MCCONNELL AIR FORCE BASE, Kan. -- A patient recently stated, "Doc, even after I finish brushing my teeth, my wife tells me I have bad breath." He then asked me what he could do.

Bad breath, or halitosis, can be an embarrassing and common problem for many people. It can lower our confidence during some of our most intimate interactions with friends, co-worker and significant others.

Halitosis can be especially troublesome when brushing your teeth, rinsing with mouthwash or sucking on breath mints does not seem to help.

When fighting halitosis, understanding the causes of bad breath will better equip you in maintaining fresh, pleasant breath. Diet, oral hygiene, dry mouth, tobacco use, medication and medical conditions can all play major roles in halitosis.

DIET
- Foods with strong odors, such as onions, garlic, fish and beverages like coffee can affect the air a person exhales.

- Foods that we eat are absorbed into the bloodstream and then transferred to the lungs, causing noticeable odors when exhaled. These foods may also cause gastrointestinal uneasiness, such as belching, which can contribute to bad breath. It is important to know that remnants of food we eat can linger for several days.

- Fasting or low carbohydrate diets can also cause what is known as "ketone breath." Low carb diets cause the body to burn fat as its energy source. The end-product of making this energy are ketones, which cause a fruity acetone-like odor on the breath when exhaled.

- Food particles that remain in the mouth may rot and cause foul odors in the moist 98 F oral cavity environment. In addition, food particles over time can promote the growth of bacteria, which can also cause unpleasant odors. Bacteria can lead to tooth decay and gum disease.

- The tongue is also a common site for food particles, plaque and bacteria, and thus is a source of bad breath.

DRY MOUTH
- Food particles, plaque and bacteria growth can be exacerbated by low saliva output and dry mouth. Medication, supplements and vitamins can directly and indirectly effect breath by causing dry mouth.

TOBACCO USE
- When smoked, tobacco releases a prominent odor that can affect our home, car and clothes. The presence of tobacco can be lingering, despite the best cleaning efforts. This is why many motels and hotels offer smoking and non-smoking rooms. The effects are the same for the mouth.

MEDICATION
- Medication, supplements and vitamins can directly and indirectly effect breath. Supplements like fish oil, will react with your body in a similar way as food. Some medication can also cause dry mouth which can indirectly lead to halitosis.

MEDICAL CONDITIONS
- Bad breath can be a byproduct of certain health conditions as well. It may result from infections in the nose, throat or lungs; chronic sinusitis; postnasal drip; chronic bronchitis; or disturbances in your digestive system. Dental diseases such as tooth decay and gum disease can also cause bad breath.

- To fight bad breath, the American Dental Association recommends that you brush your teeth twice a day with fluoride-containing toothpaste and clean between your teeth once a day by using an inter-dental cleaner such as floss.

- Additionally, using a tongue brush or scraper to clean your tongue will result in a noticeable improvement in odor.

If your problem seems to stem from dry mouth, consider chewing sugar-free gum or sucking on sugar-free candies to help stimulate salivary flow. Be aware of your diet and avoid foods with strong odor when possible.

If halitosis is still a concern, talk with your dentist and other health care providers.

A thorough health history, including a list of medications and supplements you are taking, may be helpful in determining whether the cause of your bad breath is localized to the mouth or might be a systemic condition, in which case a physician should be consulted. If your breath problems stem from an oral cause, your dentist can work with you to develop a treatment plan that minimizes halitosis.

For most people, chewing gum, or rinsing with mouth wash will solve their acute episode of bad breath. But for those of us who seem to have a more chronic and severe form of halitosis, a better understanding of the causes and a focused treatment plan will be more effective in defeating bad breath and allowing us to enjoy more confidence in our intimate relationships.