Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Halitosis - Management
When should I refer?

  • Urgently refer to an appropriate specialist, anyone with:
    • Acute necrotizing ulcerative gingivitis. See the section on Acute necrotizing ulcerative gingivitis in the CKS topic on Gingivitis and periodontitis.
    • Unexplained tooth mobility for more than 3 weeks.
    • Unexplained ulceration of the oral mucosa or mass persisting for more than 3 weeks.
    • Unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are painful or swollen or bleeding.
    • Unexplained or atypical enlargement of the gingivae (possibly indicative of leukaemia).
  • Non-urgent referral to a dentist is required for people with:
    • Clinically-apparent gingivitis that is not responding to standard oral hygiene measures.
    • Periodontitis.
    • Unexplained red and white patches (including suspected lichen planus) of the oral mucosa that are not painful, swollen, or bleeding.
    • Poorly-fitted dentures.
    • Poor oral or denture hygiene.
  • Some experts recommend referring all people with halitosis (including those without pathological causes) to a dentist for a full oral examination, as some oral diseases (such as periodontitis) may be difficult to diagnose by visual examination alone.
  • Refer non-urgently to an ear nose and throat specialist people with the following conditions in whom an oral cause has been excluded:
    • Recurrent tonsillitis (see the CKS topic on Sore throat - acute).
    • Sinonasal disease such as septal deviation, and frequent recurrent sinusitis (see the CKS topic on Sinusitis).
  • For people with other persistent symptoms or signs related to the oral cavity in whom a definitive diagnosis of a benign lesion cannot be made, refer or follow up until the symptoms and signs disappear. If the symptoms and signs have not disappeared after 6 weeks, make an urgent referral.

© NHS Institute for Innovation and Improvement