- Mel Rosenberg, PhD
Mel Rosenberg, PhD
- Professor, Department of Human Microbiology
- Sackler Faculty of Medicine
- Tel Aviv University, Israel
Bad breath (sometimes referred to as halitosis, oral malodor, fetor oris, or fetor ex ore) is defined as any detectable offensive smell carried on the breath. Gases that might appear in the breath in abnormal concentrations, yet are not detected by the nose, would not fall under this definition.
This topic will cover the etiology, pathogenesis, diagnosis, and treatment of bad breath. Other related topics such as gingivitis, periodontitis, and odontogenic infections are discussed elsewhere. (See "Gingivitis and periodontitis in adults: Classification and dental treatment" and "Epidemiology, pathogenesis, and clinical manifestations of odontogenic infections" and "Complications, diagnosis, and treatment of odontogenic infections".)
Bad breath has been with us for thousands of years. The problem is discussed at length in the Jewish Talmud, as well as by Greek and Roman writers. Islam also stresses fresh breath in the context of good oral hygiene.
Ancient folk remedies abound that are still in use. The book of Genesis (Chapter 37) mentions ladanum (mastic), which may be the mastic gum derived from the Pistacia lentiscus tree, which has been used in Mediterranean countries for breath freshening for thousands of years. Other folk cures include mint, anise, parsley (Italy), cloves (Iraq), guava peels (Thailand), and eggshells (China).
Modern literature on bad breath dates back to a monograph published by Howe in the 19th century. Experimental research on the subject dates back over 70 years.
- Porter SR, Scully C. Oral malodour (halitosis). BMJ 2006; 333:632.
- Rosenberg M, Knaan T, Cohen D. Association among bad breath, body mass index, and alcohol intake. J Dent Res 2007; 86:997.
- Liu XN, Shinada K, Chen XC, et al. Oral malodor-related parameters in the Chinese general population. J Clin Periodontol 2006; 33:31.
- Nadanovsky P, Carvalho LB, Ponce de Leon A. Oral malodour and its association with age and sex in a general population in Brazil. Oral Dis 2007; 13:105.
- Bornstein MM, Kislig K, Hoti BB, et al. Prevalence of halitosis in the population of the city of Bern, Switzerland: a study comparing self-reported and clinical data. Eur J Oral Sci 2009; 117:261.
- Rosenberg M, Kozlovsky A, Gelernter I, et al. Self-estimation of oral malodor. J Dent Res 1995; 74:1577.
- Seemann R, Bizhang M, Djamchidi C, et al. The proportion of pseudo-halitosis patients in a multidisciplinary breath malodour consultation. Int Dent J 2006; 56:77.
- Rosenberg M. Introduction. In: Bad Breath: Research Perspectives, Rosenberg M (Ed), Ramot Publishing, Tel Aviv 1995. p.1.
- van den Broek AM, Feenstra L, de Baat C. A review of the current literature on management of halitosis. Oral Dis 2008; 14:30.
- Delanghe G, Ghyselen J, van Steenberghe D, Feenstra L. Multidisciplinary breath-odour clinic. Lancet 1997; 350:187.
- Quirynen M, Dadamio J, Van den Velde S, et al. Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 2009; 36:970.
- Sopapornamorn P, Ueno M, Shinada K, et al. Relationship between total salivary protein content and volatile sulfur compounds levels in malodor patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103:655.
- Tonzetich J. Oral malodour: an indicator of health status and oral cleanliness. Int Dent J 1978; 28:309.
- Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977; 48:13.
- Tonzetich J, Preti G, Huggins GR. Changes in concentration of volatile sulphur compounds of mouth air during the menstrual cycle. J Int Med Res 1978; 6:245.
- Kleinberg I, Codipilly M. The biological basis of oral malodor formation. In: Bad Breath: Research Perspectives, Rosenberg M (Ed), Ramot Publishing, Tel Aviv 1995. p.13.
- Persson S, Claesson R, Carlsson J. The capacity of subgingival microbiotas to produce volatile sulfur compounds in human serum. Oral Microbiol Immunol 1989; 4:169.
- Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA. Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor. J Dent Res 1991; 70:1436.
- Goldberg S, Kozlovsky A, Gordon D, et al. Cadaverine as a putative component of oral malodor. J Dent Res 1994; 73:1168.
- Rosenberg M. Clinical assessment of bad breath: current concepts. J Am Dent Assoc 1996; 127:475.
- Sterer N, Rosenberg M. Effect of deglycosylation of salivary glycoproteins on oral malodour production. Int Dent J 2002; 52 Suppl 3:229.
- Sterer N, Rosenberg M. Streptococcus salivarius promotes mucin putrefaction and malodor production by Porphyromonas gingivalis. J Dent Res 2006; 85:910.
- Haraszthy VI, Zambon JJ, Sreenivasan PK, et al. Identification of oral bacterial species associated with halitosis. J Am Dent Assoc 2007; 138:1113.
- Kleinberg I, Westbay G. Salivary and metabolic factors involved in oral malodor formation. J Periodontol 1992; 63:768.
- Kozlovsky A, Gordon D, Gelernter I, et al. Correlation between the BANA test and oral malodor parameters. J Dent Res 1994; 73:1036.
- Bosy A, Kulkarni GV, Rosenberg M, McCulloch CA. Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations. J Periodontol 1994; 65:37.
- van den Broek AM, Feenstra L, de Baat C. A review of the current literature on aetiology and measurement methods of halitosis. J Dent 2007; 35:627.
- Rosenberg M. Bad breath and periodontal disease: how related are they? J Clin Periodontol 2006; 33:29.
- Biesbrock A, Corby PM, Bartizek R, et al. Assessment of treatment responses to dental flossing in twins. J Periodontol 2006; 77:1386.
- Finkelstein Y. The otolaryngologist and the patient with halitosis. In: Bad Breath: Research Perspectives, Rosenberg M (Ed), Ramot Publishing, Tel Aviv 1995. p.175.
- Sterer N, Rosenberg M. Breath Odors: Origin, Diagnosis, and Managment, Springer, 2011.
- Katz HP, Katz JR, Bernstein M, Marcin J. Unusual presentation of nasal foreign bodies in children. JAMA 1979; 241:1496.
- Ferguson M, Aydin M, Mickel J. Halitosis and the tonsils: a review of management. Otolaryngol Head Neck Surg 2014; 151:567.
- Tsuneishi M, Yamamoto T, Kokeguchi S, et al. Composition of the bacterial flora in tonsilloliths. Microbes Infect 2006; 8:2384.
- Finkelstein Y, Talmi YP, Ophir D, Berger G. Laser cryptolysis for the treatment of halitosis. Otolaryngol Head Neck Surg 2004; 131:372.
- Attia EL, Marshall KG. Halitosis. Can Med Assoc J 1982; 126:1281.
- Durham TM, Malloy T, Hodges ED. Halitosis: knowing when 'bad breath' signals systemic disease. Geriatrics 1993; 48:55.
- Keles M, Tozoglu U, Uyanik A, et al. Does peritoneal dialysis affect halitosis in patients with end-stage renal disease? Perit Dial Int 2011; 31:168.
- Johnstone AM, Horgan GW, Murison SD, et al. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr 2008; 87:44.
- Moshkowitz M, Horowitz N, Leshno M, Halpern Z. Halitosis and gastroesophageal reflux disease: a possible association. Oral Dis 2007; 13:581.
- Lee H, Kho HS, Chung JW, et al. Volatile sulfur compounds produced by Helicobacter pylori. J Clin Gastroenterol 2006; 40:421.
- Adler I, Denninghoff VC, Alvarez MI, et al. Helicobacter pylori associated with glossitis and halitosis. Helicobacter 2005; 10:312.
- Suzuki N, Yoneda M, Naito T, et al. Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis. J Med Microbiol 2008; 57:1553.
- Ayesh R, Mitchell SC, Zhang A, Smith RL. The fish odour syndrome: biochemical, familial, and clinical aspects. BMJ 1993; 307:655.
- Preti G, Clark L, Cowart BJ, et al. Non-oral etiologies of oral malodor and altered chemosensation. J Periodontol 1992; 63:790.
- Leo Sreebny, personal communication.
- Suarez F, Springfield J, Furne J, Levitt M. Differentiation of mouth versus gut as site of origin of odoriferous breath gases after garlic ingestion. Am J Physiol 1999; 276:G425.
- Eli I, Baht R, Kozlovsky A, Rosenberg M. The complaint of oral malodor: possible psychopathological aspects. Psychosom Med 1996; 58:156.
- Murata T, Rahardjo A, Fujiyama Y, et al. Development of a compact and simple gas chromatography for oral malodor measurement. J Periodontol 2006; 77:1142.
- Rosenberg M, McCulloch CA. Measurement of oral malodor: current methods and future prospects. J Periodontol 1992; 63:776.
- Outhouse TL, Al-Alawi R, Fedorowicz Z, Keenan JV. Tongue scraping for treating halitosis. Cochrane Database Syst Rev 2006; :CD005519.
- McCullough MJ, Farah CS. The role of alcohol in oral carcinogenesis with particular reference to alcohol-containing mouthwashes. Aust Dent J 2008; 53:302.
- Rosenberg M. The science of bad breath. Sci Am 2002; 286:72.