Some Causes of Halitosis
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Oral conditions | ||
Bacteria on dorsum of tongue | Malodorous tongue scrapings, healthy oral tissue | Clinical evaluation |
Gingival or periodontal disease | Oral disease, often including bleeding and/or purulent exudate Apparent during the examination Often history of poor oral hygiene | Clinical evaluation Dental consultation |
Necrotic oral cancer (rare—usually identified before becoming necrotic) | Lesion usually identifiable during the examination In older patients, who often have extensive history of using alcohol, tobacco, or both | Biopsy, CT, or MRI |
Extraoral disorders | ||
Nasal foreign body* | Usually in children Purulent or bloody nasal discharge Visible on examination | Clinical evaluation Sometimes imaging |
Necrotic nasopharyngeal cancer* | Discomfort with swallowing | Clinical evaluation |
Necrotic pulmonary infection (eg, lung abscess, bronchiectasis, foreign body) | Productive cough Fevers | Chest x-ray Sputum cultures Sometimes CT or bronchoscopy |
Psychogenic halitosis | Malodor not detected by others Often history of other functional complaints | Clinical evaluation |
Sinus infection* | Purulent nasal discharge Facial pain, headache, or both | Clinical evaluation Sometimes CT |
Undigested food regurgitated when lying down or bending over | Video barium swallow or upper gastrointestinal endoscopy | |
Ingested substances† | ||
Use apparent on history | Clinical evaluation Trial of avoidance | |
* Malodor is typically more prominent from the nose than the mouth. | ||
† Typically, a diagnosis of exclusion after examination rules out other causes. | ||