Halitosis better known as bad breath or bad oral odor is the term used to describe the offensive odor that comes from the oral cavity, frequently associated with poor oral hygiene or diseases of the oral cavity, but it can also be related to severe systemic diseases that they need a specific diagnosis and treatment.

Most people suffer from a bad mouth odor at some point in their life. Halitosis patients are often unaware of it due to the inability to smell their own breath, or because they are used to their breath.

Breath can change for various reasons, and bad breath can appear temporarily in some moments and situations of daily life, or be persistent and / or pathological and be caused by oral or systemic conditions as initially explained.

Types of halitosis (bad breath)

  • Pseudohalitosis: it is the halitosis perceived by the patient in which there are no clinical signs of real halitosis.
  • Halitophobia: when once the causes have been eliminated and the problem solved, the patient persists in considering himself to be suffering from halitosis.
  • True halitosis: it can be divided into physiological halitosis and pathological halitosis that may or may not be of oral origin.

True halitosis

Most of the mouth odor has its origin in local oral factors that produce a high microbial metabolism, which causes the emission of volatile molecules responsible for the bad odor.

Studies affirm that 80-90% of bad breath is of oral origin. True halitosis, in turn, can be classified as physiological and pathological.

Physiological halitosis

It is of oral origin and is related to the covering of the surface of the tongue, it is easily solved with oral hygiene measures.

  • Morning breath : the flow of saliva decreases while we sleep, this facilitates the uncontrolled growth of bacteria that produce a smelly gas.
  • Age:  breath changes with age. From adolescence to middle age it becomes progressively rougher.
  • Dental prostheses:  orthodontics and prosthetics can accumulate food debris.
  • Saliva:  the level of mouth odor is inversely proportional to the flow of saliva.
  • Tobacco:  creates a characteristic breath, which can even last more than a day after smoking.
  • Food:  certain foods such as garlic or onion can cause a bad mouth odor .

Pathological halitosis

Its cause can be oral or extraoral. It is chronic, it does not resolve only with oral hygiene, although it can be masked for short periods of time.

  • Poor oral hygiene: dental plaque (tartar) and food particles that allow bacterial growth. The lingual origin of halitosis is the most frequent in the absence of gum disease .
  • Cavities: Large cavities with accumulation of food cause great bad breath .
  • Chronic periodontal disease and gingivitis : gum disease is the most common cause, despite the fact that most people with a bad mouth odor do not suffer from this disease. It is produced by the deposit of bacteria in the plaque of the teeth. The presence of active inflammation and hemorrhage accentuates the rotting process.
  • Tooth  abscess : they can cause a bad smell coming specifically from the affected tooth.
  • Necrotizing ulcerative gingivitis: it is one of the variants of gum disease but much more aggressive, it produces a typical metallic smell.


Ideally, identify the source of bad breath so that you can develop an appropriate treatment plan. The following are general measures that will help improve or even eradicate bad breath :

  • Good oral hygiene and that the teeth are in good condition are the best methods. Use of dental floss, fluoride pastes; cleaning the tongue as well as the palate should be done in conjunction with brushing. Vigorous brushing of the tongue at night and in the morning helps reduce morning odor.
    Dentures and other prosthetic materials should also be removed and cleaned at least once a day. A biannual visit to the dentist is advised.
  • A diet rich in fruits and vegetables, low in fat and meat, reduces halitosis.
  • To avoid the use of tobacco.
  • Drink enough water to avoid dry mouth and reduce the consumption of drinks high in caffeine.
  • Chewing gum helps reduce mouth odor by  increasing salivary flow.
  • The use of mouthwashes, it is recommended to use them before sleeping, since the remains of the product remain in the mouth at night, which is when the bacterial activity is greater, and the flow of saliva less.
  • Pathological halitosis of oral origin is mainly caused by gum disease , as well as deficiencies in prosthetic material that can increase the accumulation of food debris and waste material. Therefore, the treatment is dental combined with general measures.

It is important to see your treating doctor or dentist if you notice persistent symptoms or a bad mouth odor related to a systemic disease.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses. He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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