Halitosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Luke Rusowicz-Orazem, B.S.

Synonyms and keywords: oral malodor; breath odor; foul breath; fetor oris; fetor ex ore; bad breath

Classification

• Halitosis can be classified into physiologic, pathologic, or subjective.
• Physiologic halitosis occurs due to decreased saliva production. It occurs in the morning when the mouth is dry, and there is an overgrowth of oral bacteria [2]. Tobacco smoking and certain food items like garlic and onion also cause bad breath due to aromatic compounds. Physiological halitosis improves significantly by flossing, tooth brushing, rinsing with mouthwash, and drinking water.
• Pathological halitosis occurs due to an underlying disease. The common causes include postnasal drip, sinusitis, gingivitis, and caries [2]. The tonsillar inflammation and peri-tonsillar abscesses can also result in bad breath.

Pathophysiology

• It is thought that [halitosis] is produced by bacterial overgrowth in the oral cavity.
• Poor oral hygiene, dental caries, or gum infection results in the growth of gram-negative anaerobes in the mouth [3].
• These bacteria thrive on debris material entrapped between teeth and gums. Lysosomal enzymes secreted by the bacteria break down the glycoproteins in the food particles. It results in volatile compounds like hydrogen sulfide, dimethyl sulfide, and methyl mercaptan, resulting in [halitosis] [4].
• The Bacteroides, Prevotella, and Fusobacterium species are mainly responsible for [halitosis] [5].