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Halitosis

Last reviewed: 15 Apr 2025
Last updated: 26 Apr 2022

Summary

Definition

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
Full details

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
Full details

Risk factors

  • oral disease
  • respiratory disease
  • gastrointestinal disease
  • hepatic disease
  • renal disease
  • endocrine disease or hormonal changes
  • metabolic disease
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests 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
Full details

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Stephen R. Porter, BSc, PhD, MD, FDSRCS, FDSRCSEd, FHEA
Stephen R. Porter

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
Stefano Fedele

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Yaegaki K, Coil JM. Examination, classification, and treatment of halitosis: clinical perspectives. J Can Dent Assoc. 2000;66:257-261.Full text  Abstract

Porter SR, Scully C. Oral malodour (halitosis). BMJ. 2006;333:632-635. Abstract

Delanghe G, Ghyselen J, van Steenberghe D, et al. Multidisciplinary breath-odour clinic. Lancet. 1997;350:187. Abstract

Iwu CO, Akpata O. Delusional halitosis: review of the literature and analysis of 32 cases. Br Dent J. 1990;168:294-296. Abstract

Pratten J, Pasu M, Jackson G, et al. Modelling oral malodour in a longitudinal study. Arch Oral Biol. 2003;48:737-743. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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