Bad Breath

Bad Breath overview and Definition

It is also known as Halitosis. It is an subjective perception when one inhales the breathe


it accounts for 20% of gingival infection

Structure of Bad Breath


Two main classification schemes exist for bad breath, although neither are universally accepted.

The Miyazaki et al. classification was originally described in 1999 in a Japanese scientific publication,] and has since been adapted to reflect North American society, especially with regards halitophobia. The classification assumes three primary divisions of the halitosis symptom, namely genuine halitosis, pseudohalitosis and halitophobia. This classification has been suggested to be most widely used, but it has been criticized because it is overly simplistic and is largely of use only to dentists rather than other specialties.

  • Genuine halitosis
    • A. Physiologic halitosis
    • B. Pathologic halitosis
      • (i) Oral
      • (ii) Extra-oral
  • Pseudohalitosis
  • Halitophobia

The Tangerman and Winkel classification was suggested in Europe in 2002. This classification focuses only on those cases where there is genuine halitosis, and has therefore been criticized for being less clinically useful for dentistry when compared to the Miyazaki et al. classification.

  • Intra-oral halitosis
  • Extra-oral halitosis
    • A. Blood borne halitosis
      • (i) Systemic diseases
      • (ii) Metabolic diseases
      • (iii) Food
      • (iv) Medication
    • B. Non-blood borne halitosis
      • (i) Upper respiratory tract
      • (ii) Lower respiratory tract

The same authors also suggested that halitosis can be divided according to the character of the odour into 3 groups:[20]

  • "Sulfurous or fecal" caused by volatile sulphur compounds such as mercaptan,disulphide,hydrogen sulphide
  • Fruity odour caused by the acetone in diabetic ketoacidosis.

Based on the strengths and weaknesses of previous attempts at classification, a cause based classification has been proposed:

  • Type 0-physiological
  • Type 1 -oral
  • Type 2 -airway
  • Type 3 -gastro esophageal
  • Type 4  -blood borne
  • Type 5 -subjective


Diet,bacteria,epithelial cells leads to breakdown of peptides and proteins and release of amino acids resulting in putrefaction reaction. This leads to formation of malodour.

If bad breathe is ruled out the first step is to find out whether it is systemic cause or local factors should be obtained.they ar various diagnostic aids by which the dentist  finds out the underlyinfg cause


Clinical signs & symptoms

bad odour

calcified masses surrounding the teeth structure in some areas

xerostomia(dry mouth)

Increase in viscosity in saliva

Metallic taste

Whitish coating on the tongue.



Differential Diagnosis

  • Halimeter: it is a portable substance usually used to monitor the sulphur compounds especially hydrogen sulphide.
  • When placed in the mouth it detects the halitosis causing bacteria mainly the volatile sulphur compounds.
  • Other sulphur compounds such as mercaptan are difficulty to detect in halimeter.
  • The other foods such as garlic,onion cannot be assesses when it crossess 48 hours. The Halimeter is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol-containing mouthwashes for at least 12 hours prior to being tested. This analog machine loses sensitivity over time and requires periodic recalibration to remain accurate.
  • Gas chromatography:portable machines are being studied.] This technology is designed to digitally measure molecular levels of major VSCs in a sample of mouth air (such as hydrogen sulphide,methyl mercapton,disulphide). It is accurate in measuring the sulfur components of the breath and produces visual results in graph form via computer interface.
  • BANA test: this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
  • beta galactosidase test: salivary levels of this enzyme were found to be correlated with oral malodour.
  • Organoleptic: The patient inhale deeply and the examiner uses the pippete to evaluate the halitosis and scoring is done.


The prognosis purely depends upon the oral healthcare status of an individual.The prognosis is good incase if the halitosis is caused by the local factors



Maintain the oral health properly

Brush the twice daily

Swish the oral cavity with normal water after havimg meals

Use mouthwashes.The mouthwashes should be diluted with water for better use.

Avoid the food substance that causes the oral malodor

Check if any cavities I present and gets treated earlier

Use tongue cleaner and floss regularly.