Halitosis is common even in fit, healthy individuals and will occur in most patients at some part of the day due to a variety of factors. In most, halitosis is short lived as the cause is immediately recognised and addressed, but in others, further investigation is required. Persistent objective halitosis is usually caused by poor oral hygiene or by volatile sulphur compounds collecting within layers of dead squames on the dorsal surface of the tongue. A range of systemic disease and certain drugs can also cause halitosis so that a detailed history is important. There are some patients with no objective halitosis, who may have visited doctors in many specialties for advice, and continue to complain of bad breath. Such patients may require psychological counselling.
The causes of halitosis can be divided into the following:
a. Oral cavity.
• Upper aerodigestive tract, gastro-oesophageal and lower respiratory tract.
• Systemic causes.
3. Drug causes.
About 15% of patients who complain of smelly breath have no detectable malodour (pseudohalitosis). In view of there being no true halitosis, the treatment of such patients consists of counselling and reassurance about their misconception. In this group, some will have had true halitosis that has been successfully treated but they still believe, despite counselling, that they have halitosis. Other patients with pseudohalitosis have never had true halitosis and they too may not respond to counselling. These patients are described as having halitophobia or delusional halitosis.
34.2 Physiological Halitosis
This is usually mild and short lived. It is often present on waking when it is due to a reduction in saliva production at night combined with the drying effects of mouth breathing. Dehydration has similar effects as it will lead to a reduction in saliva production and a dry mouth. This then allows the increased production of volatile sulphur compounds (VSCs) by oral bacteria and gives rise to halitosis. Drinking tea, coffee or alcohol, smoking a pipe or cigarettes and eating certain food such as garlic and raw onion may also cause a physiological halitosis.