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Halitosis - Management
How should I assess someone with halitosis?
- Enquire about:
- The person's own perception of the problem — including the impact on their quality of life (education, work, and social activities).
- Severity, timing, and duration of the halitosis — for example breath odour upon waking (morning breath) is normal and transient.
- Possible trigger factors — for example certain foods and drinks (including alcohol) and smoking.
- Treatments used to manage halitosis — for example oral hygiene measures.
- Examine the oral cavity to look for oral causes of halitosis including:
- Oral infections — for example oral candidiasis and herpetic gingivostomatitis (see the CKS topics on Candida - oral and Herpes simplex - oral).
- Dental and gum diseases — for example dental abscess or decay, periodontitis, and acute necrotizing ulcerative gingivitis (see the CKS topics on Dental abscess and Gingivitis and periodontitis).
- Suspected cancer — see Referral.
- Dry mouth — which can lead to decreased taste sensation and difficulty in swallowing.
- Problems with dentures — including denture hygiene.
- Tongue coating.
- Review oral hygiene measures — poor oral hygiene is a common cause of halitosis. Ask about:
- Methods used (for example brushing, flossing, use of mouthwashes).
- Frequency of brushing and inter-dental cleaning (for example flossing).
- Denture hygiene — for example whether the person takes their dentures out at night and if they clean their dentures regularly.
- Frequency of dental visits.
- Consider tongue coating as a source of halitosis — particularly in people with good dental hygiene and oral health.
- The posterior region of the tongue is a main source of oral-related halitosis.
- Consider gently but thoroughly scraping the area (for example with a clean plastic spoon or proprietary tongue scraper or tongue brush). The odour from the scraping (which is often yellow in colour) is generally similar to overall mouth odour.
- Review the person's medical history and consider non-oral causes of halitosis. Certain conditions will produce distinctive odours.
- Consider asking the person to breathe out of their mouth (pinching the nose) and then to breathe out of their nose (with the mouth closed). The condition is likely to be:
- Oral or pharyngeal in origin — if odour is detected from the mouth but not from the nose.
- Nasal in origin or from the sinus — if odour is detected from the nose but not from the mouth.
- Systemic in origin — if odour from the nose and mouth are of equal intensity (generally rare).
- Review the person's medication history for drugs known, or suspected, to cause or contribute to halitosis (uncommon).
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