Halitosis is the term used to describe the foul smell of breath (‘bad breath’) and is associated with psychosocial consequence and self-consciousness. Most primary healthcare practitioners have insufficient information on the diagnosis and treatment of halitosis. There are various causes of halitosis and therefore different treatments depending on the cause.

‘Morning breath’ is caused by the decrease in saliva flow in the mouth during the night and the disintegration of trapped food particles left in the mouth. 80-85% of halitosis is caused by the mouth itself. Periodontitis (gum disease) is a major cause of halitosis due to the presence of certain bacteria that release volatile sulphur compounds. Other oral conditions such as ulcers, infected gums and abscesses also involve these kinds of bacteria. The tongue is a major reservoir of bacteria that can cause halitosis.

Other causes of halitosis include tooth decay, food trapped between the teeth, wearing dentures through the night, not cleaning dentures, and the myriad of oral infections such as syphilis, tuberculosis, traumatic ulcer infection, peri-implantitis (infected implant) and so on. Certain foods and beverages are also known to cause halitosis, most are common-knowledge and include onions, garlic, alcohol, pickles, condiments, spices, tobacco and betel nut. This kind of halitosis can last a few hours but is not permanent unless the food/drink is consumed regularly. Up to 10% of halitosis can be caused by the ears, nose or throat (tonsils). Infection or cancer of the tonsils, nose, sinuses or ears can cause foul smell due to the bacteria present or secondary infection of carcinoma.

Various gastric disorders such as gastric reflux, peptic ulcers, and stenosis can cause halitosis. In addition, some systemic, endocrinological and metabolic conditions can cause associated halitosis. For example, Diabetes Mellitus is known to cause a fruity, sweet odor of the breath. Kidney insufficiency is characterized by a fish odor breath and liver cirrhosis is known to cause a decayed wound smelling breath.

Halitosis is diagnosed via examination, complete history taking and the use of an organoleptic test. This tests the odor of the air exhaled through the mouth and then the nose. Halitosis through the mouth usually indicates the mouth or throat are the cause, while halitosis through the nose implies the source is the nose or sinuses. Both through the nose and mouth indicates a possible systemic cause. The test is quick and easy and inexpensive.

Management of halitosis includes oral hygiene measures like oral cleaning and education on homecare practices. Tongue scrapers and mouth rinses are types of adjunctive oral hygiene products that can be added to routine hygiene practices (brushing and flossing). Halitosis caused by infection or other need to be managed accordingly by removal of the source of infection. Systemic conditions causing halitosis require intervention of a medical specialist. Often the management includes a multidisciplinary approach with the intervention of the dentist, ENT, nutritionist, endocrinologist, gastroenterologist and even a psychologist.

Halitosis is a treatable condition that can cause the sufferer to undergo unnecessary social anxiety and embarrassment. If you are concerned that you may have halitosis, consult your primary healthcare provider such as an oral hygienist or dentist. Be sure to divulge any medical condition you may have in order to prevent misdiagnosis or unnecessary treatment.


  • Kapoor U, Sharma G, Juneja M, Nagpal A. Halitosis: Current concepts on etiology, diagnosis and management. Eur J Dent. 2016 Apr-Jun; 10(2): 292–300

With thanks to Oral-B – Preventing Gum Diseases

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