Halitosis Diagnosis
By Rear Adm. Joyce Johnson, D.O., M.A.

What can I do about halitosis?

Halitosis is a fancy word for a problem everyone is familiar with—bad breath. Bad breath can be a social issue as well as a sign of a systemic medical problem. Folklore has it that the breath reflects the health of the bowels and digestive tract. But the esophagus generally is closed and not connected to the airway. More often, the breath reflects the health of the mouth and respiratory system.

The cause of bad breath usually is poor oral hygiene. When people don’t brush and floss their teeth and mouth after eating, particles of food are attacked by bacteria, decompose, and smell. Oral diseases, especially those caused by bacteria, also can lead to bad breath. Keep areas around dental crowns and bridges clean; bacteria can live in hidden crevices. Partial plates and full dentures require impeccable cleaning; electronic cleaning devices work well.

Dry mouth, whether caused by medication or dehydration, can result in foul-smelling breath. Drinking fluids washes away bacteria that can cause such odors. Someone who is well-hydrated also has more saliva, which serves to cleanse the entire oral cavity.

Strong-smelling foods, especially bulbous vegetables such as onions, garlic, and leeks, give the breath a characteristic odor, as can food supplements such as garlic pills. Alcohol also can be detected in the breath; alcohol in the blood evaporates into the air in the lungs, which then is exhaled.

A number of systemic diseases result in characteristic breath odors. A patient with diabetes can develop diabetic ketoacidosis and produce acetone, which is excreted in the breath, where others can smell it. Liver failure can cause a mousy odor, and severe kidney failure can leave a urine-like scent to the breath.

Diseases of the respiratory tract also are a common cause of odors. Streptococcal tonsillitis results in a musty smell in the breath. A lung abscess with anaerobic bacteria has a rotten smell. Cancer (with necrosis) of the respiratory tract, pneumonia, and chronic sinusitis all can cause bad breath.

Treatment of bad breath begins with good oral hygiene. Brush, floss, and rinse with mouthwash. Paying attention to diet and limiting strong-smelling foods helps. Diagnosis and treatment of related medical problems—including systemic diseases and bacterial disease of the teeth, gums, and entire respiratory tract—is another step. Trying to cover up the smell with breath mints is counter-productive: The sugar in the mints provides food for more bacteria.