Bad breath

Bad breath
Other names	Halitosis, fetor oris, oral malodour, putrid breath
Specialty	Gastroenterology, otorhinolaryngology, dentistry
Symptoms	Unpleasant smell present on breath[1]
Complications	Anxiety, depression, obsessive compulsive disorder[1]
Types	Genuine, non-genuine[2]
Causes	Usually from inside the mouth[1]
Treatment	Depends on cause, tongue cleaning, mouthwash, flossing[1]
Medication	Mouthwash containing chlorhexidine or cetylpyridinium chloride[1]
Frequency	~30% of people[1]

Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odour is present.^[1] It can result in anxiety among those affected.^[1] It is also associated with depression and symptoms of obsessive compulsive disorder.^[1]

The concerns of bad breath may be divided into genuine and non-genuine cases.^[2] Of those who have genuine bad breath, about 85% of cases come from inside the mouth.^[1] The remaining cases are believed to be due to disorders in the nose, sinuses, throat, lungs, esophagus, or stomach.^[3] Rarely, bad breath can be due to an underlying medical condition such as liver failure or ketoacidosis.^[2] Non-genuine cases occur when someone complains of having bad breath but other people cannot detect it.^[2] This is estimated to make up between 5% and 72% of cases.^[2]

The treatment depends on the underlying cause.^[1] Initial efforts may include tongue cleaning, mouthwash, and flossing.^[1] Tentative evidence supports the use of mouthwash containing chlorhexidine or cetylpyridinium chloride.^[1] While there is tentative evidence of benefit from the use of a tongue cleaner it is insufficient to draw clear conclusions.^[4] Treating underlying disease such as gum disease, tooth decay, tonsil stones, or gastroesophageal reflux disease may help.^[1] Counselling may be useful in those who falsely believe that they have bad breath.^[1]

Estimated rates of bad breath vary from 6% to 50% of the population.^[1] Concern about bad breath is the third most common reason people seek dental care, after tooth decay and gum disease.^[2][3] It is believed to become more common as people age.^[1] Bad breath is viewed as a social taboo and those affected may be stigmatized.^[1][2] People in the United States spend more than $1 billion per year on mouthwash to treat it.^[3]