Treatment of Halitosis
The primary treatment for halitosis involves meticulous oral hygiene with twice-daily tooth brushing (including the gingival sulcus), daily flossing, tongue cleaning, and vigorous rinsing with bland saline solution, while avoiding alcohol-based mouthwashes. 1
Foundational Oral Hygiene Protocol
The cornerstone of halitosis management addresses the fact that 90% of cases originate from the oral cavity, particularly from bacterial putrefaction on the posterior dorsal tongue surface 2, 3, 4:
- Brush teeth twice daily with prescription-strength fluoride toothpaste, ensuring coverage of the gingival portion and periodontal sulcus 1
- Floss at least once daily using waxed floss to minimize gingival trauma 1
- Clean the tongue routinely using a soft toothbrush or tongue scraper on the dorsal surface, as plaque accumulation on the tongue is the most common cause of oral halitosis 5, 6
- Rinse vigorously several times daily with bland saline solution (1 teaspoon salt, 1 teaspoon baking soda in 4 cups water) 1
Critical Avoidances
Several common products paradoxically worsen halitosis and must be avoided:
- Avoid alcohol-based or astringent commercial mouthwashes as they dry the mouth 1, 5
- Avoid glycerin or lemon-glycerin swabs which promote mucosal dehydration 1, 5
- Avoid petroleum-based lip products as they cause drying and cracking; use animal or plant-based oils instead 1, 5
- Avoid club soda for rinsing due to carbonic acid content 1
Management of Dry Mouth (Xerostomia)
Since dry mouth significantly contributes to halitosis, address this systematically 1:
- Improve hydration and limit caffeine intake 1
- Moisturize the mouth with water, artificial saliva products, or water-soluble lubricants 1
- Use salivary stimulants including sugarless chewing gum, lozenges, or candy 1
- For severe xerostomia, consider systemic sialagogues (cevimeline or pilocarpine) 1
Antimicrobial Interventions
When basic oral hygiene is insufficient:
- Hydrogen peroxide mouthwash 1.5% (10 mL twice daily) reduces bacterial colonization 1
- Chlorhexidine rinse can be used, but dilute by up to 50% to reduce associated soreness 1
- Alcohol-free antimicrobial mouthwashes may be prescribed for non-respondents to basic measures 7
Treatment of Underlying Oral Pathology
Address specific oral conditions that perpetuate halitosis 3, 4:
- Periodontal disease: Perform scaling and root planing 3
- Faulty restorations and food impaction: Correct with appropriate dental treatment 2, 3
- Unclean dentures: Provide instructions for proper denture hygiene 2, 3
- Oral candidiasis (if white plaques present): Treat with nystatin oral suspension (100,000 units) four times daily for 1 week, or miconazole oral gel 5-10 mL four times daily 5
Ongoing Maintenance
- Regular dental follow-ups every 6 months minimum to maintain periodontal health and address emerging issues 1
- Maintain rigorous oral hygiene as a long-term strategy, since halitosis management is fundamentally about controlling bacterial putrefaction 2, 4
When to Consider Non-Oral Causes
If halitosis persists despite optimal oral hygiene and dental treatment, investigate the remaining 10-20% of cases with systemic origins 2, 3, 4: