What is Halitosis ?

Halitosis in general means bad breath. It is also known as oral malodor. The term halitosis comes from the Latin word halitus, breath, and the Greek – osis, meaning abnormal condition.

Reasons for Halitosis

1. Due to local factors of pathologic origin or of non-pathologic origin

2. Due to systemic factors of non-pathologic origin or of pathologic origin

3. Due to systemic administration of drugs

4. Due to xerostomia / dry mouth

5. Normal breath of physiologic mouth odor

6. Odors from oral conditions

7. Odors from nasopharynx, pharynx and lungs

8. Odors excreted via lungs

9. Primary halitosis: Patients do not actually have halitosis but suffer from imaginary halitosis

10. Secondary halitosis: Patients actually have halitosis

Poor oral hygiene, inflammation of gums, extensive caries, dry mouth, hairy tongue disorder, healing of extraction wound, ulcerations, diabetes and other health conditions, dentures, smoking, intake of a few food items such as onion, diseases of the oral cavity etc are a few condition leading to bad breath.

Usually drugs containing iodine or chloral hydrate can reach the breath thus causing halitosis.

Oral malodor is common on awakening (morning breath) due to low salivary flow and stagnation of saliva during sleep. It has any significance and can be readily rectified by eating, tongue brushing, tooth brushing and by rinsing the mouth with fresh water.

Psychogenic Malodor – A group of patients who are by no means has any evidence of bad odour which can be detected even with objective testing and the halitosis may be attributable to a form of delusion (self-halitosis; halitophobia). Many of these patients will adopt a behavior to minimize their perceived problem, i.e. using chewing gum, mints, mouthwash or sprays. They cover their mouth while talking. Avoid or keep a distance from other people. They tend to clean their tongue. They also avoid social situations.

Examination of Halitosis

It has a multi-factorial etiology. It can be caused either by local factors or systemic factors. Intraoral examination consists of assessment of all abnormal findings of soft tissue, hard tissue and supporting structures such as dental decay, periodontal disease, lesions present on buccal mucosa, labial mucosa, tongue, palate, vestibule and floor of the mouth of bacterial, viral and fungal origin which can contribute in the production of the malodor due to putrefaction of bacteria. A thorough physical examination of the head and neck area must be performed as a bad breath can arise from other regions apart from oral cavity. If a strong smell arises from nasally expired air, it indicates that the lesions or disease of nasopharynx, nose or sinuses whereas a more noxious odor from orally expired air indicates an oral, oropharyngeal, hypopharyngeal or rarely a gastric source. Extra oral examination should be carried out as well. Therefore the treatment approach should be primarily based on elimination of etiological factors.

Take home message

Basic tooth brushing, use of interdental brushes, flossing, tongue cleaning should be always followed. Mouth rinses as per dentist’s guidance can be used. Once in six month scaling / cleaning of the teeth from dentist is beneficial as well. Halitosis due to systemic factors has a different approach. Keeping the mouth moist is a key to avoid bad breath. Rinsing mouth after every meal helps in combating this problem.

Author: Dr. Siri P.B.