From the Guidelines
Management of halitosis should start with improved oral hygiene, including rinsing the mouth with an alcohol-free mouthwash at least four times a day, as recommended by the Annals of Oncology 1. This approach is crucial in reducing the accumulation of bacteria in the mouth, which is a primary cause of halitosis. Key components of oral hygiene include:
- Twice-daily brushing to remove plaque and bacteria
- Daily flossing to prevent interdental accumulation of food particles and bacteria
- Tongue cleaning with a tongue scraper to remove bacteria from the tongue's surface
- Using an antimicrobial mouthwash, such as those containing chlorhexidine 0.12% or cetylpyridinium chloride, twice daily for 30 seconds to reduce oral bacteria Additionally, ensuring adequate hydration by drinking plenty of water, avoiding tobacco products, alcohol, and strong-smelling foods, and using artificial saliva substitutes for dry mouth can help manage halitosis. It is also essential to inspect the oral mucosa daily and eliminate sources of trauma, such as ill-fitting prostheses or fractured teeth, as suggested by the ESMO clinical practice guidelines 1. Lubricating lips with vaseline or lip balm and drinking ample amounts of fluids to keep the mouth moist are also recommended general measures 1. If halitosis persists despite these measures, seeking professional dental care to rule out underlying conditions such as periodontal disease, dental caries, or oral infections is necessary.
From the Research
Causes of Halitosis
- Halitosis is formed by volatile molecules caused by pathological or nonpathological reasons, originating from an oral or non-oral source 2
- The source of 90% of halitosis cases is the oral cavity, including poor oral hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat infections 2, 3
- In approximately 80% of all cases, halitosis is caused by microbial degradation of oral organic substrates, with major degradation products being volatile sulphur-containing compounds 4
Diagnosis of Halitosis
- Halitosis can be diagnosed using modern analytical and microbiological techniques 3
- The organoleptic test (OLT) can be used to assess the severity of halitosis 5
Management of Halitosis
- Management of halitosis involves maintaining proper oral hygiene, periodontal treatment, including tongue brushing 3
- Simple measures such as scaling and root planning, instructions for oral hygiene, tongue cleaning, and mouth rinsing can be effective in treating halitosis 2
- Chlorhexidine can be used as a chemical method of oral hygiene practice to reduce halitosis 4, 5
- Probiotic therapy following oral disinfection with chlorhexidine may reduce the severity of halitosis over longer periods 5
- Masking products are not effective, and antimicrobial ingredients in oral healthcare products are only temporarily effective in reducing micro-organisms or their substrates 4
- Tonsillectomy might be indicated if all other causes of halitosis are managed properly, halitosis still persists, and crypts in tonsils are found to contain malodorous substrates 4