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Halitosis

Halitosis is defined as a foul breath odor arising from a person's oral cavity or nasal passages. It differs from disorders of taste and smell in that the condition is typically not noticeable to the patient. The condition may be physiologic or a manifestation of oral-nasal or...

Pathophysiology

The most common physiologic cause is so-called morning breath. The universal condition derives from the cessation of regular salivary flow with sleep. Its marked reduction and resulting buccal cavity stasis allow mouth flora an opportunity to feed on remaining food particles, sloughed epithelial cells, and stagnant saliva. The byproducts of bacterial metabolism cause the foul odor. Pathologic halitosis may derive from impairment of normal salivary flow (eg, parotid disease, Sjogren's syndrome), increased presentation of bacterial substrate (periodontitis, sinusitis), or a metabolic derangement (renal or hepatic failure) halitosis, halatosis, bad breath. In rare instances, the patient is the only one to note the condition, strongly suggesting a hallucination of psychiatric or...

Workup

is similar to that described above for disorders of taste and smell, with more attention paid to possible oral cavity pathology. It helps to begin the assessment by directly confirming the reported odor. Differentiating an oral source from a nasal one can be done by pinching the nares closed while exhaling and exhaling through the...

Esophageal and gastric etiologies may require eructation for detection. If the mouth is believed to harbor the suspected source, then the oral cavity should be examined carefully for poorly fitting dental work, periodontal disease, glossitis, tooth abscess, and tonsillar disease. The salivary glands should be checked for free flow of clear saliva in adequate volumes. Pulmonary disease and metabolic dysfunction are important to consider when the oral cavity and sinus tracts appear normal. Patients who have no objective findings but are convinced of halitosis derived from an internal source have a high probability of a hypochondriacal psychosis and...

Treatment

Treatment should be etiologic. Trying to mask the odor is far less effective than addressing its etiology. Mouthwashes are a poor substitute for good oral hygiene. Despite advertisements to the contrary, mouthwashes do little to suppress oral flora. Oral hygiene is particularly important in the elderly. Patients should be encouraged to floss and brush regularly, which help remove trapped food particles and promote healthy gums. Regular dental checkups are...

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