Term used to describe any disagreeable odor of expired air from the mouth. In most cases, it arises from the presence of volatile sulfur compounds (VSCs), diamines, and short-chain fatty acids in the exhaled air.
More likely to occur in individuals with oral, dental, and nasopharyngeal disease that can increase the accumulation of food debris and bacterial plaque.
If persistent and severe, it is defined as "pathologic halitosis." Very rarely, a spectrum of systemic disorders may also give rise to altered breath smell.
Diagnosis usually entails smelling the exhaled air of the mouth and nose (organoleptic assessment). More objective diagnostic tools include gas chromatography of oral breath and detection of oral bacteria likely to give rise to halitosis.
When associated with dental, oral, and pharyngeal disease, appropriate management of these conditions usually results in reduced accumulation of bacteria and reduced malodor. Therapy of halitosis due to systemic disease is based on treatment of relevant associated disorder.
Some individuals complain of oral malodor yet have no detectable halitosis Such pseudohalitosis remains difficult to resolve. Affected individuals require appropriate psychological investigation and treatment.
Halitosis is a general term used to describe any disagreeable odor of expired air from the mouth. Mild transient halitosis is usually caused by release of volatile odorous compounds from bacteria colonizing oral surfaces. A more persistent form of halitosis is associated with certain oral, respiratory, and gastrointestinal disease that triggers local accumulation of bacteria. Odorous compounds can be released into the bloodstream and eventually exhaled into the breath as a consequence of certain foods, drugs, or systemic disease. Self-reported oral malodor without detectable halitosis is considered to be delusional or a reflection of monosymptomatic hypochondriacal psychosis.
History and exam
- malodorous breath
- halitosis not noticed by either clinician or patient's partner/relatives
- history of obsessive behavior, depression, phobic anxiety, paranoid ideation, and reduced social interaction
- patient reports that people react to his/her bad breath by covering their nose and opening windows
- 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
Stephen R. Porter, BSc, PhD, MD, FDSRCS, FDSRCSEd, FHEA
Director and Professor of Oral Medicine
UCL Eastman Dental Institute
SRP declares that he has no competing interests.
Stefano Fedele, DDS, PhD
Senior Clinical Lecturer in Oral Medicine
UCL Eastman Dental Institute
SF has received research funding and advisory/consultancy fees from Amgen for work unrelated to this article. SF has also received fess from professional conferences for lecturing on topics unrelated to this article.
Giuseppina Campisi, DDS, PhD
Professor of Oral Medicine
Department of Oral Sciences
University of Palermo
GC declares that she has no competing interests.
Ronald S. Brown, MD, DDS
Howard University College of Dentistry
RSB declares that he has no competing interests.
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