Halitosis is derived from a Latin word which means unpleasant breath. If not treated, it could affect your social life. Majority of the cases of halitosis have oral origin. Therefore, appropriate dental treatment eliminates the cause.

1. HALITOSIS
-Dr.Shraddha Kode

2. Halitosis – any disagreeable odour of
expired air
Synonyms: fetor oris, fetor ex ore,
oral malodour, bad breath
Prevalence of halitosis: 10-30% in the
United States
87% o f the cases with halitosis had
oral causes

3. Biochemistry of halitosis?
3
Primary cause – degradation of oral
substances by bacteria
Main micro-organisms – gram
negative anaerobic bacteria
Most important substrates – cysteine
& methionine
Degradation results in – formation
of volatile sulfur compounds (VSC’s)

4. “Different types of VSC’s
4
Hydrogen sulfide (H2S)
Methyl mercaptan (CH3SH)
Dimethyl sulfide (CH3)2S
Other molecules: diamines (indole
& skatole)or polyamines (cadverin
and putrescin)

5. 5
Classification
Genuine halitosis Pseudo halitosis Halitophobia
1. Physiological
halitosis
2. Pathological
halitosis
Oral
origin
Systemic
origin
Originates from
the oral cavity
No halitosis
present but patient
believes so – brain
dysfunctions:
delusional cacosmia,
olfactory reference
syndrome
Persistent belief of
patient that he/she
has halitosis
despite
reassurance,
treatment and
counselling
PHYSIOLOGICAL – Absence of disease; eating or
drinking food – malodour
PATHOLOGICAL – Presence of disease

6. 6
Etiology of halitosis
Oral causes :
Tongue coating – niche for oral bacteria – embedded
desquamating epithelial cells, food remnants, components
of saliva – putrefaction of these substrates – lead to
halitosis
Periodontal infections – positive correlation with
gingivitis and periodontitis; NUG/NUP – extremely
offensive malodour due to excessive periodontal destruction

7. 7
Xerostomia – reduced salivary flow –
favours proliferation of Gram –ve bacteria – increased
accumulation of plaque on the tooth surfaces and
increased tongue coating
Other oral causes – decayed teeth with exposed
necrotic pulp, extraction wounds, dry socket, food
impaction, pericoronitis, peri-implantitis, recurrent
oral ulcerations, herpetic gingivitis

8. 8
Non-oral causes :
ENT & pulmonary causes: Tonsilitis, post
nasal drip – excess mucus formation due to
cold, allergies, bacterial infection, rhinitis,
sinusitis, bronchiectasis, lung abscesses,etc
Gastrointestinal causes: Gastric
regurgitation, gastric cancer, malabsorption,
intestinal obstruction

9. Diabetes mellitus: uncontrolled diabetes
mellitus having diabetic ketoacidosis –
ketonic breath/sweet fruity smell, rotten
apple breath
Liver pathologies: reduced liver function
– accumulation of metabolites in the blood
– eliminated thr lungs – sweet,
excremental odour – fetor hepaticus

10. 10
Renal disorders: impaired renal function – high
blood urea nitrogen levels – typical uremic odour
Trimethylamineuria: genetic disorder of bowels –
fish smelling compound trimethylamine –
accumulates in the body - excreted – fishy odour
Medications: bisphosphonates – necrosis of tissues –
filthy odour

11. Intestinal obstruction Fecal odour
Diabetes mellitus Fruity odour/ketonic
breath/rotten apple odour
Hepatic cirrhosis Musty or mousey odour
Renal insufficiency
Trimethylaminuria
Ammonia/fishy odour
Wegner’s
granulomatosis
Necrotic or putrefactive
odour
Methionine
adenosyltransferase
(MAT) deficiency
Cooked cabbage odour
Maple syrup urine
disease
Burned sugar odour
Lung abscess,
tuberculosis
Foul putrefactive odour

12. 12
Diagnosis of halitosis
Identify the source of malodour (oral/non-oral)
Organoleptic grading: Sniffing the patient’s breath
(expired air) and grading the level of halitosis
0 = no odour
1= barely noticeable odour
2= slight but clearly noticeable odour
3= moderate odour
4= strong offensive odour
5= extremely foul odour

13. 13
Gas chromatography: OralChroma -
measurement of VSC’s – to assess breath
malodour – identifies various components in a
minute quantity of air
Sulfide Monitors: Halimeter – electrochemical
voltammetric sensor generates a signal when
exposed to sulfur gases

14. 14
Bacterial culture & smear: Samples taken
from oral cavity are cultured and bacterial
species identified
BANA TEST: Benzoyl-DL-arginine-2-
naphthylamide
Detect T.denticola, B.forsythus, P.gingivalis
which are capable of producing VSC’s
Sample placed on BANA test strip – incubated
at 55degrees for 5mins – strip turns blue in
presence of above micro-organisms

15. 15
Treatment
Oral origin :
Periodontal therapy – along with mechanical and
chemical plaque control
Tongue cleaning– to reduce the bacterial load – tongue
scraper
Dietary counselling– drink plenty of fluids, eat fresh,
fibrous vegetables, imp to rinse the mouth especially after
meals

16. 16
Treatment of pathologies associated with teeth – decayed
and endodontically involved teeth, unhealed extraction
sockets, pus discharging sinus and fistula
Non-oral origin :
Identify the systemic cause – & refer to a specialist

17. CONCLUSION:
Halitosis affects the social life
Most commonly patients use masking
agents to get temporary relief
But, identify the exact cause
Majority of cases – oral origin;
appropriate dental treatment eliminates
the cause
Systemic origin – refer to a specialist