Halitosis (Bad Breath)

Halitosis can be very misunderstood. Is it a result of oral conditions such as periodontal (gum) disease, lack of tongue cleaning or is it more than these things? The answer can be complicated for some people. The following table is an attempt to describe the major types of halitosis most often found:

Types of halitosis (bad breath)

A. Genuine Halitosis  
1. Physiologic halitosis
  • Obvious bad odor
  • No specific disease cause nor pathologic condition that could cause halitosis is present.
  • The main cause is bacteria on the mid to back of tongue.
2. Pathologic halitosis
  • Bad odor caused by disease or pathologic condition.
    • Originates from nasal or throat area.
    • Originates from lungs
    • Originates from digestive tract.
    • Originates from disorders anywhere in body - odor is blood borne and emitted via the lungs.
B. False-halitosis
  • Obvious bad breath is not perceived by others even though person is certain exists.
C. Halitophobia
(fear of having bad breath)
  • After receiving treatment for halitosis the person persists in believing it is still present.

Examination for presence of genuine halitosis is most accurately performed using  a gas chromatography (GC) unit - only a few halitosis clinics have these devices). When being tested, a person usually closes their mouth, breathes through their nose for one minute, and then exhales into the GC tube. Some clinics also make use of a 'odor judge' - a person trained to smell and then score the amount of malodor present in the breath. A GC unit measures for volatile sulfur compounds (VSCs), such as hydrogen sulfide, methyl mercaptan and dimethyl sulfide which are the  main components of oral bad breath.

Treatment of Halitosis

  1. Tongue cleaning is the very most important aspect when treating 'genuine halitosis'. The tongue harbors bacteria that produce the VSCs mentioned above. Most people when asked say that the tongue has a light color  - actually a tongue when cleaned properly has a dark rose color to it. Although a toothbrush is most commonly used to clean the tongue, there are devices specifically designed for this purpose. These devices do a better job of getting to the back of the tongue without triggering the gag reflex as well as 'scrape' the tongue clean. To best achieve getting to the back of the tongue a person should stick the tongue out as far as possible and hold their breath to minimize gagging.

  2. Mouth rinses are most often only effective for a short time in reducing malodors. Most often they only mask the odor and do not effectively deal with the VSCs that cause them. There are mouth rinses containing zinc and chlorine compounds that can significantly reduce the  VSCs present in the mouth.

  3. Proper attention to home oral hygiene

  4. Regular thorough professional cleaning appointments are also a great aid in treating halitosis.

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Dr. Maury Hafernik
11645 Angus Road, Suite 10
Austin, Texas 78759
P: (512) 345-5552

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