Bad Breath (Halitosis)

Bad breath or Halitosis (oral malodour) is an unpleasant odour of the mouth. It is a common complaint for both genders and for all age groups. Nearly more than 50% of the general population in developed countries have halitosis.

Bad breath affects a person's daily life, causes social and psychological discomfort for individuals and affect their relation with other people.

Mild transient bad breath which often arises after sleep is common and generally not regarded as halitosis. It is termed as “morning halitosis.”

Some people complain of halitosis yet there is no measurable halitosis, even with objective testing, this may be a symptom of delusion or mono symptomatic hypochondriasis (self oral malodour). It is known as HALITOPHOBIA or PSEUDOHALITOSIS.

Such people may wrongly perceive other’s actions as an indicator that their breath is offensive so they adopt a variety of behaviours to overcome their perceived problem like covering the mouth while talking, keeping a distance from other people, or avoiding social interactions. These patients may become fixated with teeth cleaning, tongue cleaning and frequently use mints, chewing gums, mouthwashes, and sprays to reduce their distress.

Halitosis has numerous causes and origins.

Poor Oral hygiene:

  • Sometimes it may be a consequence of lifestyle. If you don't brush and floss daily, food particles accumulate in between your teeth and on tongue; bacteria grow on the food left in your mouth and leave foul-smelling waste products (volatile sulphur compounds) behind, which lead to bad breath.
  • Lack of regular tongue cleaning, may be a cause of bad breath despite proper brushing and flossing.     


Dietary Habits:

  • Intake of certain foods and drinks such as onion, garlic, spices etc. and certain habits such as smoking, using tobacco products, drinking alcohol cause halitosis.
  • Fasting or starvation can also cause bad breath.


Source of 90% cases of bad breath is oral cavity such as food impaction in between teeth, gum diseases, dry mouth or reduced flow of saliva. Dry mouth or decreased flow of saliva reduces self-cleaning of the mouth and inadequate cleaning of the mouth causes halitosis.

Not maintaining hygiene of orthodontic fixed appliances, wearing dentures and not cleaning them regularly, throat infections, oral ulcers and oral carcinomas may cause bad breath.

Non-oral reasons such as sinus (upper respiratory tract infections), diabetes (diabetic ketoacidosis), lung and kidney diseases (end stage renal failure), gastrointestinal disease such as gastroesophageal reflux disease (GERD), menstruation (menstrual breath) accounts for 9% of halitosis cases.

In 1% of patients, the source of halitosis is diets or drugs.


Diagnosis of bad breath or halitosis, and assessment of its severity is very important to find out if it is genuine halitosis or pseudo-halitosis or halitophobia.


  • Organoleptic measurement
  • gas chromatography
  • sulfide monitoring
  • the BANA test
  • chemical sensors


  • quantifying β-galactosidase activity
  • salivary incubation test
  • ammonia monitoring or ninhydrin method


  • Brush your teeth twice daily and clean between your teeth using floss.
  • Don’t forget to clean your tongue using a toothbrush or tongue scraper. Tongue cleaning is usually effective in reducing bad breath.
  • After meals, rinse your mouth vigorously with water.
  • People wearing dentures should make sure that they remove the dentures at night and clean them thoroughly before using them next morning.
  • People with fixed orthodontic appliances should take extra care to maintain their oral hygiene to prevent bad breath.
  • Quit smoking, tobacco, alcohol intake for a better breath and better quality of life.
  • Mouthwash will only mask the bad breath temporarily.


For treatment of halitosis, detecting the cause or determining its source, by detailed clinical examination is important.

  • If you have bad breath despite maintaining good oral hygiene visit your dentist to rule out gum diseases (Gingivitis or Periodontitis) or dry mouth (Xerostomia) and for proper identification and treatment of the problem.
  • Lastly, see your physician if halitosis is persistent as it may be due to some medical problem
  • Management of halitophobia may be complex but is very important because persons with halitophobia avoid socialising and even avoid talking with people. Before treating people with halitophobia, it must be proven to them that they do not have measurable halitosis by measuring devices. If the person is obsessed with the idea of having bad breath, consultation with a psychologist is required. 






  • PUBLISHED DATE : Apr 14, 2019
  • LAST UPDATED ON : Apr 14, 2019


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The content on this page has been supervised by the Nodal Officer, Project Director and Assistant Director (Medical) of Centre for Health Informatics. Relevant references are cited on each page.