aetiology
Last reviewed 01/2018
Oral malodour can be due to oral causes or non-oral causes (1).
Oral causes:
- the commonest cause of halitosis is poor oral hygiene –
- this is due accumulation of food debris and dental bacterial plaque on teeth and the tongue.
- oral microbes such as Prevotella (Bacteroides) melaninogenica, Treponema
denticola, Porphyromonas gingivalis and other gram negative bacteria break
down food debris resulting in production of chemicals such as volatile sulphur
compounds, diamines, and short chain fatty acids which is responsible
for the oral malodour
- other oral causes include:
- acute necrotising ulcerative gingivitis (Vincent's disease, trench mouth) – responsible for most notable halitosis
- acute gingivitis
- adult and aggressive periodontitis
- pericoronitis
- dry socket
- xerostomia
- oral ulceration
- oral malignancy
Non oral causes:
- respiratory disease
- foreign body
- sinusitis, tonsillitis
- lung diseases – malignancy, bronchiectasis, lung abscesses, necrotizing pneumonia (1,2)
- gastrointestinal tract
- pharyngo-oesophageal diverticulum
- gastro-oesophageal reflux disease
- pyloric stenosis or duodenal obstruction
- Helicobacter pylori infection may cause halitosis
- systemic disease
- hepatic failure (fetor hepaticus)
- renal failure (end stage)
- diabetic ketoacidosis
- leukaemias
- Trimethylaminuria (“fish odour syndrome”)
- drugs
- solvent misuse
- chloral hydrate
- nitrites and nitrates
- dimethyl sulphoxide
- disulphiram
- some cytotoxic agents
- phenothiazines
- amphetamines
Transient halitosis is common and can be caused by
- volatile foods such as garlic, onions, or spices (durian is reputed to be the worst)
- tobacco and alcohol
- betel nut products (1,2)
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