Materiały źródłowe

• #1 Halitosis – An overview: Part-I – Classification, etiology, and pathophysiology of halitosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4606616/

  Halitosis is a condition where the breath is altered in an unpleasant manner for the affected individuals and impairs them socially as well as psychologically. […] Real halitosis has oral and extra-oral etiologies and the pathophysiology involves interaction of anaerobic microbes (mainly) with the proteins present in the oral cavity fluids and contents, resulting in production of volatile sulfur compounds (VSCs). […] Though the exact pathogenesis of oral malodor is not known, the most accepted one is that the microbial putrefaction of food debris, desquamated cells, saliva and blood causes oral malodor. […] The bacterial interactions are mainly due to several proteolytic and anaerobic, Gram-negative bacterial species and are not associated with any specific bacterial infection. […] Various agents such as volatile sulfur compounds (VSCs), diamines and short chain fatty acids are produced due to this microbial breakdown of amino acids by enzymes, resulting in oral malodor.

• #1 Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

  https://www.mdpi.com/1660-4601/19/18/11303

  Hydrogen sulfide, methyl mercaptan and, to a lesser extent, dimethyl sulfide, represent 90% of the VSCs in bad breath. […] These VSCs result from bacterial metabolism and its pathways are well described. […] The understanding and the development of VSCs measurement procedures could be used as clinical levels for the diagnosis of halitosis. […] Several classifications of halitosis are described in the literature, we considered the classification based on the origin of the VSCs which was established by the International Society for Breath Odor Research. […] Genuine halitosis is an oral malodor that is noticeable and exceeds the socially acceptable level. […] Pathological halitosis can originate from oral diseases—intra-oral halitosis, (e.g., tongue coating, periodontal infections, odontogenic infections, xerostomia, mucosal lesions) or systemic diseases—extra-oral pathologic halitosis (e.g., respiratory tract infections, gastrointestinal disease, metabolic disorders, endocrine system disorders, medication).

• #1

  https://journals.lww.com/jdyu/fulltext/2015/04010/oral_malodor__a_review_of_etiology_and.1.aspx

  The general view is that halitosis reflects complex interactions between several oral, mostly anaerobic, Gram-negative bacteria, and no specific bacterial strain is responsible for the condition. […] Studies have shown that five common bacteria are responsible for oral malodor in saliva and lingual dorsum, namely Porphyromonas gingivalis, Tanerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, and Treponema denticola. […] Volatile sulfur compounds are likely to result from bacterial metabolism of amino acids in food debris, desquamated cells from oral mucosa, and leukocytes that accumulate in the oral cavity.

• #1

  https://resou.osaka-u.ac.jp/en/research/2024/20240214_1

  Researchers from Osaka University find that a metabolite produced by the commensal oral bacterium Streptococcus gordonii activates another bacterial species, Fusobacterium nucleatum, to produce the malodorous compound methyl mercaptan. […] In a study published last month in mSystems, researchers from Osaka University revealed that the interaction between two common types of oral bacteria leads to the production of a chemical compound that is a major cause of smelly breath. […] Bad breath is caused by volatile compounds that are produced when bacteria in the mouth digest substances like blood and food particles. […] The results were very intriguing, says Masae Kuboniwa, senior author. We found that Fusobacterium nucleatum produces large quantities of CH3SH in response to Streptococcus gordonii, another oral bacterium.

• #1 Halitosis – An overview: Part-I – Classification, etiology, and pathophysiology of halitosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4606616/

  The intensity of malodor corresponds to the level of odoriferous substances in the oral cavity and gingival crevices, periodontal pockets, and posterior dorsum of the tongue are the most likely sites involved in the whole process. […] Saliva, performing numerous functions in the oral cavity, has protective and anti-bacterial properties as prime functions. […] Its protective function is mainly due to cleansing action causing constant removal of bacteria and food debris, and the anti-bacterial property is attributed to the presence of salivary Ig A, lysozyme, lactoferrin, and several glycoproteins. […] Thus, the activation of enzymes necessary for the putrefaction of amino acids such as cystine, cysteine, and methionine is hindered, preventing the production of foul smelling sulfur-containing compounds.

• #1 Halitosis: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/867570-reference

  In most cases (perhaps 85%), bad breath (halitosis) comes from the mouth itself. […] The simplest way to distinguish oral from nonoral etiologies is to compare the smell coming from the patient’s mouth with that exiting the nose. […] In people with rigorous oral hygiene, good dentition and a healthy periodontium, the main cause of bad breath (halitosis) is likely to be the back of the tongue. […] People whose tongues are deeply grooved or furrowed have more potential to accumulate the white coating than those with smoother tongue surfaces. A coating 0.1-0.2 mm thick can deplete an environment of oxygen. The bacteria that cause bad breath can flourish in this type of „anaerobic” environment. […] Research has shown a direct correlation between the amount of coating on a person’s tongue and the total number of anaerobic bacteria present in the coating. An improvement in the odor emanating from the mouth is usually seen as the anaerobic bacterial count on a person’s tongue is reduced.

• #1 Bad breath – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bad-breath/symptoms-causes/syc-20350922

  Bacteria on the tongue surface can trap bacteria that produce odors, leading to bad breath. […] Most bad breath starts in your mouth. There are many possible causes, including: The breakdown of food particles in and around your teeth can lead to more bacteria and cause a foul odor. […] If you don’t brush and floss daily, food particles remain in your mouth, causing bad breath. A colorless, sticky film of bacteria called plaque forms on your teeth. […] Saliva helps cleanse your mouth, removing particles that cause bad odors. A condition called dry mouth or xerostomia can be a part of bad breath because you produce less saliva. […] Surgical wounds after mouth surgery, such as tooth removal, as well as tooth decay, gum disease or mouth sores, can cause bad breath. […] Small stones that form in the tonsils, called tonsil stones or tonsilloliths, are covered with bacteria that can cause bad breath. Infections, or constant swelling in the nose, sinuses or throat, can lead to postnasal drip. […] Diseases such as some cancers can cause a distinctive breath odor. The same is true for disorders related to the body’s process of breaking food down into energy. Constant heartburn, which is a symptom of gastroesophageal reflux disease or GERD, can lead to bad breath.

• #1 Halitosis: Practice Essentials, Epidemiology, Etiology

  https://emedicine.medscape.com/article/867570-reference

  Dentures are another important cause of oral malodor (bad breath), particularly if they are worn overnight. […] Saliva plays a big role in bad breath (halitosis) elimination. Bad breath (halitosis) levels during the day are inversely related to saliva flow. […] The most common bacterium found among people with fresh breath was Streptococcus salivarius. This bacterium was present in only 1 out of 6 people with halitosis (bad breath), at extremely low levels. […] The role of the tonsils in chronic bad breath (halitosis) is unclear. […] A study by Vali et al found that psychological factors, such as anxiety, depression and stress, as well as some personality traits, can be considered as risk factors for subjective halitosis.

• #1 14 Bad Breath (Halitosis) Causes: Why Does My Breath Smell? | LISTERINE®

  https://www.listerine.com/bad-breath/causes-bad-breath

  Tobacco products whether its cigarettes, chew, or pipe all cause bad breath and lead to much more serious oral health issues. […] Poor digestion, constipation, or bowel disorders can all cause bad breath from the stomach. […] When the production of saliva slackens or stops, a condition known as xerostomia, bad breath is likely to follow. […] Certain medications including those for blood pressure, antihistamines, and antidepressants, can cause xerostomia, or dry mouth. […] The systemic inflammation associated with diseases like diabetes can affect your mouth and contribute to bad breath. […] Constant or chronic bad breath can be a warning sign that other diseases or illnesses are present.

• #1

  https://journals.lww.com/jdyu/fulltext/2015/04010/oral_malodor__a_review_of_etiology_and.1.aspx

  Oral malodor is related to the salivary flow. Bad breath levels during the day are inversely related to salivary flow. […] Xerostomia or dry mouth is considered to be a major contributory factor in the production of oral malodor because reduced salivary flow weakens the normal cleansing mechanism of the mouth and predisposes the oral flora toward the Gram-negative organisms responsible for the malodor. […] The most likely pathogenesis of halitosis is microbial putrefaction of food debris, defoliated epithelial cells, saliva and blood. […] It is generally believed that halitosis reflects putrefaction by anaerobic, Gram-negative bacteria. […] These microorganisms digest proteins from food residues, cells and other saliva debris into amino acids. This is followed by further cleavage of certain amino acids to bad-smelling by-products of bacterial metabolism, predominantly VSCs (H2S, CH3SH and dimethyl sulfide [CH3]2S), organic acids (butyric acid), aromatic compounds (indole, skatole) and amines (putrescine, cadaverine).

• #1 Bad Breath – CMS Dental

  https://cmsdental.com/en/patients/bad-breath/

  85% of cases of persistent bad breath originate from the oral cavity. […] It is caused by sulfur fumes produced by bacteria living in the furrows of the tongue. […] In 85% of cases, the problem is caused by bacteria in the grooves on the upper surface of the back 1/3 of the tongue. These are so-called gram-negative anaerobic bacteria (i.e. bacteria that live in an oxygen-free environment) that live in the very deep grooves of the tongue. […] What causes bad breath is sulfurous fumes produced by bacteria breaking down amino acids containing sulfur atoms. These are the same chemical processes that take place in a sewer. […] There are two main players in the development of bad breath and they are two different types of bacteria working together. […] One type of bacteria is the one that produces sulfur dioxide and the other type of bacteria is the one that helps to break down carbohydrate side chains.

• #1 Bad Breath – CMS Dental

  https://cmsdental.com/en/patients/bad-breath/

  Most of the amino acids supplied come from the diet in the form of glycoproteins, i.e. proteins with carbohydrate side chains. […] The carbohydrate side chains have to be cut off before the anaerobic bacteria mentioned above can break them down into sulfur vapors (called VSC: volatile sulphuric compounds). […] This cutting is done by an enzyme called beta-galactosidase. It is an enzyme produced by other bacteria on the surface of the tongue, and is quite differently accessible to the toothbrush, but can also be affected by the composition of your oral bacteria. […] The bacteria that produce the sulfur fungi that cause bad breath are the same ones that cause periodontal disease (gum disease), so the two conditions are linked. […] P.Gingivalis and T.Forsythia are the two bacteria that produce sulfurous fungi in the oral cavity.

• #1 Halitosis – An overview: Part-I – Classification, etiology, and pathophysiology of halitosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4606616/

  These VSCs released during microbial interactions are capable of initiating and accelerating periodontal pathology. […] Recently, it has been reported that hydrogen sulfide induce mitochondria-mediated apoptosis and DNA damage in human gingival fibroblasts by increasing the levels of reactive oxygen species. […] Extracellular matrix degradation is facilitated by induction of immune responses, matrix metalloproteinase activity by these VSCs. […] VSCs inhibit osteoblastic activity, activate osteoclastic activity, thus leading to pathogenic bone loss.

• #1 Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

  https://www.mdpi.com/1660-4601/19/18/11303

  The proposed microbiological link between halitosis and periodontal disease is based on three assumptions: (1) Periodontal patients have a higher prevalence of intraoral bacteria (bacterial plaque and tongue coating), decreased pH, which is necessary for amino acid putrefaction and formation of VSCs. (2) The microbially generated VSCs (hydrogen sulfide and methyl mercaptan) facilitate the penetration of lipopolysaccharide into the gingival epithelium, inducing inflammation. (3) VSCs also aid in bacterial invasion of connective tissue by their toxic effects on epithelial cells, while methyl mercaptan prevents the growth and proliferation of epithelial cells. […] This mechanism is enhanced by the decrease in oxygen tension due to the increase in the depth of the periodontal pocket, with a concomitant decrease in pH, which is necessary for the putrefaction of the amino acids that create VSCs.

• #1 Halitosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534859/

  The intraoral milieu contributes to 80% to 85% of cases of halitosis, where decarboxylation of amino acids such as acetic acid and propionic acid leads to malodorous amines like putrescine and cadaverine and other volatile aromatic compounds like indole and skatole. […] In physiological halitosis, which occurs on waking, the cause is putrefaction of entrapped food particles and desquamated epithelial cells by bacteria. […] The surface of the tongue has desquamated epithelial cells, leucocytes from periodontal pockets, food residues, and bacteria. The depth of the tongue papillae affects the biofilm coating on top, which prevents the cleansing action of saliva and promotes the growth of anaerobic bacteria, giving rise to halitosis. […] In individuals with halitosis, the posterior dorsum of the tongue is the main source of malodor.

• #1 Halitosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534859/

  Halitosis is classified into 2 groups: genuine and delusional halitosis. […] These account for nearly 80% to 85% of all halitosis cases. Gingival and periodontal diseases (acute necrotizing ulcerative gingivitis, herpetic gingivitis, periodontitis, pericoronitis, periodontal abscess), Sjogren syndrome, cancer treatment, and bone pathologies like alveolitis and osteomyelitis attribute to halitosis. Contributing factors are deep carious lesions and large interdental areas where retention of food debris could occur, malaligned teeth, exposed necrotic pulp, ill-fitting dentures and orthodontic appliances, tongue biofilm, and candidiasis. […] A drop in the oxygen saturation of saliva results in a lowering of the pH of saliva, causing diamines to form, resulting in malodor. […] The gases emanating from the mouth that cause oral malodor are the volatile sulfur compounds (VSCs). These include hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. Gram-negative and anaerobic bacteria from periodontal infections generate these compounds.

• #1 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  Microbial degradation in the oral cavity is the main cause of oral malodour. Due to this process, volatile sulphur compounds (VSCs) are formed. The most important VSCs involved in halitosis are hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide (CH3)2S. These VSCs are mainly produced by Gram-negative anaerobic oral bacteria. […] Most of the responsible microorganisms in halitosis are involved in periodontitis. So, there is a positive correlation between bad breath and periodontitis: the depth of the periodontal pockets is positively correlated to the height of the VSC concentrations in the mouth. […] In nearly 85% of all halitosis cases, the origin is found in the oral cavity. A clinical evaluation of malodour on 2000 patients in Belgium, showed that 76% of these patients had oral causes: tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%).

• #1 Halitosis (Bad Breath): What It Is, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17771-bad-breath-halitosis

  Halitosis is a symptom of many different conditions. In other words, its like a warning message from your body. Finding the root cause of halitosis is the first step in treating the issue. […] The most common cause of halitosis is poor oral hygiene. Without proper oral hygiene like brushing, flossing and routine dental cleanings harmful bacteria invade your mouth and multiply out of control. This can lead to several oral health issues like halitosis, cavities and gum disease. […] Halitosis treatment depends on the root cause of the issue. For example, if bad breath is due to poor oral hygiene, a dental cleaning and improved oral hygiene at home will likely help. […] But if halitosis is a symptom of another condition somewhere else in your body, your primary healthcare provider can help you with proper diagnosis and treatment. […] As mentioned above, treating the underlying condition is the only halitosis cure. Gum and breath mints only cover up the problem.

• #1 Bad Breath (Halitosis) Types, Causes, Treatment, Elimination

  https://www.medicinenet.com/bad_breath/article.htm

  Infection and disease conditions that cause bad breath include: […] Sinus infections […] Pneumonia […] Sore throat (pharyngitis) and other throat infections […] The common cold and influenza(flu) […] Tonsil stones (tonsilloliths) […] Thrush […] Bronchitis […] Postnasal drip […] Diabetes […] Acid reflux (gastroesophageal reflux disease or GERD) […] Lactose intolerance, other stomach or digestion problems […] Some liver diseases or kidney diseases may be associated with bad breath. […] A dry mouth may be caused by salivary gland problems, connective tissue disorders (Sjgren’s syndrome), medications, or breathing through the mouth. […] Many medications used to treat allergies can cause dry mouth, another cause of halitosis. […] Bad breath in the morning is very common. Saliva production nearly stops during sleep, allowing odor-causing bacteria to grow, and causing bad breath.

• #1 Common Causes of Bad Breath

  https://patient.info/oral-dental-care/bad-breath-halitosis/causes

  Tonsil stones are clusters of calcified material that form in the tonsillar crypts, or crevices of the tonsils. They are made up mostly of calcium but can contain other ingredients such as magnesium and phosphorus, and can feel like a small lump in the tonsils. Rarely harmful, they can be a nuisance and hard to remove and can often cause bad breath.

• #1 Why Does My Breath Smell Bad? The Causes of Bad Breath – MD Periodontics

  https://mdperio.com/blog/causes-of-bad-breath/

  A key side effect of periodontal disease is chronic bad breath along with an unpleasant taste in the mouth. […] Chronic acid reflux, also known as gastroesophageal reflux disease (GERD), is a medical condition. Acid reflux is the backward flow of stomach contents such as undigested food, regurgitated bile, and stomach acid into the esophagus. This can lead to bad breath from stomach contents. […] In a large population-based study, the relationship between GERD-related symptoms and halitosis was confirmed, suggesting that GERD increases the risk of halitosis.

• #1 What metabolic disorders cause bad breath?

  https://www.medicalnewstoday.com/articles/metabolic-disorders-that-cause-bad-breath

  As a result, the methionine builds up and causes the smell. […] If a person is unable to control their diabetes effectively, high glucose levels can cause harmful bacteria to grow. […] When this happens, the body begins to burn fat instead, producing compounds called ketones. […] These may build up in the blood and urine and cause bad breath. […] People with kidney failure may develop bad breath. […] As the kidneys begin to fail, they cannot efficiently excrete the metabolite urea in the urine, and it builds up in the blood and saliva. […] One of the symptoms of liver disease is the presence of volatile organic compounds in the breath. […] If a person’s breath has a strong, musty smell, it is a sign that their liver is not filtering out toxic substances, indicating liver disease. […] PKU is a genetic condition that causes the body to be unable to break down the amino acid phenylalanine. […] These conditions may cause metabolites to build up in the saliva, leading to bad breath.

• #1 What metabolic disorders cause bad breath?

  https://www.medicalnewstoday.com/articles/metabolic-disorders-that-cause-bad-breath

  Metabolic disorders disrupt these natural chemical reactions. […] This imbalance can cause specific substances to build up in the bodily fluids, leading to bad breath, or halitosis. […] Some metabolic disorders can cause bad breath, including: trimethylaminuria (TMA), diabetes, chronic kidney disease (CKD), liver disease, phenylketonuria (PKU), hypermethioninemia. […] These disorders may cause bad breath because of various issues with the intestines, blood, or liver. […] People with halitosis often have elevated salivary urea and uric acid concentrations compared with those without the issue. […] TMA runs in families and happens because someone has a fault with the FM03 gene. […] The smell occurs because the body cannot break down a particular amino acid called methionine in the blood.

• #1 Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

  https://www.mdpi.com/1660-4601/19/18/11303

  Periodontal diseases (gingivitis and periodontitis) are the oral inflammatory conditions that most often contribute to oral malodor, with the production of a very distinct, fetid or putrid smell. […] In patients with active periodontitis there is a significantly higher prevalence of damaged epithelial cells, leukocytes and bacteria in saliva compared to normal subjects. […] Many studies support a direct correlation between periodontal disease and halitosis.

• #1 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  This phenomenon is the most common cause of bad breath. The dorsum of the tongue, which is irregular and has a surface of 25 cm2 is an ideal niche for oral bacteria. Since desquamating epithelial cells and food remnants are available, putrefaction occurs. Hence, the tongue surface seems to be an important reservoir in the recolonisation of tooth surfaces. […] Poor oral hygiene, dental plaque, dental caries, accumulation and putrefaction of food remnants and unclean acrylic dentures (worn at night or not regularly cleaned or with rough surfaces) contribute to bad breath. […] A positive correlation between the depth of the pockets and the concentration of the sulphur components has been shown. […] Patients with a dry mouth often show an increased volume of plaque on teeth and tongue. The lack of salivary flow, leads to the disappearance of the antimicrobial activity of the saliva and the transition from Gram-positive bacteria to Gram-negative species.

• #1 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  Although xerostomia is associated with aging, studies have demonstrated that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably a condition of systemic or extrinsic origin. […] Halitosis is a common condition, affecting around 25% of the general population. The origin of the problem largely arises from intra-oral causes, whereas only a limited number of cases are the result of extra oral or systemic problems.

• #1

  https://perforacare.com/blogs/bad-breath/mouth-breath-odour-causes?srsltid=AfmBOoq-qQn3zdRGOlclAdXH0P-GGQFtMc7U7TCRz5k5-PRWBBTDaB0p

  GERD is a condition where the stomach acid flows back into the esophagus, causing heartburn, chest pain, nausea, and bad breath. This is because the stomach acid can irritate the lining of the esophagus and the throat, and also bring up the food and bacteria from the stomach, which can cause bad breath from the stomach. […] Diabetes can cause bad breath in several ways. First, diabetes can cause dry mouth, which can lead to bad breath. Second, diabetes can cause ketoacidosis, which is a life-threatening condition where the body breaks down fat for energy, producing ketones, which can cause a fruity or acetone-like breath odor. […] Chronic bad breath, on the other hand, is usually caused by internal factors, such as medical conditions, infections, or systemic diseases, and requires professional diagnosis and treatment. Chronic bad breath can also be a sign of a serious health problem, such as diabetes, kidney failure, liver disease, or cancer, and should not be ignored.

• #1 Bad breath – Wikipedia

  https://en.wikipedia.org/wiki/Bad_breath

  The bacteria that cause gingivitis and periodontal disease (periodontopathogens) are invariably gram negative and capable of producing VSC. Methyl mercaptan is known to be the greatest contributing VSC in halitosis that is caused by periodontal disease and gingivitis. […] The lower esophageal sphincter, which is the valve between the stomach and the esophagus, may not close properly due to a hiatal hernia or GERD, allowing acid to enter the esophagus and gases to escape to the mouth. […] There are a few systemic (non-oral) medical conditions that may cause foul breath odour, but these are infrequent in the general population. Such conditions are: Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure. […] One quarter of the people seeking professional advice on bad breath have an exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of the olfactory reference syndrome.

• #1 Halitosis or bad breath | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/halitosis-or-bad-breath

  Halitosis is caused by sulphur-producing bacteria in the tongue and throat. […] The major causes include a dry mouth caused by certain foods, smoking, poor oral hygiene and a coated tongue. […] Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. […] There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis. […] A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help.

• #1 Bad Breath (Halitosis) Treatment – Causes & Prevention

  https://adwcenter.com/blog/bad-breath/

  In complex clinical cases, beyond cleaning with ozonated water and laser therapy, we conduct an analysis on a microscopic level. Based on the results, we prescribe targeted medications that eliminate pathogenic bacteria without disrupting the oral microbiome. […] Malocclusion is one of the most common causes of bad breath in children. […] When the bite is misaligned, it becomes impossible to fully clean teeth and interdental spaces from plaque and food particles. This leads to tartar buildup, which causes gingivitis, bleeding gums, and a foul odor.

• #1 Halitosis: Etiology, diagnosis, and treatment | Perio Implant Advisory

  https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16411613/halitosis-etiology-diagnosis-and-treatment

  Mechanical removal of biofilm and microorganisms is the first step in the control of halitosis. […] Systemic removal of microorganisms (extraorally) is needed if the source of halitosis is not in the mouth. […] Due to the multifactorial complexity of halitosis, patients should be treated individually, rather than categorized.

• #2 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  Although xerostomia is associated with aging, studies have demonstrated that salivary gland function is well preserved in the healthy geriatric population. Therefore, dry mouth is probably a condition of systemic or extrinsic origin. […] Halitosis is a common condition, affecting around 25% of the general population. The origin of the problem largely arises from intra-oral causes, whereas only a limited number of cases are the result of extra oral or systemic problems.

• #2 Halitosis or bad breath | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/halitosis-or-bad-breath

  Halitosis is caused by sulphur-producing bacteria in the tongue and throat. […] The major causes include a dry mouth caused by certain foods, smoking, poor oral hygiene and a coated tongue. […] Halitosis (bad breath) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. Sometimes, these bacteria start to break down proteins at a very high rate and odorous volatile sulphur compounds (VSC) are released from the back of the tongue and throat. […] There is no one treatment for halitosis. The treatment will depend on what is causing the problem. Avoiding dehydration and good oral hygiene, including brushing and flossing, are important. Some mouthwashes, lozenges and toothpastes can assist in fighting halitosis. […] A course of an antibiotic, effective against anaerobic bacteria (such as metronidazole, to reduce the overgrowth of sulphur-producing bacteria), may also help.

• #2 Halitosis – Dental Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dental-disorders/symptoms-of-dental-and-oral-disorders/halitosis

  Halitosis most often results from degradation of food particles by anaerobic gram-negative bacteria in the mouth, producing volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan. […] Factors contributing to the overgrowth of causative bacteria include decreased salivary flow (eg, due to parotid disease, Sjgren syndrome, or use of anticholinergic medications), salivary stagnation, and increased salivary pH. […] Most halitosis results from degradation of food particles by anaerobic gram-negative bacteria that reside around the teeth and on the dorsum of the tongue.

• #2 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  Microbial degradation in the oral cavity is the main cause of oral malodour. Due to this process, volatile sulphur compounds (VSCs) are formed. The most important VSCs involved in halitosis are hydrogen sulphide (H2S), methyl mercaptan (CH3SH) and dimethyl sulphide (CH3)2S. These VSCs are mainly produced by Gram-negative anaerobic oral bacteria. […] Most of the responsible microorganisms in halitosis are involved in periodontitis. So, there is a positive correlation between bad breath and periodontitis: the depth of the periodontal pockets is positively correlated to the height of the VSC concentrations in the mouth. […] In nearly 85% of all halitosis cases, the origin is found in the oral cavity. A clinical evaluation of malodour on 2000 patients in Belgium, showed that 76% of these patients had oral causes: tongue coating (43%), gingivitis/periodontitis (11%) or a combination of the two (18%).

• #2 Bad Breath – CMS Dental

  https://cmsdental.com/en/patients/bad-breath/

  Most of the amino acids supplied come from the diet in the form of glycoproteins, i.e. proteins with carbohydrate side chains. […] The carbohydrate side chains have to be cut off before the anaerobic bacteria mentioned above can break them down into sulfur vapors (called VSC: volatile sulphuric compounds). […] This cutting is done by an enzyme called beta-galactosidase. It is an enzyme produced by other bacteria on the surface of the tongue, and is quite differently accessible to the toothbrush, but can also be affected by the composition of your oral bacteria. […] The bacteria that produce the sulfur fungi that cause bad breath are the same ones that cause periodontal disease (gum disease), so the two conditions are linked. […] P.Gingivalis and T.Forsythia are the two bacteria that produce sulfurous fungi in the oral cavity.

• #2

  https://resou.osaka-u.ac.jp/en/research/2024/20240214_1

  Taken together, these findings suggest that CH3SH production in the mouth is driven by the interaction between S. gordonii and F. nucleatum, says Hara. […] Understanding how these two bacterial species work together to cause bad breath could be helpful in developing ways to treat or even prevent bad breath.

• #2 Halitosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534859/

  The intraoral milieu contributes to 80% to 85% of cases of halitosis, where decarboxylation of amino acids such as acetic acid and propionic acid leads to malodorous amines like putrescine and cadaverine and other volatile aromatic compounds like indole and skatole. […] In physiological halitosis, which occurs on waking, the cause is putrefaction of entrapped food particles and desquamated epithelial cells by bacteria. […] The surface of the tongue has desquamated epithelial cells, leucocytes from periodontal pockets, food residues, and bacteria. The depth of the tongue papillae affects the biofilm coating on top, which prevents the cleansing action of saliva and promotes the growth of anaerobic bacteria, giving rise to halitosis. […] In individuals with halitosis, the posterior dorsum of the tongue is the main source of malodor.

• #2 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  This phenomenon is the most common cause of bad breath. The dorsum of the tongue, which is irregular and has a surface of 25 cm2 is an ideal niche for oral bacteria. Since desquamating epithelial cells and food remnants are available, putrefaction occurs. Hence, the tongue surface seems to be an important reservoir in the recolonisation of tooth surfaces. […] Poor oral hygiene, dental plaque, dental caries, accumulation and putrefaction of food remnants and unclean acrylic dentures (worn at night or not regularly cleaned or with rough surfaces) contribute to bad breath. […] A positive correlation between the depth of the pockets and the concentration of the sulphur components has been shown. […] Patients with a dry mouth often show an increased volume of plaque on teeth and tongue. The lack of salivary flow, leads to the disappearance of the antimicrobial activity of the saliva and the transition from Gram-positive bacteria to Gram-negative species.

• #2 Bad Breath (Halitosis) Types, Causes, Treatment, Elimination

  https://www.medicinenet.com/bad_breath/article.htm

  Other foods may get stuck in the teeth, promoting the growth of bacteria and dental plaques, which causes bad breath odor. […] Low carbohydrate diets may also cause „ketone breath.” These diets cause the body to burn fat as its energy source. […] The end-product of making this energy is ketones, which cause a fruity acetone-like odor on the breath when exhaled. This fruity odor in a diabetic might indicate uncontrolled blood sugars. […] Smoking and chewing tobacco can leave chemicals that remain in the mouth. […] Poor dental care can lead to a buildup of plaque in the mouth, which causes an odor of its own. Plaque buildup on the teeth can also lead to an unhealthy condition called periodontal (gum) disease. […] When plaque hardens, it is referred to as tartar (calculus). […] Tartar contains bacteria that can irritate the gums and lead to gum disease.

• #2

  https://journals.lww.com/jdyu/fulltext/2015/04010/oral_malodor__a_review_of_etiology_and.1.aspx

  Oral malodor is related to the salivary flow. Bad breath levels during the day are inversely related to salivary flow. […] Xerostomia or dry mouth is considered to be a major contributory factor in the production of oral malodor because reduced salivary flow weakens the normal cleansing mechanism of the mouth and predisposes the oral flora toward the Gram-negative organisms responsible for the malodor. […] The most likely pathogenesis of halitosis is microbial putrefaction of food debris, defoliated epithelial cells, saliva and blood. […] It is generally believed that halitosis reflects putrefaction by anaerobic, Gram-negative bacteria. […] These microorganisms digest proteins from food residues, cells and other saliva debris into amino acids. This is followed by further cleavage of certain amino acids to bad-smelling by-products of bacterial metabolism, predominantly VSCs (H2S, CH3SH and dimethyl sulfide [CH3]2S), organic acids (butyric acid), aromatic compounds (indole, skatole) and amines (putrescine, cadaverine).

• #2 Bad Breath (Halitosis) Types, Causes, Treatment, Elimination

  https://www.medicinenet.com/bad_breath/article.htm

  Infection and disease conditions that cause bad breath include: […] Sinus infections […] Pneumonia […] Sore throat (pharyngitis) and other throat infections […] The common cold and influenza(flu) […] Tonsil stones (tonsilloliths) […] Thrush […] Bronchitis […] Postnasal drip […] Diabetes […] Acid reflux (gastroesophageal reflux disease or GERD) […] Lactose intolerance, other stomach or digestion problems […] Some liver diseases or kidney diseases may be associated with bad breath. […] A dry mouth may be caused by salivary gland problems, connective tissue disorders (Sjgren’s syndrome), medications, or breathing through the mouth. […] Many medications used to treat allergies can cause dry mouth, another cause of halitosis. […] Bad breath in the morning is very common. Saliva production nearly stops during sleep, allowing odor-causing bacteria to grow, and causing bad breath.

• #2 Bad Breath – CMS Dental

  https://cmsdental.com/en/patients/bad-breath/

  85% of cases of persistent bad breath originate from the oral cavity. […] It is caused by sulfur fumes produced by bacteria living in the furrows of the tongue. […] In 85% of cases, the problem is caused by bacteria in the grooves on the upper surface of the back 1/3 of the tongue. These are so-called gram-negative anaerobic bacteria (i.e. bacteria that live in an oxygen-free environment) that live in the very deep grooves of the tongue. […] What causes bad breath is sulfurous fumes produced by bacteria breaking down amino acids containing sulfur atoms. These are the same chemical processes that take place in a sewer. […] There are two main players in the development of bad breath and they are two different types of bacteria working together. […] One type of bacteria is the one that produces sulfur dioxide and the other type of bacteria is the one that helps to break down carbohydrate side chains.

• #2

  https://journals.lww.com/jpbs/fulltext/2015/07002/halitosis___an_overview__part_i___classification,.6.aspx

  The intensity of malodor corresponds to the level of odoriferous substances in the oral cavity and gingival crevices, periodontal pockets, and posterior dorsum of the tongue are the most likely sites involved in the whole process. […] These VSCs released during microbial interactions are capable of initiating and accelerating periodontal pathology. Recently, it has been reported that hydrogen sulfide induce mitochondria-mediated apoptosis and DNA damage in human gingival fibroblasts by increasing the levels of reactive oxygen species. […] Extracellular matrix degradation is facilitated by induction of immune responses, matrix metalloproteinase activity by these VSCs. VSCs inhibit osteoblastic activity, activate osteoclastic activity, thus leading to pathogenic bone loss.

• #2 Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

  https://www.mdpi.com/1660-4601/19/18/11303

  Hydrogen sulfide, methyl mercaptan and, to a lesser extent, dimethyl sulfide, represent 90% of the VSCs in bad breath. […] These VSCs result from bacterial metabolism and its pathways are well described. […] The understanding and the development of VSCs measurement procedures could be used as clinical levels for the diagnosis of halitosis. […] Several classifications of halitosis are described in the literature, we considered the classification based on the origin of the VSCs which was established by the International Society for Breath Odor Research. […] Genuine halitosis is an oral malodor that is noticeable and exceeds the socially acceptable level. […] Pathological halitosis can originate from oral diseases—intra-oral halitosis, (e.g., tongue coating, periodontal infections, odontogenic infections, xerostomia, mucosal lesions) or systemic diseases—extra-oral pathologic halitosis (e.g., respiratory tract infections, gastrointestinal disease, metabolic disorders, endocrine system disorders, medication).

• #2

  https://perforacare.com/blogs/bad-breath/mouth-breath-odour-causes?srsltid=AfmBOoq-qQn3zdRGOlclAdXH0P-GGQFtMc7U7TCRz5k5-PRWBBTDaB0p

  Bad breath, also known as halitosis, is caused by the breakdown of food particles and bacteria in the mouth, which produce volatile sulfur compounds (VSCs) that cause the unpleasant odor. […] Bad breath is usually caused by the breakdown of food particles and bacteria in your mouth, especially on your tongue, teeth, and gums. The bacteria produce volatile sulfur compounds (VSCs), which are the main source of the unpleasant odor. […] Some VSCs are also produced by the bacteria in your nose, throat, and lungs, which can also contribute to bad breath. […] Sinusitis can cause nasal congestion, postnasal drip, headache, fever, and bad breath. This is because the mucus and bacteria that accumulate in your sinuses can produce VSCs that can escape through your mouth or nose. […] Tonsillitis can cause sore throat, difficulty swallowing, fever, and bad breath. This is because the bacteria and debris that collect on your tonsils can form white or yellow patches, called tonsil stones, which can emit a foul odor.

• #2 Revisiting Standard and Novel Therapeutic Approaches in Halitosis: A Review

  https://www.mdpi.com/1660-4601/19/18/11303

  Halitosis, or bad breath, is an oral health problem characterized by an unpleasant malodor emanating from the oral cavity. This condition can have different origins and causes a negative burden in social interactions, communication and quality of life, and can in uncommon cases be indicative of underlying non-oral non-communicable diseases. […] Most cases of halitosis are due to inadequate oral hygiene, periodontitis and tongue coating, yet the remaining proportion of cases are due to ear–nose–throat-associated (10%) or gastrointestinal/endocrine (5%) disorders. For this reason, the diagnosis, treatment and clinical management of halitosis often require a multidisciplinary team approach. […] Halitosis is characterized by an unpleasant odor emanating from the mouth, from oral or non-oral sources. This malodor mainly results from the presence of odoriferous substances–named volatile sulfur compounds (VSCs)–present in the exhaled air as a result of the action of anaerobic oral Gram-negative bacteria on substrates containing sulfur.

• #2 Bad Breath (Halitosis): Cure, Symptoms, Treatments & 6 Home Remedies

  https://www.emedicinehealth.com/bad_breath_halitosis/article_em.htm

  Bad breath (halitosis) can be caused by a variety of things, including diet, medication, poor oral hygiene, and diseases or conditions. […] Causes of bad breath include diet, medication, poor oral hygiene, and diseases such as diabetes, GERD, gum disease, and more. […] Bad breath (halitosis) can be caused by a variety of things, including diet, medication, poor oral hygiene, and diseases or conditions such as diabetes, GERD, lactose intolerance, gum disease, and more. Treatment for bad breath depends on the cause. […] Medications that cause a dry mouth can trigger bad breath. In addition, certain medications, such as triamterene and paraldehyde, have bad breath as a side effect. […] Bad breath can also be caused by decreased flow of saliva, which is a vital part of the digestive process and removes odor-causing particles in the mouth. Also called xerostomia, dry mouth may be caused by medications, breathing through the mouth, or salivary gland problems.

• #2

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=sig258649spec

  Everybody has bad breath from time to time, especially first thing in the morning. Saliva has a cleaning action that helps reduce or get rid of bad breath. When you have less saliva, bacteria can grow, causing bad breath. The flow of saliva almost stops during sleep. […] A major cause is decreased saliva. Saliva has a cleaning action that helps reduce or eliminate bad breath. When saliva decreases, bacteria can grow, causing bad breath. […] The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] When you become dehydrated, you do not produce as much saliva. The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] Bad breath caused by a decrease in saliva may be especially noticeable: In the morning. […] Bad breath is more common in people who miss meals or are dieting. […] The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] When you are dehydrated, you do not produce as much saliva. The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath.

• #2 What metabolic disorders cause bad breath?

  https://www.medicalnewstoday.com/articles/metabolic-disorders-that-cause-bad-breath

  As a result, the methionine builds up and causes the smell. […] If a person is unable to control their diabetes effectively, high glucose levels can cause harmful bacteria to grow. […] When this happens, the body begins to burn fat instead, producing compounds called ketones. […] These may build up in the blood and urine and cause bad breath. […] People with kidney failure may develop bad breath. […] As the kidneys begin to fail, they cannot efficiently excrete the metabolite urea in the urine, and it builds up in the blood and saliva. […] One of the symptoms of liver disease is the presence of volatile organic compounds in the breath. […] If a person’s breath has a strong, musty smell, it is a sign that their liver is not filtering out toxic substances, indicating liver disease. […] PKU is a genetic condition that causes the body to be unable to break down the amino acid phenylalanine. […] These conditions may cause metabolites to build up in the saliva, leading to bad breath.

• #2 Bad breath – Wikipedia

  https://en.wikipedia.org/wiki/Bad_breath

  The bacteria that cause gingivitis and periodontal disease (periodontopathogens) are invariably gram negative and capable of producing VSC. Methyl mercaptan is known to be the greatest contributing VSC in halitosis that is caused by periodontal disease and gingivitis. […] The lower esophageal sphincter, which is the valve between the stomach and the esophagus, may not close properly due to a hiatal hernia or GERD, allowing acid to enter the esophagus and gases to escape to the mouth. […] There are a few systemic (non-oral) medical conditions that may cause foul breath odour, but these are infrequent in the general population. Such conditions are: Fetor hepaticus: an example of a rare type of bad breath caused by chronic liver failure. […] One quarter of the people seeking professional advice on bad breath have an exaggerated concern of having bad breath, known as halitophobia, delusional halitosis, or as a manifestation of the olfactory reference syndrome.

• #2 Halitosis: Etiology, diagnosis, and treatment | Perio Implant Advisory

  https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16411613/halitosis-etiology-diagnosis-and-treatment

  Halitosis, also commonly known as bad breath, is a concern of many patients seeking help from health-care professionals. […] This article will briefly discuss the etiology, diagnosis, and treatment of halitosis. […] Morning breath (physiologic halitosis) is caused by stagnation of saliva, entrapment of food particles, and presence of bacteria on the dorsum of the tongue due to the decrease in salivary movement during sleep. […] Dental origin (intraoral) 75% of all cases. […] Medical origin (extraoral) 20% of all cases. […] Imaginary halitosis or delusional halitosis is a condition in which a subject believes that his or her breath odor is offensive despite any verification by a clinician or confidant. […] The available methods of halitosis treatment can be divided into these categories: mechanical reduction of microorganisms, chemical reduction of microorganisms, use of masking products, and chemical neutralization of VSCs. Etiology of halitosis is extremely important in order to determine if medical intervention is needed to treat systemic issues in addition to addressing the dental component.

• #3 Halitosis: How It Happens and How to Help | Office for Science and Society – McGill University

  https://www.mcgill.ca/oss/article/health/halitosis-how-it-happens-and-how-help

  Halitosis or chronic bad breath is very common, affecting up to 50% of the general population. […] Although halitosis can be multifactorial, 90% of cases arise from the mouth with poor oral hygiene being the leading culprit. […] Ingesting food left following eating, oral bacteria produce the volatile sulphur compounds mainly responsible for halitosis. […] Gum disease, oral infections and untreated cavities can all contribute to halitosis. […] Xerostomia, often caused by certain medications, dehydration and mouth breathing can be a leading cause of halitosis. […] While mostly emanating from the mouth, certain medical conditions can cause halitosis.

• #3 Halitosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK534859/

  The intraoral milieu contributes to 80% to 85% of cases of halitosis, where decarboxylation of amino acids such as acetic acid and propionic acid leads to malodorous amines like putrescine and cadaverine and other volatile aromatic compounds like indole and skatole. […] In physiological halitosis, which occurs on waking, the cause is putrefaction of entrapped food particles and desquamated epithelial cells by bacteria. […] The surface of the tongue has desquamated epithelial cells, leucocytes from periodontal pockets, food residues, and bacteria. The depth of the tongue papillae affects the biofilm coating on top, which prevents the cleansing action of saliva and promotes the growth of anaerobic bacteria, giving rise to halitosis. […] In individuals with halitosis, the posterior dorsum of the tongue is the main source of malodor.

• #3 Halitosis: the multidisciplinary approach | International Journal of Oral Science

  https://www.nature.com/articles/ijos201239

  This phenomenon is the most common cause of bad breath. The dorsum of the tongue, which is irregular and has a surface of 25 cm2 is an ideal niche for oral bacteria. Since desquamating epithelial cells and food remnants are available, putrefaction occurs. Hence, the tongue surface seems to be an important reservoir in the recolonisation of tooth surfaces. […] Poor oral hygiene, dental plaque, dental caries, accumulation and putrefaction of food remnants and unclean acrylic dentures (worn at night or not regularly cleaned or with rough surfaces) contribute to bad breath. […] A positive correlation between the depth of the pockets and the concentration of the sulphur components has been shown. […] Patients with a dry mouth often show an increased volume of plaque on teeth and tongue. The lack of salivary flow, leads to the disappearance of the antimicrobial activity of the saliva and the transition from Gram-positive bacteria to Gram-negative species.

• #3

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=sig258649spec

  Everybody has bad breath from time to time, especially first thing in the morning. Saliva has a cleaning action that helps reduce or get rid of bad breath. When you have less saliva, bacteria can grow, causing bad breath. The flow of saliva almost stops during sleep. […] A major cause is decreased saliva. Saliva has a cleaning action that helps reduce or eliminate bad breath. When saliva decreases, bacteria can grow, causing bad breath. […] The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] When you become dehydrated, you do not produce as much saliva. The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] Bad breath caused by a decrease in saliva may be especially noticeable: In the morning. […] Bad breath is more common in people who miss meals or are dieting. […] The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath. […] When you are dehydrated, you do not produce as much saliva. The reduced cleaning action of the saliva allows bacteria to grow, causing bad breath.

• #3 Bad Breath – CMS Dental

  https://cmsdental.com/en/patients/bad-breath/

  Most of the amino acids supplied come from the diet in the form of glycoproteins, i.e. proteins with carbohydrate side chains. […] The carbohydrate side chains have to be cut off before the anaerobic bacteria mentioned above can break them down into sulfur vapors (called VSC: volatile sulphuric compounds). […] This cutting is done by an enzyme called beta-galactosidase. It is an enzyme produced by other bacteria on the surface of the tongue, and is quite differently accessible to the toothbrush, but can also be affected by the composition of your oral bacteria. […] The bacteria that produce the sulfur fungi that cause bad breath are the same ones that cause periodontal disease (gum disease), so the two conditions are linked. […] P.Gingivalis and T.Forsythia are the two bacteria that produce sulfurous fungi in the oral cavity.

• #3 Halitosis (Bad Breath): Definition, Causes and Treatment

  https://professional.sunstargum.com/en-en/news-events/halitosis-definition-and-causes.html

  True halitosis, in which bad breath is objectively shown to exist, is divided into physiological and pathological halitosis. […] Pathological halitosis on the other hand, is often caused by blood born and gastroesophageal diseases, pathological processes in the oral cavity, or dysfunction of the oral tissues. […] The most common cause of halitosis has its origin in the oral cavity (93%), in particular, the metabolic activity of oral bacteria is a major cause, whereby gas-emitting bacteria on the tongue and below the gum line are largely responsible for the condition. […] In summary, changes in oral ecology have clear repercussions in the form of halitosis, while conditions related to poor dental hygiene such as tongue plaque, gingivitis and periodontitis are clearly responsible for some 83% of cases. […] Halitosis is therefore undoubtedly a matter for the dental practice.

• #3 Bad breath – Wikipedia

  https://en.wikipedia.org/wiki/Bad_breath

  Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odour is present. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder. […] Of those who have genuine bad breath, about 85% of cases come from inside the mouth. The remaining cases are believed to be due to disorders in the nose, sinuses, throat, lungs, esophagus, or stomach. Rarely, bad breath can be due to an underlying medical condition such as liver failure or ketoacidosis. […] In about 90% of genuine halitosis cases, the origin of the odour is in the mouth itself. This is known as intra-oral halitosis, oral malodour or oral halitosis. […] The most common causes are odour producing biofilm on the back of the tongue or other areas of the mouth due to poor oral hygiene. This biofilm results in the production of high levels of foul odours. The odours are produced mainly due to the breakdown of proteins into individual amino acids, followed by the further breakdown of certain amino acids to produce detectable foul gases. Volatile sulfur compounds are associated with oral malodour levels, and usually decrease following successful treatment.

• #3 Halitosis: Etiology, diagnosis, and treatment | Perio Implant Advisory

  https://www.perioimplantadvisory.com/clinical-tips/hygiene-techniques/article/16411613/halitosis-etiology-diagnosis-and-treatment

  Mechanical removal of biofilm and microorganisms is the first step in the control of halitosis. […] Systemic removal of microorganisms (extraorally) is needed if the source of halitosis is not in the mouth. […] Due to the multifactorial complexity of halitosis, patients should be treated individually, rather than categorized.

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