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Bad breath

Authors
Alessandro Villa, DDS, PhD, MPH
Jean M Bruch, DMD, MD
Section Editor
Daniel G Deschler, MD, FACS
Deputy Editor
Daniel J Sullivan, MD, MPH

INTRODUCTION

Halitosis (from the Latin word for breath, “halitus”; also known as oral malodor, “fetor ex ore,” or “fetor oris”) is a common condition. Patients may not be aware of their own bad breath and learn of it from another person.

This topic will cover the epidemiology, pathogenesis, causes, evaluation, and management of halitosis. Related topics such as gingivitis, periodontitis, and odontogenic infections are discussed elsewhere. (See "Gingivitis and periodontitis in adults: Classification and dental treatment" and "Gingivitis and periodontitis in children and adolescents" and "Epidemiology, pathogenesis, and clinical manifestations of odontogenic infections" and "Complications, diagnosis, and treatment of odontogenic infections".)

TERMINOLOGY

Halitosis – Halitosis is defined as “malodor with intensity beyond a socially acceptable level perceived” [1,2]. It is a significant concern for many individuals and may negatively affect their quality of life and personal relationships [3].

Physiologic halitosis – Bad breath that does not have a specific cause. It is usually worse in the morning and often transient.

Pathologic halitosis – Bad breath that results from a specific identifiable cause.

                               
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Literature review current through: Nov 2017. | This topic last updated: Nov 27, 2017.
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References
Top
  1. Hughes FJ, McNab R. Oral malodour--a review. Arch Oral Biol 2008; 53 Suppl 1:S1.
  2. Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis; clinical perspectives. J Can Dent Assoc 2000; 66:257.
  3. Porter SR, Scully C. Oral malodour (halitosis). BMJ 2006; 333:632.
  4. Slot DE, De Geest S, van der Weijden FA, Quirynen M. Treatment of oral malodour. Medium-term efficacy of mechanical and/or chemical agents: a systematic review. J Clin Periodontol 2015; 42 Suppl 16:S303.
  5. Rosenberg M, Kozlovsky A, Gelernter I, et al. Self-estimation of oral malodor. J Dent Res 1995; 74:1577.
  6. Villa A, Zollanvari A, Alterovitz G, et al. Prevalence of halitosis in children considering oral hygiene, gender and age. Int J Dent Hyg 2014; 12:208.
  7. 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.
  8. Rosenberg M, Knaan T, Cohen D. Association among bad breath, body mass index, and alcohol intake. J Dent Res 2007; 86:997.
  9. Falcão DP, Vieira CN, Batista de Amorim RF. Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia. J Breath Res 2012; 6:017105.
  10. Fedorowicz Z, Aljufairi H, Nasser M, et al. Mouthrinses for the treatment of halitosis. Cochrane Database Syst Rev 2008; :CD006701.
  11. De Geest S, Laleman I, Teughels W, et al. Periodontal diseases as a source of halitosis: a review of the evidence and treatment approaches for dentists and dental hygienists. Periodontol 2000 2016; 71:213.
  12. Rosenberg M. Clinical assessment of bad breath: current concepts. J Am Dent Assoc 1996; 127:475.
  13. 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.
  14. Sterer N, Rosenberg M. Effect of deglycosylation of salivary glycoproteins on oral malodour production. Int Dent J 2002; 52 Suppl 3:229.
  15. Sterer N, Rosenberg M. Streptococcus salivarius promotes mucin putrefaction and malodor production by Porphyromonas gingivalis. J Dent Res 2006; 85:910.
  16. Haraszthy VI, Zambon JJ, Sreenivasan PK, et al. Identification of oral bacterial species associated with halitosis. J Am Dent Assoc 2007; 138:1113.
  17. Vancauwenberghe F, Dadamio J, Laleman I, et al. The role of Solobacterium moorei in oral malodour. J Breath Res 2013; 7:046006.
  18. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977; 48:13.
  19. Scully C, Greenman J. Halitosis (breath odor). Periodontol 2000 2008; 48:66.
  20. Goldberg S, Kozlovsky A, Gordon D, et al. Cadaverine as a putative component of oral malodor. J Dent Res 1994; 73:1168.
  21. Ferguson M, Aydin M, Mickel J. Halitosis and the tonsils: a review of management. Otolaryngol Head Neck Surg 2014; 151:567.
  22. Tsuneishi M, Yamamoto T, Kokeguchi S, et al. Composition of the bacterial flora in tonsilloliths. Microbes Infect 2006; 8:2384.
  23. Stoodley P, Debeer D, Longwell M, et al. Tonsillolith: not just a stone but a living biofilm. Otolaryngol Head Neck Surg 2009; 141:316.
  24. Aydin M, Harvey-Woodworth CN. Halitosis: a new definition and classification. Br Dent J 2014; 217:E1.
  25. Yoo SH, Jung HS, Sohn WS, et al. Volatile sulfur compounds as a predictor for esophagogastroduodenal mucosal injury. Gut Liver 2008; 2:113.
  26. Kinberg S, Stein M, Zion N, Shaoul R. The gastrointestinal aspects of halitosis. Can J Gastroenterol 2010; 24:552.
  27. Moshkowitz M, Horowitz N, Leshno M, Halpern Z. Halitosis and gastroesophageal reflux disease: a possible association. Oral Dis 2007; 13:581.
  28. Adler I, Denninghoff VC, Alvarez MI, et al. Helicobacter pylori associated with glossitis and halitosis. Helicobacter 2005; 10:312.
  29. Dou W, Li J, Xu L, et al. Halitosis and helicobacter pylori infection: A meta-analysis. Medicine (Baltimore) 2016; 95:e4223.
  30. Ayesh R, Mitchell SC, Zhang A, Smith RL. The fish odour syndrome: biochemical, familial, and clinical aspects. BMJ 1993; 307:655.
  31. Wise PM, Eades J, Tjoa S, et al. Individuals reporting idiopathic malodor production: demographics and incidence of trimethylaminuria. Am J Med 2011; 124:1058.
  32. Preti G, Clark L, Cowart BJ, et al. Non-oral etiologies of oral malodor and altered chemosensation. J Periodontol 1992; 63:790.
  33. Phillips KA, Menard W. Olfactory reference syndrome: demographic and clinical features of imagined body odor. Gen Hosp Psychiatry 2011; 33:398.
  34. Gokdogan O, Catli T, Ileri F. Halitosis in otorhinolaryngology practice. Iran J Otorhinolaryngol 2015; 27:145.
  35. Tonzetich J. Oral malodour: an indicator of health status and oral cleanliness. Int Dent J 1978; 28:309.
  36. Seemann R, Conceicao MD, Filippi A, et al. Halitosis management by the general dental practitioner--results of an international consensus workshop. J Breath Res 2014; 8:017101.
  37. 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.
  38. Rosenberg M, McCulloch CA. Measurement of oral malodor: current methods and future prospects. J Periodontol 1992; 63:776.
  39. Rosenberg M, Septon I, Eli I, et al. Halitosis measurement by an industrial sulphide monitor. J Periodontol 1991; 62:487.
  40. Babacan H, Sokucu O, Marakoglu I, et al. Effect of fixed appliances on oral malodor. Am J Orthod Dentofacial Orthop 2011; 139:351.
  41. Bollen CM, Beikler T. Halitosis: the multidisciplinary approach. Int J Oral Sci 2012; 4:55.
  42. Lin MI, Flaitz CM, Moretti AJ, et al. Evaluation of halitosis in children and mothers. Pediatr Dent 2003; 25:553.
  43. Dal Rio AC, Passos CA, Nicola JH, Nicola EM. CO2 laser cryptolysis by coagulation for the treatment of halitosis. Photomed Laser Surg 2006; 24:630.
  44. Finkelstein Y, Talmi YP, Ophir D, Berger G. Laser cryptolysis for the treatment of halitosis. Otolaryngol Head Neck Surg 2004; 131:372.