Some Causes and Features of Bad Breath
Cause | Common Features* | Tests |
|---|---|---|
Disorders in the mouth (oral) | ||
Bacteria on the back of the tongue | Unpleasant-smelling tongue scrapings Healthy gums and teeth | A doctor’s or dentist's examination |
Periodontal disorders, such as gingivitis and periodontitis | Affected gums and teeth noted during the examination In people with a history of poor oral hygiene | A dentist’s examination |
Cancers of the mouth (most are identified during a doctor's or dentist's examination long before they cause bad odors) | Usually identified during the examination More common among older adults, who often have an extensive history of using alcohol and/or tobacco | Biopsy, CT, or MRI |
Disorders outside the mouth (extraoral) | ||
A foreign object (body) in the nose† | Often a pus-filled or bloody discharge from the nose Seen during the examination Usually in children | A doctor's examination Sometimes imaging |
Cancer of the nasal passages and upper throat† | Discomfort when swallowing | A doctor's examination |
Lung infections, such as a lung abscess, bronchiectasis, or an infection caused by an inhaled foreign object | Cough that produces blood or sputum (phlegm) Fevers | Chest x-ray Cultures of sputum Sometimes CT or bronchoscopy |
Imagined halitosis (psychogenic halitosis) | Unpleasant smell not detected by others Often in people known to exaggerate other normal body sensations | A doctor's examination Sometimes a consultation with a psychologist |
Sinus infection† | A pus-filled discharge from the nose Face pain, headache, or both | A doctor's examination Sometimes CT |
Gastroesophageal reflux (GERD) disease | Spitting up of undigested food (regurgitation) when lying down or bending over | Video of the upper digestive tract after barium is given by mouth (barium swallow) |
Swallowed or inhaled substances | ||
Alcoholic beverages, garlic, onions, tobacco | Apparent based on the person's history Diagnosed after the doctor's examination rules out other causes | A doctor's examination Avoidance of the substance to see if symptoms go away |
* Features include symptoms and the results of a doctor's or dentist's examination. Features mentioned are typical but not always present. | ||
† The odor is typically more noticeable from the nose than from the mouth. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||