Last reviewed: 5 May 2023
Last updated: 26 Apr 2022
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- malodorous breath
- consumption of onions, garlic, or spiced food
- evidence of dental and/or periodontal disease
- evidence of disease of the oral mucosa
- evidence of nasopharyngeal disease
More key diagnostic factors
Other diagnostic factors
- evidence of upper respiratory tract or gastrointestinal disease
- evidence of upper respiratory tract and gastrointestinal malignancy
- evidence of endocrine, metabolic, hepatic, or renal disease
Other diagnostic factors
Risk factors
- oral disease
- respiratory disease
- gastrointestinal disease
- hepatic disease
- renal disease
- endocrine disease or hormonal changes
- metabolic disease
More risk factors
Diagnostic investigations
1st investigations to order
- clinical diagnosis
More 1st investigations to order
Investigations to consider
- sulfide monitor
- gas chromatography
- benzol-arginine-naphthylamide (BANA) test
- dark-field microscopy
- polymerase chain reaction of oral bacteria
- selected ion flow tube mass spectroscopy
More investigations to consider
Treatment algorithm
ACUTE
all patients
Contributors
Authors
Stephen R. Porter, BSc, PhD, MD, FDSRCS, FDSRCSEd, FHEA

Director and Professor of Oral Medicine
UCL Eastman Dental Institute
London
UK
Disclosures
SRP declares that he has no competing interests.
Stefano Fedele, DDS, PhD

Professor of Oral Medicine
UCL Eastman Dental Institute
London
UK
Disclosures
SF declares that he has no competing interests.
Peer reviewers
Giuseppina Campisi, DDS, PhD
Professor of Oral Medicine
Department of Oral Sciences
University of Palermo
Palermo
Italy
Disclosures
GC declares that she has no competing interests.
Ronald S. Brown, MD, DDS
Professor
Howard University College of Dentistry
Washington
DC
Disclosures
RSB declares that he has no competing interests.
Differentials
- Pseudo-halitosis
More DifferentialsPatient leaflets
Bad breath
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer