Halitosis also known as bad breath, fetor oris, oral malodor, can be described as a frequent or persistent unpleasant odour to the breath. It is a major concern to the general populace and can have consequences for private or professional life. About 85-90% of cases result from oral conditions. A variety of systemic and extra-oral conditions account for the remainder.

In the mouth, bad breath is caused by sulphur-producing bacteria that normally live within the surface of the tongue and in the throat. The odour is caused by bacteria from the decay of food particles, other debris in the mouth, and poor oral hygiene resulting in the release of odorous volatile sulphur compounds that are very offensive even in low concentration.

Halitosis can be genuine or delusional.

Genuine halitosis can be physiological or pathological.

Physiologic – usually temporary, mostly due to transient reduction in salivary flow which allows accumulation of oral bacteria e.g early morning breath, after sleep, fever, dehydration, during fasting etc.

Pathological causes of genuine halitosis include intraoral or systemic factors:


  • Dental caries
  • Poor oral hygiene
  • Periodontal diseases
  • Necrotic oral ulcers,
  • Fissured tongue, dry mouth, stagnation areas such as pericoronal flaps,
  • Improper cleaning of dentures and other prosthesis,
  • Oral infections or abscesses.
  • Tonsillitis
  • Dietary habits (betel nut, eating raw onions, garlic, smoked fish, cheese, tobacco smoking /chewing, alcoholism)
  • High protein diet

Systemic causes of genuine halitosis are-

  • Upper respiratory tract diseases such as chronic sinusitis, post-nasal drip, bronchiectasis, lung cancer, emphysema, and lung abscess.
  • Diseases of gastrointestinal tract (gastroesophagial reflux disease, Pyloric stenosis or duodenal obstruction
  • Hormonal factors such as menstrual cycle or pregnancy
  • Uncontrolled diabetes e.g. diabetic ketoacidosis
  • Kidney diseases (acute and end stage renal failure)
  • Liver diseases (hepatic failure)
  • Drugs- Disulfiram, griseofulvin, chloral hydrate, amphetamines etc.
  • Dieting can contribute to bad breath and,
  • Stressful life conditions


Delusional (Psychogenic) halitosis: This is a psychosomatic disorder. It refers to the thought or fear that you have bad breath when in reality you don’t. Halitosis in this context only exist in the mind of the patient. Delusional halitosis can become a full-blown phobia and can begin to interfere with one’s job or life in general. It is also associated with depression and symptoms of obsessive compulsive disorder.

Social effects of Halitosis: 

Bad breath is often associated with social stigma. Certain patients with halitosis especially those with psychogenic halitosis avoid work and any other social situation in general. They may lose their job and have difficulties with intimate physical relationships. It can lead to divorce and low self-esteem. They avoid any social situation that brings them into close contact with others. It can affect performance at school and other life endeavours. Some patients with halitosis have contemplated suicide and pose a risk of danger to themselves and the community at large.



  • Treatment strategy should focus on the exact cause and on oral hygiene maintenance.
  • oral care products (mouth rinses, toothpastes, chewing gums) which contain metal ions, especially zinc, that inhibit odor formation because of its affinity to sulphur compounds, and oxygenating mouthwashes such as hydrogen peroxide and Chlorine dioxide gel (oxyfresh) which destroy sulphur containing compounds by oxidizing sulphur bonds should be used
  • Brush your teeth twice daily, also brush your tongue. The tongue is covered with papillae that can trap bacteria. The use of tongue scrapper can be helpful
  • Avoid alcohol, smoking and caffeine consumption, which can dry the mouth
  • Drink plenty of water and snack on vegetables such as raw celery or carrots which can keep plaque from forming
  • Avoid breath mints and mouthwashes that contain alcohol. They dry the oral mucosa causing more halitosis and mask the odour temporarily
  • A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help.
  • Avoid stress and seek out ways to relax and resolve stressful conditions in your life.
  • Psychogenic halitosis may require psychiatric consultation.
  • Visit the dentist for more information.


Halitosis can be treated and should not be regarded as a stigma.




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