Oral Malodour / Foetor / Bad Breath / Halitosis

Halitosis is a common social condition that affects a considerable portion of the general population. The prevalence of halitosis is close to 50% in a few populations. Under few circumstances, this oral condition may cause embarrassment, depression and make relationships more difficult. Some studies have investigated whether the psychology of the patients might have some influence on the complaints about halitosis, or even on halitosis itself. In a study that included more than one thousand participants and self-reported halitosis, scientists have reported that poor oral hygiene and general anxiety are associated with halitosis.[1]
Halitosis is divided into intraoral, extraoral, pseudohalitosis and halitophobia. Intraoral halitosis, responsible for 85% of the cases of halitosis, is subdivided into physiologic (genuine) halitosis or pathologic halitosis. Extraoral halitosis occurs when malodor appears with no oral cause, as in the case of pulmonary causes. Both patients with pseudohalitosis and halitophobia present with complaints of halitosis, but without any diagnostic evidence of malodor.[1]
The most common cause of oral malodor is the poor oral hygiene. Due to poor oral hygiene, a large number of bacteria belonging to different species make their home in the mouth. They survive on the food particles entangled in between the teeth and as a by-product, produce different substances like Sulphides, Mercaptans and Amines in gas form. These gases are perceived as bad breath by other people.  

Few other diseases may also cause bad breath or oral malodor. Sometimes, a person may feel his / her own bad breath even after a thorough examination and investigations with no apparent cause. The psychological evaluation helps in these cases.  

To treat bad breath, one can follow a home care routine. If it is not going away, contact your dentist or a doctor, because bad breath is also caused by the diseases mentioned below. 

Common causes of Halitosis / Foetor / Bad Breath

Bad breath is not always related to an underlying condition. It may also be caused by:   

  1. Eating food including garlic, onions and strong Indian spices   
  2. Consuming strong- smelling drinks, e. g. coffee and alcohol   
  3. Smoking and other tobacco products
  4. Crash diets, low carbohydrate diets   
  5. Certain medicines   
  6. Poor oral hygiene  

Certain oral diseases can cause bad breath. They are  

  1. Acute gingivitis  
  2. Acute necrotising ulcerative gingivitis  
  3. Aggressive adult periodontitis  
  4. Pericoronitis  
  5. Dry socket  
  6. Xerostomia  
  7. Oral ulcers  
  8. Oral cancer  

Few respiratory diseases can cause bad breath too. They are  

  1. Sinusitis  
  2. Tonsillitis  
  3. Bronchiectasis  
  4. Bronchitis  
  5. Malignancy  

There are few systemic diseases that may cause halitosis. They are  

  1. Acute febrile illness as in acute viral fever  e. g. Coronavirus disease
  2. Upper respiratory tract infection  
  3. Hepatic failure  
  4. End stage renal failure  
  5. Diabetic ketoacidosis  
  6. Leukaemia  
  7. Menstruation  
  8. Trimethylaminuria  
  9. Hypermethioninemia 
  10. Pyloric stenosis   
  11. Helicobacter pylori infection   
  12. Pharyngo-esophageal diverticulum   
  13. Gastro esophageal reflux disease  

As in all cases of viral infection, there always remains the possibility of bad breath/halitosis in Covid-19 patients.


Home care: 

Routine steps that may be helpful in few less-serious cases are:

  1. Brush your teeth at least twice a day  
  2. Floss daily  
  3. Use a tongue cleaner to clean the tongue  
  4. Use a mouthwash  
  5. Quit smoking and avoid tobacco products  
  6. Eat a sugarless candy or chew sugarless gum  
  7. Drink water at regular intervals  
  8. Eat fresh fruits or vegetables between meals  

See a dentist if:  

  1. It affects interpersonal relationships 
  2. It is not controlled in spite of maintaining good oral hygiene 
  3. It is associated with severe toothache, oozing fluids from the gums 
  4. Visible vesicles (an abnormal spot, bump, patch, or sore) in the mouth 
  5. Discharge from the nose 
  6. Sputum with pus when spitting or coughing

Emotional impact of halitosis

In a sample of 2,224 individuals, 12.0% were concerned about their oral malodor. Findings were associated with low income and lower level of education. Halitosis may lead to changes in the behavior and social life of those affected by it.[1]