Why does your breath sometimes get worse even after brushing your teeth?

Brushing your teeth twice a day is one of the pillars of oral hygiene, but for many people it does not necessarily solve bad breath problems. Dentists say there are often causes of halitosis, or bad breath, that cannot be dealt with by brushing alone.

So why does breathing emit a foul smell even after brushing, and what can you do about it?

Dr. Jaclyn Tomsick said that oral care companies are better as they are oral and maxillofacial surgeons and oral hygiene experts. “The food we eat is easily trapped between our teeth,” Tomsick told Live Science in an email. Brushing rather than brushing allows food fragments to sit between the teeth, where they slowly break down. This decomposition can occur within a few days, which is a common cause of bad breath, she said.

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Her advice is to floss once a day. “Flossing will reach areas where you don’t brush, so brush your brush and floss and floss it!” She prefers traditional string floss, but Tomsick said floss picks and water flossers also work. The key is to use them consistently.

However, even if you brush your teeth and floss, your mouth may still be carrying odor-causing bacteria.

“Sulfur-producing bacteria thrive on the surface of the tongue and on the back of the throat,” Dr. Fatima Khan, dentist and co-founder of Riven Oral Care, a mouthwash company for probiotics, told Live Science in an email. These bacteria can break down proteins from food very quickly, releasing dirty odor molecules called volatile sulfur compounds from behind the tongue and throat, she said. (Volatile sulfur compounds are the gas that causes the smell of classic “rotten eggs.”

Related: How does plaque cause cavity?

Dr. Jenna Chimon, a lead cosmetic dentist at Long Island Veneer, sees patients who often brush their teeth but ignore other important aspects of oral hygiene. “If you’re not cleaning your tongue or brushing your teeth, no matter how juice your toothpaste is, bacteria can remain and release odors,” Chimon told LiveScience in an email.

Her initial guidance for patients seeking help with bad breath is to help them improve their oral hygiene routine. “Cleaning your tongue is very important, either with a tongue scraper or a brush, as you floss every day.”

Another possible cause of the oral cavity is often caused by the use of certain medications (such as antihistamines), mouth breathing, or preservative mouthwash, Kahn said. Saliva acts as a natural cleanser in the mouth, rinsing food particles and bacteria. Without sufficient saliva, your mouth will not be able to properly clean, leading to bacteria buildup and bad breath.

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Hydration could be another issue that needs to be improved, Chimon said.

Drinking coffee regularly can exacerbate the problem, as caffeine lowers saliva production for two hours after intake, contributing to mouth and bad breath, studies suggest.

Bad breath can also be derived from the food you eat. Foods with strong aromas like garlic and onions are absorbed into the bloodstream, moved into the lungs, and exhaled with breath. Smoking – Both cigarettes and weeds cause bad breath even after brushing, as smoke particles remain in the mouth, throat and lungs. It also drys the mouth and creates a breeding ground for bacteria that cause odor.

Some medical conditions can also cause bad breath. Periodontal disease is one of the most common, Chimon said. “Inflammation and infection of the gums creates pockets for bacteria to grow and cause bad breath.” (Smokers are at a higher risk of developing periodontal disease than those who don’t.)

In addition to proper oral hygiene to reduce gum inflammation, a simple home remedy to protect periodontal disease is to suck up your mouth with warm salt water, Khan said. “Salt water not only cleanses the affected area, it also reduces inflammation and promotes an environment that inhibits the growth of pathogenic bacteria.”

Beyond oral health, sinus problems are another cause of bad breath that is often overlooked, Chimon said. For example, sinus problems that cause postnasal infusions, similar to stomach reflux, which can cause stomach acid to rise and irritate the nasal passages and sinuses, “can be inhaled,” explained Khan.

Furthermore, diabetes that is not properly controlled by blood glucose control can cause ketoacidosis, a condition in which the body burns fat instead of glucose. This creates a unique, fruity smell in your breath.