Halitosis: knowing when 'bad breath' signals systemic disease

Halitosis in older adults is a common condition that may have oral or nonoral sources, result from a number of different etiologies, and have more than just social consequences. In some cases, bad breath may reflect serious local or systemic conditions, including gingivitis, periodontal disease, diabetic acidosis, hepatic failure, or respiratory infection. Your role as the primary care physician is first to determine whether the odor has an oral or nonoral cause. Odors can be distinct in their quality and thus can help make this determination. Management of nonoral sources requires treatment of the underlying cause, whereas suspected oral sources require referral for a dental evaluation.