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
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
Risk factors
- oral disease
- respiratory disease
- gastrointestinal disease
- hepatic disease
- renal disease
- endocrine disease or hormonal changes
- metabolic disease
Diagnostic tests
1st tests to order
- clinical diagnosis
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
Treatment algorithm
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.
References
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.
Differentials
- Pseudohalitosis
More DifferentialsPatient information
Bad breath
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer