Halitosis: Mere bad breath or something more?

Woman cleaning teeth with toothbrushHalitosis is the term used to describe unpleasant smell coming out from the mouth. This medical condition applies to 50% – 65% of the world population. Despite the prevalence of the affliction is so high, the problem is ignored and treated as a taboo. In about 90% of cases the source of halitosis is located in the oral cavity. A small portion of the problem is caused by disorders that are beyond oral cavity. There is also the phenomenon of psychogenic halitosis. In a variant called pseudo-halitosis there is no unpleasant smell from the mouth, but the patient is convinced of its existence. Worth of mentioning is also the term of halitophobia, when patient experiences exaggerated fear of this disease.

The causes of extraoral halitosis account for 10% -15% of cases of this affliction. Halitosis may be a potential sign of serious disturbances taking place in the body. Tangerman grouped the causes of extraoral halitosis basing on the anatomical origin. He distinguished the first group, which source is found in the upper respiratory tract (including the nose). The second group, which originated from lower respiratory tract and the third caused by systemic diseases. In addition, Sanz et al. distinguished real halitosis from the pseudo-halitosis in a fairly simple way, by testing the organoleptic and physico-chemical properties.

Numerous studies showed that the real intraoral halitosis is caused by microorganisms degrading proteins (especially those that contain cysteine, cystine and methionine) contained in saliva and in the remnants of food stuck between the teeth. Morning halitosis needs to be distinguished among the intraoral causes of unpleasant smell. It is caused by the accumulation of bacteria through the night, a decrease in saliva secretion and sometimes inaccurate brushing of teeth before bedtime. Some experts estimate that about 95% of the total population is involved in this phenomenon.

The patient, who believes that he or she suffers from halitosis, should firstly be examined by a physician or dentist. Doctor should determine whether his or her feelings about oral odor are accurate. If the specialist agrees with the patient he should send suffering person to the dentist in order to examine the soft and hard tissues of the oral cavity. One should ask if patient is taking any medications that predispose to the dry mouth e.g. antidepressants, antipsychotics and antihistamines. Eating habits should also be taken into consideration. Tobacco, caffeine or alcohol can cause transient bad smell from the mouth. If the patient’s personal habits do not seem to be the cause of the condition extraoral etiology of the problem should be suspected. Patient should be directed to the ENT specialist to rule out chronic tonsillitis or sinusitis. In the case where the result of ENT examination comes out negative following options ought to be explored: digestive disorders, obstruction or inflammation of the gastrointestinal tract, liver cirrhosis, lung abscess, diabetes and other metabolic disorders. It happens that halitosis which etiology is not related to the oral cavity is aggravated by the problems found in the mouth. In this case both local and systemic treatment is required.

Halitosis as it is a disease which occurs quite often cannot be treated as a taboo subject. Bad breath can be a symptom of many serious diseases. Therefore, when it appears it is important to get to know the ground of its cause.

Written by: Katarzyna Godzisz, Hubert Opaliński, Michał Godzisz

1. Giuseppina Campisi, Anna Musciotto, Olga Di Fede, Vito Di Marco, Antonio Craxı Halitosis: could it be more than mere bad breath? Intern Emerg Med (2011) 6:315–319
2. Sanz M, Roldan S, Herrera D (2001) Fundamentals of breath malodour. J Contemp Dent Pract 2(4):1–17
3. Tangerman A (2002) Halitosis in medicine: a review. Int Dent J 52(Suppl 3):201–206
4. Feller L, Blignaut E (2005) Halitosis: a review. SADJ 60(1): 17–19
5. Whittle CL et al (2007) Human breath odors and their use in diagnosis. Ann N Y Acad Sci 1098:252–266
6. Rosenberg M (2002) The science of bad breath. Sci Am 286(4):72–79

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