Halitosis is defined as breath that is offensive to others, caused by a variety of reasons including but not limited to periodontal disease, a bacterial coating of the tongue, systemic disorders and different types of food. It is one of the most frequent claims from patients to the dentist.

Calculus, plaque and scarce dental visits were significantly correlated to severe halitosis.  correlated with periodontitis and tongue coating to VSC( volatile sulfur compound) scores. Also, severe periodontitis patients present with higher halitosis scores than non-periodontal patients. Tongue coating was considered an in important factor for halitosis. 

Smoking and periodontal disease were associated with higher halitosis rankings.

 In children, caries experience and age were associated to halitosis

Periodontal pathogens and products of in inflammation to produce volatile odoriferous compounds. Therefore, the presence of periodontal inflammation needs to be considered in the management of halitosis.

 Main oral causes of halitosis

  1. Plaque-related gingival and Gingivitis, periodontitis, acute necrotizing ulcerative periodontal disease , pericoronitis and abscesses
  2. Ulceration Systemic disease (inflammatory ⁄ infectious disorders, cutaneous, gastrointestinal and hematological disease), malignancy,local causes, aphthae and drugs
  3. Hyposalivation (e.g. from drugs, Sjogren syndrome, radiotherapy, chemotherapy)
  4. Tongue coating - Poor hygiene
  5. Wearing dental appliances- Poor hygiene
  6. Dental conditions -Food impaction
  7. Bone diseases like Jaw dry sockets, osteomyelitis, osteonecrosis, malignancy

Extra-oral causes of halitosis

  1. Respiratory system (microbial etiology)
  2. Sinusitis
  3. Antral malignancy
  4. Foreign bodies in the nose, Nasal malignancy, Tonsilloliths
  5. Tonsillitis
  6. Pharyngeal malignancy and Lung infections
  7. Bronchitis
  8. Bronchiectasis
  9. Lung malignancy
  10. Gastrointestinal Esophageal diverticulum tract
  11. Gastro-esophageal reflux disease Malignancy

In some individuals, the complaint of halitosis cannot be associated with either the ability of the clinician to detect odors or with the demonstration of VSC in the exhaled air. This paradoxical situation has been classified as halitophobia, an important psychological problem that needs to be addressed with non-oral clinical strategies

Treatment

  1. Periodontal therapy-Periodontal treatment like scaling and polishing, flap surgery decreases halitosis.
  2. Approaches directed to tongue coating- Several studies have demonstrated that reducing bacteria on the dorsum of the tongue will diminish halitosis.
  3. Mouthrinses, especially chlorhexidine and cetilpyridinium chloride have been effective in reducing halitosis.
  4. \Masking agents-When it is not possible to direct the treatment approach to the cause, masking agents have been developed to decrease the odor. The use of chewing gum may decrease halitosis, especially through increasing salivary secretion. Mouthrinses containing chlorine dioxide and zinc salts have a substantial effect in masking halitosis, not allowing the volatilization of the unpleasant odor.