Discover everything about -Halitosis | Bad Breath ..?? -07/23


Halitosis is commonly known as bad breath. It can be embarrassing condition that affects many people.

It can have negative impact on our self confidence & social interactions. However with proper understanding management it can be effectively controlled.

In this article there will be complete guide about definition, classification, diagnosis, prevention & treatment options for halitosis.

I. Understanding Halitosis:

1. Definition:

  • Halitosis refers to persistent bad breath that doesn’t go away easily with regular oral hygiene measures like brushing, flossing, or using mouthwash.
  • Also called – breath malodor ,foul breath, fetor oris or bad breath
  • Intensity of bad breath differ during Day(may be due to stress or fasting),eating certain food(such as garlic ,onion , milk, fish ,cheese) smoking & alcohol consumption.
  • Because mouth is dry & inactive during night odor is usually worse upon awakening (morning breath)
  • Bad breath may also be persistent (chronic bad breath),which is more serious condition affecting at least 25% of population in varying degree.

2. Causes & types :
Halitosis can have various causes, including poor oral hygiene, gum disease, dry mouth, certain foods and drinks, smoking, medical conditions like sinus infections or respiratory tract infections, and more.

Halitosis can be classified —

a. Based on etiology (cause) b. – Based on patients criteria

based on etiology:-

1.Local factor of pathologic origin-

poor oral hygiene,

extensive dental caries, periodontal diseases ,

cysts & tumours of oral & pharyngeal cavities.

2. Local factor of non-pathologic origin-

stagnation of saliva associated with food debris, dentures & excessive smoking.

3. Systemic factor of pathologic origin-

diabetes mellitus liver failure, lung abscess, tuberculosis.

4.Systemic factor of non-pathologic origin-

eg. Diet(Onion, garlic, meat, meat products , excessive alcohol consumption.

xerostomia- decreased or absence of saliva e.g. sjogrens yndrome.

Based on patients criteria –

  1. Genuine halitosis– obvious malodor with intensity beyond socially acceptable level.
  2. Pseudohalitosis– obvious malodor is not perceived by others. Although patients stubbornly complains of its existence.
    Condition can be improved by councilling & simple Oral hygiene measures.
  3. Halitophobia -after treatment of genuine halitosis or pseudohalitosis patients persists in believing that he/ she has halitosis.
    Protein/peptides derived from diet, bacteria or desquamated epithelial cells undergo hydrolysis to form amino acids
    These amino acids undergo degradation , which are volatile & odoriferous.
  4. Causes –
    90%- oral

Oral– microbial putrefaction of food debris,cells, saliva, blood within oral cavity
Proteolysis of protein to peptides & amino acids takes place .
Resultant substrate with free thiol group such as cysteine &reduced glutathione rises to volatile sulphur compounds (VSCs). Which are malodor substance.

Most common causes

Mouth breathing
Ageing & poor dental hygiene.
Foods(onion, garlic,meat,meat products)



Periodontal infection -odor from subgingival dental biofilms.
Acute necronitizing ulcerative gingivitis.
Tounge coating harbours microorganisms
Faulty restoration retaining food & bacteria.
Unclean denture
Oral cancer
Cleft palate
Apthoous ulcer
Dental abscess.

Systemic & extraoral-

Nasal infection – rhinitis, sinusitis, tumours,& foreign bodies.
Diseases of gastrointestinal tract (GIT)like hitus hernia, carcinomas, gastroesophageal reflux disorder (GERD)
PULMONARY INFECTION – bronchitis , pneumonia, tuberculosis, carcinomas.
Certain hormonal changes – that occurs during ovulation, menstruation, pregnancy, menopause.
Systemic disease – diabetes mellitus, hepatic failure, rental failure, uremia, blood dyscrasias, rheumatolic diseases ,dehydration,fever, cirrhosis of liver.

  • 3. diagnosis
  1. Review of medical, dental & personal history.
  2. Clinical examination.
    -tounge coating
    -evidence of mouth breathing
    -xerostomia (dry mouth)
    -oral hygiene
    -old fractured restoration.
    -bleeding gum
  3. Measurement of oral malodor –
    Patients should be instructed not to eat , chew, rinse or smoke for at least 2 hr before examination.
    Patients who are on antibiotics should be seen 2 weeks after discontiuation of medicine.

    • Tests for halitosis-
      a. Subjective organoleptic methods-
    • b. Gas chromatography – digitally measures molecular level of three major volatile sulphur compounds in sample of mouth aur ( hydrogen sulfide, methyl mercaptan, dimethyl sulfide)
      c. Halimeter- very sensitive to alcohol
      One should avoid drinking alcohol or using alcohol containing moutheashes for at least 12 hour prior to being tested.
      d. BANA TEST
      e. Chemiluminescence -Highly sensititive.

II. Prevention and Maintenance:

  1. Maintain Good Oral Hygiene:
  • Brush your teeth twice a day with a fluoride toothpaste for at least two minutes.
  • Clean your tongue regularly using a tongue scraper or a toothbrush.
  • Floss daily to remove plaque and food particles from between your teeth.
  1. Hydrate Well:
    Drink plenty of water throughout the day to keep your mouth moist and prevent dry mouth, which can contribute to halitosis.
  2. Avoid Trigger Foods and Drinks:
    Certain foods and drinks like garlic, onions, coffee, alcohol, and spicy foods can leave a lingering odor in your mouth. Limit or avoid these triggers to prevent bad breath.
  3. Quit Smoking:
    Smoking not only causes its own distinct bad breath but also contributes to gum disease and dry mouth. Quitting smoking can significantly improve your breath.
  4. Regular Dental Check-ups:
    Visit your dentist at least twice a year for thorough dental exams, cleanings, and early detection and treatment of any dental issues that may contribute to bad breath.

III. Treatment Options:

  1. Professional Dental Cleaning:
    Professional cleaning by a dentist or dental hygienist can remove plaque, tartar, and bacteria that contribute to bad breath.
  2. Treating Gum Disease:
    If gum disease is present, your dentist will provide appropriate treatments like deep cleaning, antibiotics, or in severe cases, surgical intervention, to address the underlying cause of halitosis.
  3. Management of Dry Mouth:
    If dry mouth is the cause of your halitosis, your dentist may recommend artificial saliva or suggest strategies to stimulate saliva production, such as chewing sugar-free gum or using oral moisturizers.
  4. Addressing Medical Conditions:
    If a medical condition like sinusitis or respiratory tract infection is causing your halitosis, seek appropriate medical treatment to address the underlying issue.
  5. Fresh Breath Products:
    Use mouthwashes, sprays, or lozenges that are specifically designed to combat bad breath. These products can temporarily mask the odor and provide freshness.

Remember, it’s essential to consult your dentist if you’re experiencing persistent bad breath, as they can help determine the underlying cause and provide guidance on the most appropriate treatment for your specific case.

By following these preventive measures, getting regular dental check-ups, and addressing any underlying oral health issues, you can effectively manage halitosis and enjoy fresh breath.

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