Halitosis is a general term used to describe unpleasant or offensive mouth odor. It has been found that although there are several non-oral sites that contribute to halitosis, 90% of all bad breath odors originate in the mouth itself. Potential sources of halitosis include the dorsoposterior region of the tongue, gingivitis and periodontitis.
Successful treatment of halitosis depends on a correct diagnosis and therefore implementing the appropriate treatment. Five major categories of halitosis have been proposed based on etiology and they include physiologic halitosis, oral halitosis, extra-oral halitosis, pseudo halitosis and halitophobia. Halitosis with an extra-oral pathologic origin and halitophobia should be treated by a physician and a psychiatrist or a psychological specialist, respectively.
Treatment for physiologic halitosis includes education on the possible causes and oral hygiene instruction. The primary origin of physiologic halitosis is the dorsoposterior region of the tongue; therefore, the patient should be instructed on the appropriate methods to clean the tongue surface. Additional methods to treat this condition include the use of antimicrobials, mostly via mouth rinses, where the patient is instructed to gargle in the posterior region of the tongue. The most effective mouth rinses found to treat halitosis of an oral pathologic origin include those that contain chlorhexidine and cetylpyridinium chloride, where the patient is advised to gargle with 15 ml twice day for one minute. In the U.S., chlorhexidine mouth rinses are available with a prescription. Cetylpyridinuim chloride mouth rinses are available over the counter.
The regimen for treating oral pathologic halitosis includes oral prophylaxis, professional cleaning and treatment of the oral diseases, especially periodontal diseases at least every 3-months.
These treatment protocols are aimed to reduce oral biofilms at different oral bacterial microenvironments, namely tongue-coating, saliva and subgingival microflora. In particular, in periodontal patients when there is a reduction in plaque levels, especially in subgingivial plaque, we see a reduction in probing depths. With proper cleaning of the dorsum of the tongue, there is a reduction in the plaque that coats the tongue.