Halitosis

Background

• Halitosis is defined as offensive breath odor with an intensity beyond socially acceptable levels and/or affecting personal relationships.
  • Intraoral halitosis (reported in 90% of cases) is halitosis originating from within the oral cavity, including causes due to food debris and biofilm coating of the teeth and tongue, pathologic intraoral conditions, or a combination of these things.
  • Extraoral halitosis (reported in 4%-10% of cases) is halitosis originating from a source other than the oral cavity, including those due to nose and throat pathologies or systemic diseases.
    • Non-blood-borne halitosis originates from the respiratory tract and cavities or gastrointestinal tract.
    • Blood-borne halitosis is caused by volatiles from systemic circulation being transferred during pulmonary gas exchange to the breath.
• About 50% of people worldwide are reported to self-assess as having frequent or constant halitosis.

Evaluation

• Ask patients about their oral hygiene, dietary intake, and obtain a medical and dental history.
• Examine the teeth, tongue, periodontal tissues, throat, nasal cavity, and upper respiratory tract as part of a physical exam.
• The diagnosis of halitosis is made by confirmation of offensive breath odor using organoleptic (subjective) measurement whereby the examiner subjectively assesses the patient's oral and nasal breath odor.
  • Odor detected only from the mouth is consistent with intraoral halitosis.
  • Odor detected from both the mouth and nose is consistent with extraoral halitosis.
• An instrumental (objective) measurement whereby a device objectively measures the volatile sulphur compound or other volatile compounds that cause breath odor can help in the diagnosis, although volatile compounds do not always correspond to halitosis diagnosis.

Management

• Provide all patients with information on halitosis and instructions for tongue cleaning, mouth rinsing, and additional oral hygiene measures.
• For intraoral halitosis:
  • treat any underlying oral pathology (such as periodontitis, gingivitis, or dental caries) if present
  • advise about regular mechanical tongue cleaning/scraping if coating is present
  • if tongue cleaning is not sufficient, consider using toothpastes or mouth rinses containing antiseptic agents, such as chlorhexidine, cetylpyridinium chloride, or zinc
  • consider probiotics as adjunct to oral hygiene measures in patients with oral halitosis, but evidence for their efficacy is limited
• For extraoral halitosis, management of the underlying disorder may be necessary to reduce halitosis.