Sources of Bad Breath or Halitosis: Evaluate, Diagnose, and Treat

When it comes to bad breath or halitosis, treatment cannot be pursued until the location of the bad breath is identified. Broadly speaking, the source of a person’s bad breath may come from 4 different regions: the nose, mouth, throat, and lungs. Before being able to successfully treat bad breath or halitosis, one must first determine WHERE the bad breath is coming from. Is it coming from just the nose, just the mouth, or BOTH from the nose and mouth. Assuming air coming out of the lungs is fresh and pure, should bad breath emanate only from the mouth but not the nose, the source of the bad smell is somewhere in the mouth.

For example, this occurs with morning breath or patients suffering from a dry mouth or dental problems. If the bad breath ONLY occurs from the nose, but not the mouth, the source of the bad odor is due to some type of sino-nasal issue like a sinus infection or nasal foreign body. If the bad breath emanates from BOTH the nose and mouth, this suggests the source of the bad smell to be coming from the throat or even the lungs. Examples of lung or throat issues that may cause halitosis include reflux, throat cancer, and lung infections as well as more systemic issues like diabetes and advanced kidney or liver disease. Of course, one can potentially also have a simultaneous mouth and nose problem.

When it comes to the mouth, one can further localize where the bad smell is coming from by doing the finger scratch and sniff test. Basically, gently scratch with a fingernail the front surface of the tongue, tonsil, and even the very back of the tongue one at a time followed by sniffing the material collected on the finger. Once the location and because of your bad breath have been identified, only then can treatment be successfully pursued.

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