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Bad Breath: Is It Coming From Your Gut?

December 23, 2022

Halitosis, also commonly known as “bad breath,” is a concern of many patients seeking help from the periodontist as bad breath is usually associated with oral conditions. Cavities, gum disease, dry mouth, tonsil stones, poor salivary flow, acidic oral environments, and the consumption of odorous foods can all be attributed to causing bad breath. The hygienist or dentist will typically tell a patient to brush, floss, rinse, and drink more water to combat this problem.

What if bad breath is not coming from your mouth?

In that case the dentist/hygienist may tell the patient there is nothing wrong. In some cases, a referral to an Ear nose and throat (ENT) or a Gastroenterologist is made. Although oral conditions can contribute to about 60-70% of the etiology behind bad breath, the gut can play a major role (20-30%) behind a person’s bad breath. Most people who have bad breath from the digestive system describe a rotten egg/fish/meat smell due to the bacteria in the digestive system that break down food products into sulfa gases. Sulfur-digesting bacteria and other organisms in your digestive system utilize sulfur compounds within food, producing hydrogen sulfide, dimethyl sulfide, and methyl mercaptan as an end product. This can make your breath smell bad and give you chronic halitosis.

What are the top 5 digestive issues accounting for halitosis?

1. H. Pylori

H. Pylori is a type of bacteria that exists within your normal gut microbiota but, when out of balance, can cause duodenal and stomach ulcers.

2. GERD

Gastroesophageal reflux disorder (GERD) is a very common digestive system disorder that can cause bad breath. GERD is caused by the failure of the muscular valve (sphincter) that separates the lower end of the esophagus from the stomach. When this valve becomes weak, it can allow stomach acid and contents up into your esophagus, causing GERD and sometimes, bad breath. H. Pylori can also cause and/or exacerbate GERD.

3. SIBO (Small Intestinal Bacterial Overgrowth)

Because the small intestine is designed for nutritional absorption and has less digestive enzymes than the stomach, bacterial overgrowth can occur in this organ. 80% of people with irritable bowel syndrome (IBS) also have Small Intestinal Bacterial Overgrowth SIBO and can develop SIBO after gastric infections. Gasses produced in SIBO are the major cause of complaint and may cause bad breath.

4. Irritable bowel syndrome, Crohn's Disease, Celiac Disease

Irritable bowel syndrome (IBS) is a common disorder of the digestive system. Most commonly, patients suffer recurrent abdominal pain and altered bowel habits such as constipation, diarrhea or both. Both Crohn’s and celiac disease may limit digestion, providing more undigested food for sulfur-reducing bacteria to break down. This generates more hydrogen sulfide and can cause halitosis.

5. Digestive System Infection (Giardia)

A specific digestive system infection can cause bad breath. Giardiasis is a diarrheal disease caused by the parasite Giardia lamblia which can infect humans via food or water.