Can gum disease cause bad breath?

Gum disease starts when plaque, a sticky film of bacteria, builds up along the gumline. In its early form, gingivitis, gums become red, swollen and bleed easily. If it progresses to periodontitis, the gums pull away from the teeth and form pockets that are hard to clean.

Those pockets are low in oxygen, which suits the bacteria that produce volatile sulfur compounds. A review in the Journal of Breath Research describes tongue coating and periodontal disease as the two main sources of these odor gases in the mouth.

NIDCR and the NHS list these symptoms of gum disease:

• Gums that bleed when you brush, floss or eat hard foods
• Red, swollen or tender gums
• Gums pulling back so teeth look longer
• Loose or sensitive teeth, or pain when chewing
• Persistent bad breath and a bad taste in your mouth

Early gum disease is often painless, so bad breath and bleeding may be the only things you notice.

NIDCR notes that only a professional cleaning can remove tartar, the hardened plaque that builds up along and under the gums.

NIDCR calls smoking or using tobacco the most significant risk factor for gum disease. Smoking also seems to boost odor: a study found more sulfur compounds in diseased gum pockets of smokers than non-smokers. NIDCR lists other risk factors including older age, diabetes, genetics, stress, some illnesses and their medicines, and hormonal changes in girls and women. See smoking and bad breath and diabetes and bad breath.

Mouthwash cannot reach into gum pockets well enough to fix this. According to the NHS, treatment depends on severity:

• Early gum disease: advice on cleaning, including interdental brushes, a professional clean by a hygienist, and help to stop smoking.
• More serious gum disease: deep cleaning under the gums, sometimes antibiotics, gum surgery or removal of badly affected teeth.

A dentist may refer you to a periodontist, a gum specialist. Gingivitis can be reversed with good care; periodontitis can be controlled but needs ongoing maintenance visits.

1. Brush twice a day for two minutes with fluoride toothpaste, angling the bristles toward the gumline.
2. Clean between your teeth every day with floss or interdental brushes. This reaches the plaque that brushing misses.
3. Clean your tongue daily. Even with gum disease, the tongue is a major odor source, and research supports adding tongue cleaning to brushing for reducing breath odor.
4. Do not smoke.
5. Keep your checkups and cleanings, more often if your dentist recommends it.

If your gums bleed when you clean between your teeth, do not simply stop cleaning there; bleeding is a sign of gum inflammation that a dentist should check.