Bad breath is an embarrassing condition and in some cases may even cause anxiety.
Halitosis is a persistent, unpleasant odour emanating from the mouth or exhaled breath beyond socially acceptable levels.
It may be transient (e.g. morning breath, fasting, after certain foods) or chronic, in which case it often reflects underlying oral, digestive, ENT, metabolic, microbial, or systemic imbalances.
Globally, approximately 25–30% of people experience halitosis at some point, with similar prevalence across the UK and Europe.
Beyond being a cosmetic concern, halitosis significantly affects self-confidence, social interactions, emotional wellbeing, and quality of life.
Although 85–90% of cases originate in the mouth, halitosis should always be approached as a whole-body signal, not merely an oral hygiene issue.
Classification & Types of Halitosis
- Genuine (Objectively Detectable) Halitosis
Physiological (Transient)
- Morning breath
- After fasting or irregular meals
- After alcohol, tobacco, coffee, garlic, onions, strong spices
- Temporary ketosis (low-carbohydrate or ketogenic diets)
Pathological (Persistent)
Intra-oral (85–90%): tongue biofilm, gum disease, decay
Extra-oral (8–10%): ENT, gastrointestinal, respiratory, metabolic or systemic causes
Pseudo-Halitosis
No objective odour detected
The individual believes their breath smells bad
Commonly linked to anxiety, stress, or heightened self-awareness
Halitophobia
Persistent fear of having bad breath despite reassurance and absence of evidence
Often associated with social anxiety or body-focused disorders
Causes, Triggers & Risk Factors – Halitosis
Oral & Local Causes (Most Common)
Poor oral hygiene
Tongue coating / biofilm (especially posterior tongue)
Periodontal disease (gingivitis, periodontitis)
Dental caries, abscesses, ill-fitting restorations
Dry mouth (xerostomia) – dehydration, medications, mouth breathing, Sjögren’s
Oral infections (bacterial, fungal, viral)
Tonsillar crypts and tonsil stones
Food impaction
Dentures or orthodontic appliances
Oral cancers (rare but important)
ENT & Respiratory Causes
Chronic sinusitis
Post-nasal drip
Tonsillitis, pharyngitis
Nasal obstruction
Bronchial infections, bronchiectasis
Gastrointestinal Causes
GERD / acid reflux
- pylori infection
Dysbiosis
Delayed gastric emptying (gastroparesis)
Fermentation from incomplete digestion
Zenker’s diverticulum (rare)
Metabolic & Systemic Causes
Diabetes (acetone / fruity breath)
Kidney dysfunction (ammonia-like odour)
Liver dysfunction (musty, sweet odour)
Hormonal changes (menstruation, pregnancy, menopause)
Chronic inflammatory or immune conditions
Trimethylaminuria (fishy odour)
Lifestyle & Dietary Triggers
Smoking & tobacco
Alcohol
High-protein diets
Low carbohydrate / ketogenic diets
Coffee, garlic, onion, strong spices
Irregular meals or prolonged fasting
Stress and anxiety
Key Risk Factors
Smoking, Dehydration, Poor dental care, Chronic sinus issues, Chronic stress
Common Signs & Symptoms (Halitosis)
Persistent unpleasant breath despite brushing
White or yellow coating on the posterior tongue
Dry mouth and thick, sticky saliva
Metallic, sour, bitter or unpleasant taste
Bleeding, inflamed or sore gums
Chronic throat clearing
Post-nasal drip
Worse in the morning or after fasting
Social avoidance or heightened self-consciousness
Complications If Untreated – Halitosis
Physical
Progressive periodontal disease
Tooth loss and jaw bone involvement
Chronic oral infections
Worsening sinus or respiratory disease
Increased cardiovascular risk (oral bacteria entering bloodstream)
Progression of underlying systemic disease
Psychosocial
Social anxiety and isolation
Depression
Relationship difficulties
Reduced professional confidence
Development of halitophobia
Lifestyle & Daily Routine for Halitosis (Foundational)
Brush twice daily
Floss daily
Tongue scraping morning and evening
Hydration: 2–3 L water/day
Sugar-free gum with xylitol
Avoid tobacco
Balanced meals; avoid prolonged fasting if symptomatic
GERD-friendly eating habits
Stress management
Adequate sleep
Nasal irrigation for post-nasal drip
Replace toothbrush every 3 months
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