Symptom finder - The causes of halitosis
Symptom finder- The causes of halitosis
The causes of halitosis are bronchiectasis, gastro esophageal reflux disease, acute tonsillitis, necrotic nasopharyngeal /oral cancer, uremia/renal failure, liver failure, pharyngeal pouch, gingivitis, dental abscess, excessive alcohol intake, smoking, diet consists of spice, garlic, onion, smoking, chronic or acute sinusitis, nasal foreign bodies, psychogenic halitosis, poor oral hygiene, dry mouth due to salivary gland disease or starvation, drugs such as disulfiram and abdominal sepsis ( acute appendicitis /fetor breath). Psychogenic halitosis is associated with history of depression where the patient complain of halitosis while the halitosis is absence.
What is halitosis? Halitosis is described as persistent or frequent unpleasant odor in the breath ( bad breath). Halitosis has a big social impact on the sufferer socially and personally. Halitosis is rarely associated with a serious underlying disorder. The most common cause of halitosis is poor dental /oral hygiene.
Bronchiectasis may be associated with recurrent chest infection, sputum and cough. Vincent’s angina or acute necrotising ulcerative gingivitis is a rare condition. It is presented as small ulcers and swollen gum which spread to the buccal mucosa. Patient may complain of fever, malaise and bleeding gum. Facial pain over the sinus and nasal discharge are associated with sinusitis. Patient may also suffer from underlying disorders such as liver failure, renal failure and diabetes. It is vital to ask regarding the patient general health and when did the halitosis occur, either in the morning or at night. Pharyngeal pouch is presented as dysphagia due to the compression of the esophagus by the pharyngeal pouch. Aspiration pneumonia and gastro esophageal reflux disease may occur due to regurgitation of food while lying down. Prolonged starvation from acute or chronic illness of the salivary gland such as Sjorgen syndrome may lead to dry mouth. It is important to evaluate the past history of bleeding gum, painful gum alcohol, smoking, poor diet and history of toothache.
Foreign bodies and sinusitis may produce a worse odor through the nose. The nasal odor is more pungent than oral odor. Oral etiology is associated with a worse odor from the mouth. Check for dental abscess, peridontal abscess and gingivitis. Gingivitis is presented as bleeding, red swollen gum. The posterior one third of the tongue may be coated. Yellowish ulcer on the tonsil and buccal mucosa as well as swollen bleeding gum is associated with acute necrotizing ulcerative gingivitis. Feel for any tender lymphadenopathy. Neoplastic condition is associated with ulcer and hard everted edges that bleed on contact. If obvious causes are unknown, than consider full examination of the neck, head , nasal airway and oral cavity and remember to feel the lymph node for any lymphadenopathy. Complete the examination by performing the full oral cavity and salivary gland examination. Look for signs of chronic liver failure in patient with chronic alcohol abuse.
The causes of halitosis are bronchiectasis, gastro esophageal reflux disease, acute tonsillitis, necrotic nasopharyngeal /oral cancer, uremia/renal failure, liver failure, pharyngeal pouch, gingivitis, dental abscess, excessive alcohol intake, smoking, diet consists of spice, garlic, onion, smoking, chronic or acute sinusitis, nasal foreign bodies, psychogenic halitosis, poor oral hygiene, dry mouth due to salivary gland disease or starvation, drugs such as disulfiram and abdominal sepsis ( acute appendicitis /fetor breath). Psychogenic halitosis is associated with history of depression where the patient complain of halitosis while the halitosis is absence.
What is halitosis? Halitosis is described as persistent or frequent unpleasant odor in the breath ( bad breath). Halitosis has a big social impact on the sufferer socially and personally. Halitosis is rarely associated with a serious underlying disorder. The most common cause of halitosis is poor dental /oral hygiene.
Bronchiectasis may be associated with recurrent chest infection, sputum and cough. Vincent’s angina or acute necrotising ulcerative gingivitis is a rare condition. It is presented as small ulcers and swollen gum which spread to the buccal mucosa. Patient may complain of fever, malaise and bleeding gum. Facial pain over the sinus and nasal discharge are associated with sinusitis. Patient may also suffer from underlying disorders such as liver failure, renal failure and diabetes. It is vital to ask regarding the patient general health and when did the halitosis occur, either in the morning or at night. Pharyngeal pouch is presented as dysphagia due to the compression of the esophagus by the pharyngeal pouch. Aspiration pneumonia and gastro esophageal reflux disease may occur due to regurgitation of food while lying down. Prolonged starvation from acute or chronic illness of the salivary gland such as Sjorgen syndrome may lead to dry mouth. It is important to evaluate the past history of bleeding gum, painful gum alcohol, smoking, poor diet and history of toothache.
Foreign bodies and sinusitis may produce a worse odor through the nose. The nasal odor is more pungent than oral odor. Oral etiology is associated with a worse odor from the mouth. Check for dental abscess, peridontal abscess and gingivitis. Gingivitis is presented as bleeding, red swollen gum. The posterior one third of the tongue may be coated. Yellowish ulcer on the tonsil and buccal mucosa as well as swollen bleeding gum is associated with acute necrotizing ulcerative gingivitis. Feel for any tender lymphadenopathy. Neoplastic condition is associated with ulcer and hard everted edges that bleed on contact. If obvious causes are unknown, than consider full examination of the neck, head , nasal airway and oral cavity and remember to feel the lymph node for any lymphadenopathy. Complete the examination by performing the full oral cavity and salivary gland examination. Look for signs of chronic liver failure in patient with chronic alcohol abuse.
The laboratory investigations require are full blood count, urea and electrolytes, swab, liver function test, chest x ray, skull x ray, OGD, barium swallow, rheumatoid factor, antinuclear antibodies, CT scan, biopsy and laryngoscopy.
Full blood count may reveal raise white cell count due to infection etiology. Urea and electrolytes are useful to rule out any chronic renal failure, renal liver function test for chronic renal failure detection, swab is useful to rule out infection ( culture and sensitivity) , bronchiectasis and chest infection are detected by chest x ray. Skull x ray may reveal opacity of the sinus in case of sinusitis. OGD is useful to detect gastro esophageal reflux disease, pharyngeal pouch is detected with barium swallow. CT scan is considered in cases of maxillary antrum carcinoma and nasopharyngeal carcinoma. CT scan is useful to assess the extent of the disease. Biopsy is useful to differentiate between malignant and benign condition. Nasopharyngeal carcinoma is also detected with laryngoscopy. Rheumatoid factor and antinuclear antibodies are positive in Sjorgen syndrome.