Halitosis is a frequent or persistent unpleasant odour to the breath. It is usually due to poor dental hygiene. It may have a significant impact, both personally and socially, on those who suffer from it. Rarely, it may be the symptom of a serious underlying condition. History of toothache, poor diet, smoking, alcohol. Painful gums, bleeding from gums. Acute necrotising ulcerative gingivitis (Vincent’s angina) is rare but presents with swollen gums with small ulcers, which may spread to the buccal mucosa and the patient will complain of bleeding from the gums, together with a constitutional upset with fever and malaise. Heartburn (GORD), dysphagia (pharyngeal pouch): dysphagia may occur due to a pharyngeal pouch pressing on the oesophagus. It may gurgle on palpation and regurgitation of food may occur on lying down, with subsequent development of aspiration pneumonia. Sinusitis may present with a nasal discharge and facial pain over the sinus. Cough, sputum and recurrent chest infections may indicate bronchiectasis. Dry mouth may be a part of prolonged starvation with chronic or acute illness or disease of the salivary glands, e.g. Sjögren’s syndrome. There may be a history of diabetes, renal failure or liver failure. Is the halitosis worse in the morning and gets better during the day? Is the patient otherwise well?
Halitosis
History
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