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Health Condition

Halitosis

About This Condition

Halitosis is the technical term for bad breath, a condition estimated to affect 50 to 65% of the population.1

Up to 90% of cases are thought to originate from sources in the mouth, including poor oral hygiene, periodontal disease, coating on the tongue, impacted food, faulty dental restorations, and throat infections.2,3,4 The remaining 10% are due to systemic disorders, such as peptic ulcer (when associated with infection),5,6 lung infections (bad breath can be the first sign in some cases),7liver or kidney disease,4,9diabetes mellitus, cancer,3 or even a person’s imagination (healthy individuals sometimes complain of bad breath that cannot be smelled by anyone else and is not linked to any clinical disorder).11

In most cases, bad breath in the mouth can be traced to sulfur gases produced by bacteria in the mouth.12,13 Factors that support the growth of these bacteria will predispose a person to halitosis. Examples include accumulation of food within pockets around the teeth,14 among the bumps at the back of the tongue,12 or in small pockets in the tonsils; sloughed cells from the mouth; and diminished saliva flow. Mucus in the throat or sinuses can also serve as a breeding ground for bacteria. Conditions are most favorable for odor production during the night and between meals.16

Although bad breath primarily represents a source of embarrassment or annoyance, research has shown that the sulfur gases most responsible for halitosis (hydrogen sulfide and methyl mercaptan) are also potentially damaging to the tissues in the mouth, and can lead to periodontitis (inflammation of the gums and ligaments supporting the teeth).17,16 As periodontal disease progresses, so may the halitosis, as bacteria accumulate in the pockets that form next to the teeth.

Other Therapies

Improved oral hygiene and treatment of underlying infections may be effective in some cases. Mouthwashes might help to control oral bacteria. Persistent halitosis requires professional dental care.

References

1. Bollen CM, Rompen EH, Demanez JP. Halitosis: a multidisciplinary problem. Rev Med Liege 1999;54:32-6 [in French].

2. Meningaud JP, Bado F, Favre E, et al. Halitosis in 1999. Rev Stomatol Chir Maxillofac 1999;100:240-4.

3. Spielman AI, Bivona P, Rifkin BR. Halitosis. A common oral problem. NY State Dent J 1996;62:36-42.

4. Touyz LZ. Oral malodor—a review. J Can Dent Assoc 1993;59:607-10.

5. Tiomny E, Arber N, Moshkowitz M, et al. Halitosis and Helicobacter pylori. A possible link? J Clin Gastroenterol 1992;15:236-7.

6. Ierardi E, Amoruso A, La Notte T, et al. Halitosis and Helicobacter pylori: a possible relationship. Dig Dis Sci 1998;43:2733-7.

7. Lorber B. “Bad breath”: presenting manifestation of anaerobic pulmonary infection. Am Rev Respir Dis 1975;112:875-7.

8. Durham TM, Malloy T, Hodges ED. Halitosis: knowing when “bad breath” signals systems disease. Geriatrics 1993;48:55-9.

9. Iwakura M, Yasuno Y, Shimura M, Sakamoto S. Clinical characteristics of halitosis: differences in two patient groups with primary and secondary complaints of halitosis. J Dent Res 1994;73:1568-74.

10. Reiss M, Reiss G. Bad breath—etiological, diagnostic and therapeutic problems. Wien Med Wochenshchr 2000;150:98-100 [in German].

11. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977;48:13-20.

12. Kleinberg I, Westbay G. Salivary and metabolic factors involved in oral malodor formation. J Periodontol 1992;63:768-75 [review].

13. Waler SM. Bad breath from the oral cavity. Tidsskr Nor Laegeforen 1997;117:1618-21 [in Norwegian].

14. Ratcliff PA, Johnson PW. The relationship between oral malodor, gingivitis, and periodontitis. A review. J Periodontol 1999;7:485-9.

15. Iwamoto T, Suzuki N, Tanabe K, et al. Effects of probiotic Lactobacillus salivarius WB21 on halitosis and oral health: an open-label pilot trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:201-8.

16. Keller MK, Bardow A, Jensdottir T, Lykkeaa J, Twetman S. Effect of chewing gums containing the probiotic bacterium Lactobacillus reuteri on oral malodour. Acta Odontol Scand 2012;70:246-50.

17. Brunette DM, Proskin HM, Nelson BJ. The effects of dentifrice systems on oral malodor. J Clin Dent 1998;9:76-82.

18. Ng W, Tonzetich J. Effect of hydrogen sulfide and methyl mercaptan on the permeability of oral mucosa. J Dent Res 1984;63:994-7.

19. Waler SM. The effect of some metal ions on volatile sulfur-containing compounds originating from the oral cavity. Acta Odontol Scand 1997;55:261-4.

20. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

21. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

22. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

23. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

24. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

25. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

26. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

27. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

28. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

29. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

30. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

31. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

32. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

33. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

34. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

35. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

36. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

37. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

38. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

39. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

40. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

41. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

42. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

43. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

44. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

45. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

46. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

47. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

48. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

49. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

50. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

51. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

52. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

53. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

54. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

55. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

56. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

57. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

58. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

59. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

60. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

61. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

62. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

63. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

64. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

65. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

66. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

67. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

68. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

69. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

70. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

71. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

72. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

73. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

74. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

75. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

76. Kato T, Iijima H, Ishihara K, et al. Antibacterial effects of Listerine on oral bacteria. Bull Tokyo Dent Coll 1990;31:301-7.

77. Cosentino S, Tuberoso CI, Pisano B, et al. In-vitro antimicrobial activity and chemical composition of Sardinian Thymus essential oils. Lett Appl Microbiol 1999;29:130-5.

78. Petersson LG, Edwardsson S, Arends J. Antimicrobial effect of a dental varnish, in vitro. Swed Dent J 1992;16:183-9.

79. Cox SD, Mann CM, Markham JL, et al. The mode of antimicrobial action of the essential oil of Melaleuca alternifolia (tea tree oil). J Appl Microbiol 2000;88:170-5.

80. Serfaty R, Itic J. Comparative trial with natural herbal mouthwash versus chlorhexidine in gingivitis. J Clin Dent 1988;1:A34-7.

81. Dolara P, Corte B, Ghelardini C, et al. Local anaesthetic, antibacterial and antifungal properties of sesquiterpenes from myrrh. Planta Med 2000;66:356-8.

82. Hannah JJ, Johnson JD, Kuftinec MM. Long-term clinical evaluation of toothpaste and oral rinse containing sanguinaria extract in controlling plaque, gingival inflammation, and sulcular bleeding during orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:199-207.

83. Vaananen MK, Markkanen HA, Tuovinen VJ, et al. Periodontal health related to plasma ascorbic acid. Proc Finn Dent Soc 1993;89:51-9.

84. Murray M, Pizzorno J. Encyclopedia of Natural Medicine, rev2d ed. Rocklin, CA: Prima Publishing, 1998, 722-9.

85. Pack ARC. Folate mouthwash: effects on established gingivitis in periodontal patients. J Clin Periodontol 1984;11:619-28.

86. Bollen CM, Rompen EH, Demanez JP. Halitosis: a multidisciplinary problem. Rev Med Liege 1999;54:32-6 [in French].

87. Tonzetich J. Production and origin of oral malodor: a review of mechanisms and methods of analysis. J Periodontol 1977;48:13-20.

88. Astor FC, Hanft KL, Ciocon JO. Xerostomia: a prevalent condition in the elderly. Ear Nose Throat J 1999;78:476-9.

89. Waler SM. On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth. Eur J Oral Sci 1997;105:534-7.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.

Drugs used to treat HALITOSIS. Select drug name to view medication information and pricing