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Bad breath – halitosis

Halitosis-halitosis is a bad, unpleasant odor emanating from the mouth. It can originate from the mouth or outside of the mouth. Psychosocial stress leads to problems such as self-confidence problems and social pressure.

When the causes of halitosis are examined according to the regions where they originate; It was observed that 90% were caused by problems in the mouth and 10% were caused by extraoral reasons.

Halitosis can be divided into physiological halitosis and pathological halitosis.

Physiological halitosis; Some foods (such as garlic, alcohol, onions, spicy foods, etc.) occur due to decay in the mouth that has not been cleaned well. Smoking and hormonal changes during menstruation also cause bad breath. Physiological halitosis can often be kept under control by paying attention to oral and dental hygiene.

pathological halitosis;It can be caused by many reasons, both oral and extraoral.

Causes of bad breath caused by mouth:

-Tongue layer, residues accumulated on the upper part of the tongue and some tongue diseases

-Periodontal diseases, gum diseases

-Implants and prostheses


-Necrosed dental pulps

-Mucosal diseases, mucosal wounds and ulcers

– Dirty dentures that are not cleaned well

-Decreased salivary flow daughter and amount of saliva

-dry mouth

-Oral fungi, ulcerations, infections

Causes of extra-oral halitosis:


-Chronic tonsillitis (tonsils)

-Tonsillar magma (dirty yellow colored structures formed by food and bacterial residues between tonsillar crypts)

-tonsillar stones

-Chronic sinusitis

-Nasal polyps

-Foreign body in the nose


-Gastritis and Peptic ulcer

– Reflux (leakage of stomach contents into the esophagus)

-Ileus (intestinal obstruction)

-Esophageal Diverticulum (esophageal pockets)

-Liver Cirrhosis

-Liver failure


-Diabetes Mellitus (diabetes)

-Trimethylaminuria (Plasma protein metabolism disorder)



-Lung Abscess

-Bronchiectasis (widening of the bronchi in certain areas and accumulation of infected material in them.


-Stress causes dry mouth, which reduces the mechanical cleaning of the tongue and causes halitosis.


-There is no real bad breath, the patient somatizes his psychological discomfort as bad breath.


Radiation above -800 rad causes a decrease in the amount of saliva, resulting in a decrease in mechanical cleaning and causes bad breath.


– It is the cause of bad breath as a result of the decrease in saliva secretion.


-Diet, hunger and fasting cause the burning of fat. This increases ketone bodies. These cause bad odor in the respiratory air. Since staying hydrated during fasting will reduce the amount of saliva, mechanical cleaning will also decrease.

Diagnosing holitosis requires a multidisciplinary approach. Since 80-90% originates in the mouth, the factors that can cause odor in the mouth should be ruled out first. To make a diagnosis, the process should start with a dentist examination and continue with an ENT examination. Then, help from internal medicine and other branch physicians should be sought as needed.

Treatment of halitosis is aimed at the etiology (source of odor). Intraoral and extraoral sources should be identified and treatment should be applied to exclude these sources.

If bad breath originates from the mouth, to prevent the bacteria causing bad breath from multiplying in the mouth;

-Oral hygiene should be regulated and made permanent

-Teeth stones should be cleaned and gingivitis and periodontitis treated

– Gum pockets should be eliminated.

– Necessary treatment of dental caries should be done.

-Prosthesis care should be done and old prostheses and fillings should be replaced.

-Tooth brushing should be taught, and the dorsal (upper) surface of the tongue should be brushed.

-It should be cleaned between the teeth by means of work floss.

-Tea, coffee, tobacco use should be limited because it facilitates the formation of plaque on the tongue.

As bad breath bacteria cause the release of volatile sulfur compounds,

-Chlorhexidine gluconate

-Cetylpyridinium chloride mouthwashes

The use of zinc salts is effective in the palliative treatment of halitosis by binding sulfides.

As a result, halitosis is a factor that negatively affects the psychology and social communication of the person, as well as a finding seen in some organic diseases. Studies on its etiology should primarily focus on intraoral factors, but the causes of extraoral halitosis should not be ignored.

For example, magmas and tonsil stones on the tonsils should be cleaned, if necessary, tonsillectomy (tonsil surgery) should be performed.

Nasal polyps, intranasal deformities, and sinusitis findings should be evaluated.

Gastrointestinal system complaints should be sought, and if necessary, they should be referred to an internist.

Alternatively, you can use cinnamon in your drinks and suitable foods. Cinnamon is an important aid in combating oral bacteria. Sugar-free cinnamon gum can be a suitable recommendation. Consuming plenty of water also helps directly to keep bacteria at a minimum. It also helps by increasing saliva secretion.

It should not be forgotten that the etiology of halitosis may be multi-factorial, differential diagnosis should be made, possible causes should be determined and a treatment should be applied for it.