Halitosis R19.6

• Local causes in the mouth, nose and throat for foetor ex ore (often not noticed by the patient):
• Diseases of teeth and gums (caries, periodontosis, lack of teeth cleaning)
• Bacterial inflammations ( angina, plaut-vincenti, ozaena)
• Collapsing tumours
• Reduced salivation ( Sjögren's syndrome, mouth breathing, anticholinergic drugs)
• Nicotine abuse
• Exhalation of odorous substances from deeper lying organs: halitosis (is perceived by the patient).
• Lungs (purulent bronchitis, bronchiectasis, pneumonia)
• Gastrointestinal tract (esophageal diverticulum, carcinoma, achalasia, ileus)
• metabolic disorders (uremia, coma diabeticum, coma hepaticum)
• Absorption of odorous substances via the intestines and exhalation via the lungs (garlic, phosphorus, arsenic, tellurium, selenium)
• Essential halitosis: Exhalation of foul smelling fatty acids from unknown cause.

Treatment of a possible underlying disease.

Symptomatic therapy: Avoidance of food with intensive odour, tooth (pocket) cleaning, stimulation of salivary flow, e.g. by chewing gum, apples. If necessary, short-term trial with stomatological drugs such as cetylpyridinium chloride (Dobendan).

In case of essential halitosis, change to a low-fat diet (medium-chain fatty acids), change in the intestinal flora (lactulose).