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Bad breath is a common complaint, yet with no universally accepted "gold standard" of diagnosis, it is impossible to estimate the percentage of the population with "bad" breath. People struggling with bad breath will probably consult with a dental professional before seeking medical advice about the problem.
Most of the literature up to 1940 consists of anecdotes and cures with little scientific study associated with the conclusions. Some of the earliest sound studies came from Dr. Tonzetich of Northeastern University. The researchers used an osmoscope to study the sources and conditions surrounding bad breath. Their results suggested that even though there are several causes of bad breath including those resulting from a systemic or nasopharyngeal pathology or condition, the main source of most halitosis is the oral cavity. Modern research indicates that the dorsum of the tongue is the primary source of halitosis. People with periodontal disease suffer from another type of halitosis that is primarily due to the bacteria in the crevicular fluids from the pockets.i
It is very difficult to rate one's own bad breath. Many people are unaware that they have bad breath or, on the opposite extreme, feel they have very bad breath, but do not.ii
Machines are commercially available to assist in the measurement of the gasses thought to be most responsible for bad breath, but dental professionals could smell the odor (called "organoleptic sampling") in the air expired from the patient's mouth and nose.ii
In most cases, bad breath can be reduced or eliminated by proper dental care, oral hygiene, deep tongue cleaning and, if necessary, rinsing with an effective mouthwash.ii If the problem persists (or if the patient continues to think the problem persists and it actually doesn't), the patient should be promptly referred for appropriate medical or psychological care.ii
According to one study, fifty percent of middle-aged and older adults have socially unacceptable breath upon arising in the morning. This type of halitosis is readily treated.
Oral malodor appears linked to periodontal disease in some studiesiii, but the conclusion is not supported by other studies. In cases where periodontal disease is causing the odor, treatment of the disease eliminates the odor. In the same manner, if the cause is dental decay or disease, treatment of the condition removes the halitosis.
Industry-based research studies about halitosis have concentrated on it as a cosmetic problem rather than a medical one. Drinking or rinsing with plain water reduces bad breath for a brief period of time, so theoretically all mouth rinses are somewhat effective. However, many mouth rinses only mask the problem and provide temporary cosmetic relief without engaging the source of the problem. Some patients claim they have halitosis, but actually do not. This "halitophobia" can range in severity from someone worrying about bad breath and practicing obsessive masking and oral hygiene procedures but still carrying on normal life to cases of isolation, complete tooth extraction, and suicideiv. If a patient complains of bad breath that is not detectable, refer them to a mental health care professional.iii
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