What Is Halitosis?

Halitosis can cause embarrassment, low self-esteem, and impact one’s quality of life. A person may have halitosis without knowing it unless someone else informs them, so it is crucial to be aware of our dental hygiene, making it easier to know when there is a change in how our breath smells.

Halitosis is an oral condition characterised by bad breath, which may not be rectified after brushing or an oral rinse. It is a common condition and affects one in every four persons. It is caused by many factors, including poor oral hygiene.

Read on to know the causes, signs, prevention, and best treatment or management options for halitosis for improved body positivity and overall well-being.

Overview

Halitosis, also known as bad breath or oral malodor (mouth odour), is a condition in which the halitus/breath is altered in an unpleasant way for the affected individual, which impacts both the individual and those with whom they interact.^1,2,3 The foul smell can emanate from the oral cavity, the respiratory system, or the gastrointestinal tract depending on the root cause. 

Halitosis can be classified into:^1,4 

• Delusional halitosis: it has two forms - pseudo-halitosis, where the person feels they have bad breath but they do not, and halitophobia, which is the fear of having bad breath or of the treatment for the condition not working
• Genuine halitosis can be either pathological when it is caused by dental infections and other medical conditions, or physiological when it is caused by accumulated saliva in the mouth and the presence of microbes in the oral cavity, especially in the morning

The percentage of the population that presents with halitosis is about 25%. However, this number may not be accurate largely because many people with the condition are either oblivious to their condition or are too embarrassed about it to report it or seek help.^1,4

Causes of halitosis

According to research by the American Dental Association, many factors can contribute to bad breath, including: ^1,5

• Oral diseases like tooth decay and gum disease
• Ear, nose, and throat diseases such as tonsillitis, sinusitis, the presence of foreign bodies, and rhinitis
• Poor oral hygiene due to improper brushing and flossing - food particles are stuck in the teeth or the back of the tongue and are not cleared properly. Debris will accumulate in the oral cavity, where bacteria will break them down thus resulting in halitosis
• Food and beverages: some foods and beverages contain odour-causing compounds, which the body absorbs during digestion and then exhales or secretes in the saliva
• Medication-induced dry mouth, salivary gland problems, and tobacco use all cause a decrease in saliva production. This lack of saliva dries out your mouth, increasing your chances of having bad breath
• Medical conditions such as sinus or lung infections, gastrointestinal disorders, tonsillitis, diabetes, bronchitis, and certain kidney or liver diseases can all cause bad breath
• Some medications may also have a bad taste or odour
• Tobacco use, alcohol, and smoking can contribute to halitosis and lead to an increase in gum disease

Signs and symptoms of halitosis

The main symptom of halitosis is an offensive odour from the mouth. The severity of bad breath odours varies according to the time of day, and because it's difficult to judge how your breath smells, seek confirmation from a close friend or relative.

Management and treatment for halitosis

Management options include:

• Brushing the teeth twice a day
• Cleaning dentures properly after each wear
• Flossing daily
• Cleaning the tongue regularly

Mouthwash can also help reduce bacteria and freshen the breath, although it is not a substitute for good oral hygiene practices.

Before treatment, it is important to find the cause as this determines the type of treatment. If dry mouth is the cause of halitosis, drinking more water and chewing sugarless gum can help stimulate saliva production. Sometimes, a doctor may prescribe medication to increase saliva production or treat an underlying health condition. Quitting smoking and avoiding tobacco products can also help reduce the risk of bad breath and improve overall oral health. ⁴ 

People with dental problems like cavities and gum disease may require professional treatment. For physiological halitosis caused by a health condition, such as acid reflux or respiratory infections, treating the underlying condition may help improve breath. 

FAQs

How common is halitosis? 

Halitosis is common in about 25% of the adult population. 

How can I prevent halitosis? 

Good oral hygiene can best prevent halitosis caused by what we drink or bacteria buildup. For people with dry mouths, drinking enough water or chewing sugarless gum can help stimulate saliva production and keep the mouth moist. For smokers, quitting smoking can also aid in the prevention of bad breath.

Who is at risk of halitosis? 

Although anyone can develop halitosis, certain factors can increase the risk. People who practise poor oral hygiene, have a dry mouth, smoke, or have certain medical conditions are at risk of halitosis.

What can I expect if I have halitosis? 

You can expect an unpleasant odour from your mouth.

When should I see a doctor? 

You should see a doctor when the bad breath is persistent despite good oral hygiene practices. Your doctor will perform a physical exam, review your medical history, or refer you to a specialist for further evaluation and treatment to determine the underlying cause of your bad breath.

Summary

Halitosis is a common condition that affects one in every four people. It is also known as "oral malodor" or "bad breath," among others, and can cause embarrassment, anxiety, and even depression in those with the condition. Halitosis is typically caused by certain foods and drinks, poor oral hygiene, and underlying medical conditions. 

To prevent pathologic halitosis, you should practise good oral hygiene, including brushing your teeth regularly, and aim to visit a dentist at least twice a year. Physiological halitosis may resolve when the underlying medical condition is treated; hence, the need to see a doctor when your situation is persistent.