Halitosis describes 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.
It is 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.
The diagnostic approach is largely based on patient history and clinical examination (including smelling the exhaled air of the mouth and nose). More objective diagnostic tools, which may be used in a specialist setting, include oral breath sulfide monitors and gas chromatography devices, and detection of oral bacteria likely to give rise to halitosis.
When associated with dental, oral, and nasopharyngeal 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.
History and exam
Key diagnostic 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
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
- oral disease
- respiratory disease
- gastrointestinal disease
- hepatic disease
- renal disease
- endocrine disease or hormonal changes
- metabolic disease
1st investigations to order
- clinical diagnosis
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
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