Halitosis: a review

Halitosis, or bad breath, is caused by mainly volatile sulfur compounds (VSC) as a result of bacterial breakdown of protein and can be quantitatively and qualitatively measured in the expired oral breath. In eight to ninety percent of cases, halitosis originates in the mouth due to inadequate plaque control, periodontal disease, dry mouth, faulty restorations, and in particular due to excessive bacterial growth on the posterior third of the dorsal surface of the tongue. In the remaining ten to twenty percent of cases, bad breath is caused by systemic disorders such as hepatic, pancreatic and nephritic insufficiencies, trimethylaminuria, upper and lower respiratory tract infection, medication and cases where gastric content may generate oral malodour. The methods of detecting or diagnosing halitosis are organoleptic or human sense of smell, sulfide monitoring and gas chromatography. All of these methods have limitations and disadvantages. A more accurate, analytical system which will be able to precisely detect the volatile compounds in the expired air and correlate the results to a specific cause is not yet available. Dental professionals require a good knowledge on the subject of bad breath in order to feel secure about counseling and managing patients suffering from this condition. The management of halitosis involves maintenance of plaque control, elimination of active periodontal disease and cleaning the tongue on a routine basis. Oral rinsing with a mouthwash could be indicated in some instances, as a temporary measure.