Most of the time the unpleasant odor may be caused by conditions inside the mouth example:

• Odors released by bacteria present below the gum line and on the back of the tongue.

• Tooth decay

• Gum disease

• Sores inside the mouth

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About 10% of the time halitosis may be caused by conditions outside of the mouth for example.

• Disorders in the nasal cavity

• Sinuses

• Throat

• Lungs

• Esophagus

• Stomach

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Other times halitosis may be a symptom of a serious underlying medical condition for example:

• Liver failure

• Kidney disease or failure

• Diabetes

• Lung infection

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Halitosis can be categorized by the character of the odour into three groups.

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1. Sulfurous or fecal

Commonly caused by volatile sulfur compounds most notably methyl mercapton,hydrogen sulfide,and dimethyl sulfide.

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2. Fruity or Sweet

Caused by acetone present in diabetes

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3. Urine like or Ammoniacal 

Caused by ammonia,dimethyl amine and trimethyl amine that is present in Trimethyl aminuria and uremia.

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Causes of intra oral halitosis/malodour

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• Open cavities inside the mouth that causes food impaction and stagnation(food debris lodged inside the cavity for days,weeks  or even longer)

• Recent dental extraction sockets filled with blood clot which provide a habitat for bacterial growth.

• Interdental food packing or food getting pushed between the teeth and debris being trapped resulting in bacterial growth and release of toxins by bacteria.

• Poor cleaning of acrylic dentures, failure to remove the dentures at nights and causing the growth  of yeast and bacterial retention occupied by a typical smell.

• Oal infections

• Oral ulcerations or sores

• Fasting

• Stress/Anxiety

• Menstrual cycle causing an increase in volatile sulfur compounds

• Alcohol consumption

• Eating volatile food items for example onion, garlic,duriam, cabbage, cauliflower, radddish which leave malodourous residues int the mouth subjected to bacteria and volatile sulfur compounds being released.

• Medication which causes xerostomia dry mouth) causing increased microbial growth in the mouth.

• Gingivitis

• Periodontitis

• Oral cancers

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In The Nose

Air exiting the nostrils has a pungent odor that is different from the odor of the mouth. Commonly caused by sinus infections or foreign bodies lodged in the nose.

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In The Tonsils

Putrefaction from the tonsils is considered a minor cause of bad breath. Small bits of calcified matter in the tonsillar crypts called tonsilloliths (tonsil stones)  that smell extremely foul when released causing halitosis.

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In The Esophagus

The lower esophageal sphincter which is the valve between the stomach and the esophagus may not close properly due to a hiatal hernia or GERD (gastro esophageal desease) allowing acid to enter the esophagus and gases to escape to the mouth. 

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A zenker's diverticulum may also result in halitosis due to aging food retained in the esophagus.

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In The Stomach

In Belching, reflux or a continuous flow of gas or putrid substances from the stomach.

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Systemic Deseases

• Fetor Hepaticus ( bad breath caused by chronic liver failure)

• Bronchial and Lung Infections

• Renal Infections or  failure

• Carcinoma

• Trimethylaminuria(fish odour syndrome)

• Diabetes Melitus

• Metabolic conditions resulting in elevated blood dimethyl sulfide.

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Detecting Bad Breath/ Halitosis

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Due to Acclimatization it is difficult to detect ones own breath odor.

1. Ask someone preferably a trusted confidant to smell your breath.

2. Lick the back of the wrist , let the saliva dry for a few minutes then smell the back of the wrist.

3. Lightly scrape the back of the tongue with a disposable spoon then smell the drying residue.

4. Wear a disposable face mask covering your nose and mouth then speak while wearing it and smell.

5. Home tests that use a chemical reaction to test for the presence of polyamines and sulfur compounds on the tongue swabs are now available.

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Proffessional Diagnosis of Halitosis

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• Halimeter- a portable sulfide monitor used to test levels of sulfur emissions in the air of the mouth.

• Gas Chromatography- digitally measures molecular levels of hydrogen sulfide, methyl mercapton and dimethyl sulfides.

• BANA Test- A test to find the salivary levels of an enzyme showing the presence of certain halitosis related bacteria.

• B-galactosidase- Testing salivary levels of this enzyme were found to be correlated with oral malodour.

• Organoleptic  measurement is a subjective sensory test score based on the examiners perception of a patients breath odor by the use of a HaliSens

• An Instrument test is an objective way to measure the volatile sulfur compounds known to be the principal components of halitosis. 

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Treatment For Halitosis

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1. Gently cleaning the tongue at least twice daily.

2. Eating a healthy breakfast containing rough foods with the ability to clean the back of the tongue.

3. Chewing sugar free gum increasing the flow of saliva.

4. Rinsing with an antibacterial mouthwash frequently.

5. Good oral hygiene which includes, brushing the teeth at least twice daily and after meals if braces are being worn and flossing after meals.

6. Probiotic treatments for example K1 for streptococus salivarius.

7. Medical check ups and treating underlying medical conditions.

8. Consult an (ENT) Ear Nose and Throat specialist.

9. Get a professional dental cleaning at least twice yearly

10. Drink water frequently.

11. Maintaining a balanced diet.

12. Do not skip meals

13. Monitor hormonal changes.

14. Avoid eating late at nights.

15. Remove decayed teeth.

16. Treat open cavities.

17. Not every toothpaste will give you fresh smelling breath, find the one that works for you.

18. Avoid smoking and too much alcohol drinking.

19. Remember to remove dentures at nights and clean them properly.

20. Treat mouth sores and oral infections.

21. Treat sinus infections

22. Avoid consuming too much garlic or onions.

23. If braces are being worn, clean them after meals, use waterpik and seek professional dental cleaning every 3 months.

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