Symptom Finder - Halitosis and Other Breath Odors
HALITOSIS AND OTHER BREATH ODORS
What are the various causes of bad breath and how can they be recalled with ease? The best method is to visualize the respiratory and upper gastrointestinal (GI) tree, because this is where the substances (mucus, sputum, and vomitus or regurgitant material) that produce these odors may be found.
In the mouth, pyorrhea due to poor dental care and infection may cause halitosis. A stomatitis (e.g., aphthous) may also be a cause. Sinusitis and atrophic rhinitis are causes in the nasal passages. Anyone who has a friend with large tonsils knows that this is a frequent cause, especially when the tonsils become infected. Any form of pharyngitis may also cause halitosis. Carcinoma and tuberculosis (TB) of the larynx and lower respiratory tract may cause halitosis. More likely causes are bronchiectasis and lung abscess.
Proceeding down the esophagus to the stomach, one should recall the accumulation of food in diverticula, cardiospasm of the esophagus, and the frequent foul odor of chronic membranous or granulomatous esophagitis associated with a hiatal hernia. Carcinoma of the esophagus may also cause obstruction and allow putrefaction of food that accumulates there. A chronic gastritis or gastric carcinoma may also cause halitosis. A sweet odor to the breath may be found in diabetes mellitus and alcoholism. Uremia will often present with an ammoniac and urinous odor to the breath, whereas the breath of hepatic coma may be fishy (fetor hepaticus). The feculent odor of a gastrocolic fistula and late states of intestinal obstructions should also be recalled. A garlic odor is found in
many poisonings (arsenic, organophosphates, etc.).
Approach to the Diagnosis
The workup of bad breath involves a careful examination of the mouth and nasal passages. If this is negative, chest and sinus x-rays and upper GI series with barium swallow should be done. If the studies are still unrewarding, then endoscopy of the respiratory and upper GI tract would be indicated. Appropriate liver and renal function tests will be ordered when uremia or hepatic coma is suspected. If pyorrhea is suspected, refer the patient to a dentist.
What are the various causes of bad breath and how can they be recalled with ease? The best method is to visualize the respiratory and upper gastrointestinal (GI) tree, because this is where the substances (mucus, sputum, and vomitus or regurgitant material) that produce these odors may be found.
In the mouth, pyorrhea due to poor dental care and infection may cause halitosis. A stomatitis (e.g., aphthous) may also be a cause. Sinusitis and atrophic rhinitis are causes in the nasal passages. Anyone who has a friend with large tonsils knows that this is a frequent cause, especially when the tonsils become infected. Any form of pharyngitis may also cause halitosis. Carcinoma and tuberculosis (TB) of the larynx and lower respiratory tract may cause halitosis. More likely causes are bronchiectasis and lung abscess.
Proceeding down the esophagus to the stomach, one should recall the accumulation of food in diverticula, cardiospasm of the esophagus, and the frequent foul odor of chronic membranous or granulomatous esophagitis associated with a hiatal hernia. Carcinoma of the esophagus may also cause obstruction and allow putrefaction of food that accumulates there. A chronic gastritis or gastric carcinoma may also cause halitosis. A sweet odor to the breath may be found in diabetes mellitus and alcoholism. Uremia will often present with an ammoniac and urinous odor to the breath, whereas the breath of hepatic coma may be fishy (fetor hepaticus). The feculent odor of a gastrocolic fistula and late states of intestinal obstructions should also be recalled. A garlic odor is found in
many poisonings (arsenic, organophosphates, etc.).
Approach to the Diagnosis
The workup of bad breath involves a careful examination of the mouth and nasal passages. If this is negative, chest and sinus x-rays and upper GI series with barium swallow should be done. If the studies are still unrewarding, then endoscopy of the respiratory and upper GI tract would be indicated. Appropriate liver and renal function tests will be ordered when uremia or hepatic coma is suspected. If pyorrhea is suspected, refer the patient to a dentist.
