Halitosis – aetiology, diagnosis, treatment

Hippokratia 2005, 9(1):3-6

K Karnoutsos, E Blioumi
Dental Dpt, “Saint Pavlos” General Hospital, Thessaloniki, Greece


Diagnosis and treatment of bad breath is a matter that concerns a large portion of the general population and dentists. Malodorous volatile materials produced by some bacteria on the dorsal surface of the tongue are the main cause of bad breath. These are mainly volatile sulfur components, especially methyl mercaptan and hydrogen sulfide, but also short-chain fatty acids and polyamines. It appears that the gram negative anaerobic microflora is responsible for odor formation .through a two-phase metabolic process (hydrolysis and degradation of amino acids). Metabolic processes which result in pH decrease, O 2 decrease or oxidation reduction potential (Eh) increase favor the growth of gram negative anaerobes and the generation of malodor too. The three main methods of analyzing oral malodor are organoleptic measurement, gas chromatography and sulphide monitoring. A thorough medical and dental history helps the dentist to find the origin of halitosis and classify halitosis into three different categories, that is genuine halitosis (physiologic and pathologic), pseudo -halitosis and halitophobia. Furthermore, a thorough extraoral and intraoral examination may eliminate from consideration some other extraoral and intraoral causes of bad breath . The treatment of malodor consists of mechanical and chemical reduction of microbial flora. The most common ways of treatment are cleaning the tongue with a dentalcleaner or a dentalscraper, use of mouthwashes containing zinc, chlorexidine and hydrogen peroxide and periodontal treatment. Patients with pseudo-halitosis and hatitophobia need to be counseled and assisted by a psychological specialist. In conclusion, since malodor is a common condition in general population, all dentists ought to be informed the causes, diagnosis and treatment of halitosis.