA cannot break down the compound trimethylamine from certain foods. In people without the disorder, the body oxidises trimethylamine into an odourless metabolite called trimethylamine N-oxide.
When trimethylamine builds up, it causes an odour. TMA is a genetic condition that runs in families and happens because someone has a fault with the FM03 gene.
PKU is a genetic condition that causes the body to be unable to break down the amino acid phenylalanine. If PKU is untreated, or if foods containing phenylalanine are eaten, the breath, skin, ear wax and urine may have a musty odour.
This odor is due to a build-up of phenylalanine substances in the body. It is more likely to appear in white, Native American, and Alaska Native people than Black, Ashkenazi Jewish, and Japanese people. The condition affects about one in 10,000 babies in the UK are born with it and doctors screen babies for PKU shortly after birth.
No universal option exists for the treatment and management of bad breath. Although good oral hygiene may help temporarily, it will not solve any underlying problems. Therefore, the first step should be to treat the condition causing the bad breath if possible.
If metabolites cause bad breath, the symptoms can be managed by reducing the intake of foods that contribute to the odour, avoiding delaying bowel movements to minimise the duration of digestive metabolism and the absorption of metabolites, using probiotic and prebiotic treatments to attempt to change the bacterial composition of the gut and increasing water intake. However, with all of these conditions, a trip to your GP should be the first action you take.
Sarah Carter is a health and wellness expert residing in the UK. With a background in healthcare, she offers evidence-based advice on fitness, nutrition, and mental well-being, promoting healthier living for readers.
