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Akaji et al
Vol 12, No 4, 2014 297
REVIEW ARTICLE
Halitosis is an offensive or disagreeable odour
emanating from the mouth or hollow cavities of
the nose, sinuses or pharynx.71,73, 91 Other general
terms used to describe this unpleasant condition
are fetor oris, fetor ex oris, oral malodour, foul
breath or bad breath.2,18 Halitosis can be classied
as genuine halitosis, pseudo-halitosis or as halito-
phobia.35,94 Genuine halitosis is either physiologi-
cal or pathological in origin, while pseudo-halitosis
is the claim that halitosis exists when no objective
evidence can be found.35,94 In genuine halitosis,
bacterial activities in the oral cavity are implicated
in 80%–90% of cases.26,73 Researchers have de-
tected over 600 species of microorganisms in the
oral microbiota.33,36 These operate mainly by their
action on sulfur amino acids such as cysteine, cys-
tine and methionine to produce volatile sulfur com-
pounds (VSCs) such as hydrogen sulde (H2S), me-
Halitosis: A Review of the Literature on Its Prevalence,
Impact and Control
Ezi A. Akajia/Nkiru Folaranmib/Olufunmilayo Ashiwajuc
Summary: Halitosis is the offensive or disagreeable odour that may emanate from the mouth. In 80% –90% of cases,
bacterial activities especially on the dorsum of the tongue are implicated. Current studies on halitosis accessed from
electronic databases were appraised in the light of prevalence, impact and control of halitosis. Halitosis has a world-
wide occurrence with a prevalence range of 22% to 50%. Due to the associated social and psychological effects, it
should be taken seriously in all affected patients. Oral healthcare professionals ought to be well informed, because
their ofce(s) are usually the rst points of call for the affected patients.
Key words: control, halitosis, prevalence, prevention
Oral Health Prev Dent 2014;12:297-304 Submitted for publication: 17.08.13; accepted for publication:08.01.14
doi: 10.3290/j.ohpd.a33135
a Senior Lecturer and Consultant Public Health Dentist, Depart-
ment of Preventive Dentistry, College of Medicine, University of
Nigeria, Enugu Campus, Enugu, Nigeria. Study concept and de-
sign, the review of study materials, coordinated manuscript writ-
ing, proofread manuscript.
b Senior Lecturer and Consultant Orthodontist, Department of
Child Dental Health, College of Medicine, University of Nigeria,
Enugu Campus, Enugu, Nigeria. Reviewed study materials, proof-
read manuscript.
c Lecturer and Consultant Paediatric Dentist, Department of Child
Dental Health, College of Medicine, University of Lagos, Idi-Araba,
Lagos, Nigeria. Provided technical support, proofread manuscript.
Correspondence: Dr. Ezi A. Akaji, Department of Preventive Den-
tistry, College of Medicine, University of Nigeria, Enugu Campus,
Enugu 234, Nigeria. Tel: 234- 806- 956-5601.
Email: ezi.akaji@unn.edu.ng
thyl mercaptan (CH3SH) and dimethyl sulde
(CH3SCH3) as metabolites.2,18,24,57 Some micro-or-
ganisms and other conditions associated with hali-
tosis are listed in Table 1.
Various sites in the oral cavity serve as niches
for these bacteria, but the dorsum of the tongue
with its characteristic ssures and grooves is their
primary location.1,35,40,64,83,93,95 The tongue pro-
vides a suitable environment for the growth of
these organisms, as favourable redox potentials
are found in the deep crypts associated with the
structure of the tongue papillae.30 Quirynen et al61
demonstrated that tongue coating – whether pre-
sent alone or with periodontal inammation – was
associated with halitosis in more than 1200 of
2000 patients of a breath clinic. The aim of the
present study was to assess the prevalence of hal-
itosis, impact on the individual and the wider soci-
ety and the available control measures for this pub-
lic health issue.20 This review may be useful to oral
healthcare professionals in treatment planning de-
cisions and in providing information to share with
patients who are burdened with oral malodour.
DATA SOURCES AND STUDY SELECTION
Articles published between 1990 and 2012 from
the University of Nigeria electronic library and inter-
net-based publications were retrieved. The words
‘halitosis’ and ‘oral malodour’ were used as key
words for the electronic data search. Available full
Akaji et al
298 Oral Health & Preventive Dentistry
articles were accessed and stored on a CD-ROM.
Sorting was done to exclude all publications before
1990 while those from 1990 and 2012 were includ-
ed. The authors read the articles and extracted data
on prevalence, impact and control of halitosis. If any
author had more than one article on halitosis or its
correlates, the most suitable for each subheading
under focus was selected; this was done to accom-
modate as many authors’ views as possible.
PREVALENCE OF HALITOSIS
Halitosis is a problem that has plagued people for
thousands of years; it ranks third amongst the rea-
sons for patients’ visit to the dentist.14,24 It can be
detected organoleptically (i.e. by nose) and instru-
mentally using sulde monitors or gas chromatogra-
phy,57,66,68 ,96 although results of these different
methods do not always agree.15 The prevalence of
halitosis differs across the globe due to variations
in the perception of odours among people of differ-
ent races and cultures, absence of uniformity in
evaluation as well as a disparity between self-per-
ceived and clinically detected halitosis re-
ports.11,44,63 However, the overall prevalence ranges
from 22% to 50%, being higher when self-reported
than clinically detected.18,71 Table 2 shows the prev-
alences of halitosis extracted from some studies.
Tangerman and Winkel,88 in their assessment of
58 subjects without periodontal disease but with
complaint of malodour, found 10.4% of them with
halitosis from non-oral sources. They also repor ted
dimethyl sulde (CH3SCH3) and methyl mercaptan
(CH3SH) as the main VSCs associated with extra-
oral and intra-oral halitosis, respectively.12 In their
study on daily variation of oral malodour and related
factors in community-dwelling elderly subjects, Sam-
nieng et al72 found a signicant association between
the concentration of CH3SCH3 with systemic diseas-
es and routine intake of medications at all times of
measurements. Subjects with systemic disease and
routine intake of medicines (80.7%) tended to have
a higher concentration of CH3SCH3 than their coun-
terparts. Although halitosis from non-oral sources is
generally not common, records from a multidisciplin-
ary breath clinic show that the most frequent non-
oral source is in the ear, nose and throat area.21,22
IMPACT OF HALITOSIS ON THE INDIVIDUAL
AND SOCIETY
Halitosis has both medical and social aspects, the
latter being responsible for most of the concern in
recent times.9,19,73 Some phrases used to describe
it in the literature include social stigma,6 social
health problem,63 universal medico-social prob-
Table 1 Aetiological agents/conditions associated with halitosis
Bacteria in oral cavity
Other oral
contributory
factors Consumables (food and drugs) Non- oral sources
Treponema denticola, Porphyr-
omonas gingivalis, Porphyromonas
endodontalis, Prevotella interme-
dia, Bacteroides loescheii,
Enterobacteriaceae, Tannerella
forsythia, Centipeda periodontii,
Eikenella corrodens, Fusobacte-
rium nucleatum, Micromonas
micros, Campylobacter rectus,
Desulfovibrio and Eubacterium
spp.8,16,37,43,58
Tooth decay,
gingival
inammation,
poor oral
hygiene,
dental
abscesses
and presence
of dental
prosthe-
ses6,55
Drugs causing dry mouth
(xerostomia) – anti- cholinergics,
e.g. atropine, anti-depressants;
diuretics, e.g. furosemide;
anti-hypertensives, e.g. methyl-
dopa and captopril; analgesics,
e.g. codeine, methadone,
ibuprofen and piroxicam; anti -
histamines, e.g. brompheniramine
and diphenhydramin; some
cytotoxic agents, solvent
abuse45,58
Non- oral sources of halitosis
include ENT infections (acute
pharyngitis, purulent sinusitis, and
postnasal drip); bronchial and lung
disease (chronic bronchitis,
bronchiectasis, bronchial carci-
noma), liver diseases (cirrhosis),
kidney disorders (chronic renal
failure), metabolic disorders
(diabetes/diabetic ketoacidosis),
GIT disorders, e.g.
GERD11,45,58,84,91
Peptostreptococcus anaerobius,
Collinsella aerofaciens, Veillonella
spp., Selenomonas flueggei, and
Proteus mirabilis89
Dry mouth,
food impac-
tion areas in
between
teeth, oral
ulcerations,
oral malignan-
cies6,24,39,58,87
Onions, garlic, cof fee, alcohol,
cigarettes14,35,38 ,68,74
Other conditions linked with
halitosis: dehydration, old age,
anaemia, hypovitaminosis,
emotional stress, inammatory
autoimmune diseases and
obstruction of salivar y glands,
malignancy and irradiation for
head and neck cancers, multiple
sclerosis, menopause45,58
Atopobium pavulum, Eubacterium
sulci, Fusobacterium periodonti-
cum, Dialister spp., Solobacterium
moorei, certain uncharacterised
Streptococcus species29,33
Akaji et al
Vol 12, No 4, 2014 299
lem63 and social-life killer.9 Hence, it could consti-
tute a handicap leading to withdrawal from social
circles by affected individuals.24,34 Data analysed
from 465 patients who attended the halitosis clinic
at the University of Basel over a 7-year period re-
vealed that social life was affected in about 388 of
them.97 Sufferers of halitosis can also be plagued
with anxiety regardless of whether the condition is
real or imagined.4,75,90 Anxiety in this context is
mo re or l ess phobia-me diate d, leading to avoidance
of dental visits, poorer oral health and ultimately to
a heightened or real oral malodour.75 Clinicians ob-
served a trend among victims: behavioural practic-
es such as use of mints and chewing gum, mouth-
wash, sprays and dental oss, increased frequency
of toothbrushing and toothbrushing force were ap-
plied to mask bad breath.10,14,49,58 Thus, proper pro-
fessional guidance in employing some of these
practices is strongly encouraged to avoid unwanted
side effects, such as tooth-wear lesions and caries.
Other challenges that can ensue from halitosis
are low self-esteem and self-condence, hampered
intimate relationships such as dating and marriage,
decreased quality of life, unfullled career aspira-
tions, loneliness, depression, substance abuse,
dropping out of school, suicidal tendencies and di-
Table 2 Prevalence of halitosis extracted from some studies
Authors /
year Location Subjects/N
Typ e o f
assessment Prevalence report
Other observations /
conclusion
Odai et al,
201055 Benin city,
Nigeria
41 consecutive
patients attending a
halitosis clinic
Organoleptic
assessment
80.5% with genuine
halitosis
The most af fected
population was the age
group 60–69
Eldarrat et
al, 200824 Libya
498 student volun -
teers and of ce
workers
Self-perceived 44.4% in males and
54.2% in females
Halitosis was perceived
mostly upon awakening
Almas et
al, 20036Riyadh 481 dental students
(19 –24 years) Self-perceived 44% in males and 32% in
females
Smoking, dr y mouth and
tea consumption were
the other features
Mbodj et
al, 201147 Senegal 62 dental prostheses
users
Measurement
of VSCs using
halimeter
35.4% for all cases:
72.2% for xed denture
users and 27.3% for users
of removable dentures
Mean VSC level 157.7 ±
152.6 ppb was much
higher than the cut-off
point VSC ≥ 152.6
Arowojolu
and
Dosunmu,
20047
Ibadan,
Nigeria
255 consecutive
patients (16–74 years)
Organoleptic
assessment
14.5% among attendees
of the periodontology
clinic
Signicant differences
were found in the
prevalence of halitosis
according to age group,
oral hygiene status and
social class
Liu et al,
200642 China 2000 (15–64 years)
Organoleptic
assessment
and with
sulde monitor
27.5% by organoleptic
score
Tongue coating, peri-
odontal status and
plaque index had positive
associations with level of
oral malodour
Bornstein
et al,
2009a12
Switzer-
land
419 individuals
from Bern,
(18 –9 4 years)
Organoleptic
assessment
and VSC
measurement
28% had readings of ≥
75 ppb VSCs in their
breath (halimeter)
Weak correlation
between self-reported
with either organoleptic
or VSC measurement
Bornstein
et al,
2009b13
Switzer-
land
625 Army recruits
(18 –25 yea rs)
Compared
self-perceived
halitosis with
clinical data
20% prevalence of
halitosis
No correlation between
self-reported halitosis
and clinical measure-
ment was detected
Söder et
al, 200080 Sweden Swedish men/ 1681 Clinically rated
halitosis 41 (2.4%) prevalence
Signicantly higher
probing depth and
gingival index
Miyazaki et
al, 199551 Japan 2672 individuals aged
18 to 64 years
VSCs scores
with halimeter 6%–23%
Signicant link between
VSC values and tongue
coating status; periodontal
conditions were observed
Akaji et al
300 Oral Health & Preventive Dentistry
vorce.3,4,9 Ancient Hebraic texts (the Talmud) pro-
vided legal backing to broken marriages if one part-
ner had oral malodour and similar references were
found in writings from Greek, Roman, early Chris-
tian and Islamic cultures.73
The effect of halitosis goes beyond the immedi-
ate sufferer as relatives and friends also share in
the burden.9,19 Apart from the awkward scenario
created by the condition, relatives may need to re-
assure or counsel the sufferers about their bad
breath.9,55 Delanghe et al22 reported that more than
70% of the attendees at a Belgian breath clinic were
advised by others to seek treatment; in a suburban
health facility in Nigeria, 31.7% and 24.4% were in-
formed of the symptoms by friends and spouses,
respectively, before they visited the clinic.55 From
an economic point of view, productive hours are lost
while sufferers seek solutions to their predicament,
with a concurrent boom in the mouthwash indus-
try.9,55 This is evidenced by the $700 million dollars
spent on mouthwashes by Americans in 2000 and
more than $850 million dollars in the previous
years.52,67 Meningaud et al49 reported over 2 billion
dollars spent annually on products to mask halito-
sis. It can be concluded that a great deal of social,
psychological and economic resources are devoted
to halitosis both at the individual and community
levels, since its impact cuts across culture, religion,
race, sex and social taboos.63,73
PREVENTION AND CONTROL OF HALITOSIS
Halitosis, a condition with known microbial and bio-
chemical parameters, can be prevented and/or
controlled.2,41,44,85 Each case is treated differently
depending on its origin, making a holistic approach
necessary.53 Before a treatment plan can be devel-
oped for any patient, an accurate diagnosis based
on the patient’s history, physical examination, or-
ganoleptic assessment and evaluation of any la-
boratory tests must be made.48 Also, a review of
signicant aspects of the patient’s family and so-
cial history (such as dietary and smoking habits),
drug histories, illnesses, hospitalisations and sur-
geries are invaluable in reaching an appropriate di-
agnosis.48 In 1999, Miyazaki et al50 established
the recommended classication for halitosis with
the corresponding treatment needs:
• TN-1: Explanation of halitosis and instructions
for oral hygiene (support and reinforcement of a
patient’s own self-care for further improvement
of his/her oral hygiene).
• TN-2: Oral prophylaxis, professional cleaning and
treatment of oral diseases, especially periodon-
tal diseases.
• TN-3: Referral to a physician or medical specialist.
• TN-4: Explanation of examination data, further pro-
fessional instruction, education and reassurance.
• TN-5: Referral to a clinical psychologist, psychia-
trist or other psychological specialist.
Dental clinicians may implement the TN-1 modality
as treatment of physiologic halitosis; TN-1 and TN-2
apply to oral pathological halitosis, while TN-1 and
TN-4 would sufce for pseudo-halitosis.50,94 Treat-
ment of extraoral halitosis should be performed by
a physician or medical specialist in line with TN-3,
while treatment of halitophobia should be by a clin-
ical psychologist, psychiatrist or psychologist (TN-
5).50,94 TN-2 procedures entail mechanical reduc-
tion of tongue coating as well as gingivitis and
periodontitis therapy.50,59 Some clinicians have ad-
vised adequate oral hygiene at home: toothbrush-
ing, ossing and moderate tongue scraping or
brushing using an infant toothbrush or a small
tongue brush to remove the microbial causal
agent(s).53,54,85 Chemical agents and use of natural
ingredients such as mouthrinses containing chlor-
hexidine, triclosan, cetylpyridinium chloride, essen-
tial oils or hydrogen peroxide could also be pre-
scribed.18,35,64 Metal ions, e.g. stannous, zinc and
copper ions, are useful in controlling halitosis
through their anti-plaque properties, that is, by the
oxidation of either thiol groups in the sulfur-contain-
ing precursors of VSCs or the odoriferous substanc-
es themselves to non-volatile substances.35 Chlor-
ine dioxide is another antibacterial mouthwash that
may be used against oral malodour.28,79 Two sepa-
rat e cli nica l tri als b y the s ame r esea r ch gr oup f ound
it effective as an oxidant in both healthy and af-
fected subjects for the control of oral malodour.77,78
Other agents against halitosis include bacterio-
cin-producing microorganisms (probiotics) such as
Streptococcus salivarius K12 and Lactobacillus sali-
varius WB21.16,32,46 Here, the objective is to pre-
vent re-establishment of undesirable bacteria,
thereby limiting the re-occurrence of oral malodour
over a prolonged period, since probiotics are keen
competitors of oral malodour bacteria.11 Herbal
and natural products have also been advocated for
the control of halitosis.31,62,76,81,82, 86 Green tea
mouthwash containing green tea extracts demon-
strated an appreciable effect among 60 patients
with gingivitis who had at least 80 ppb VSCs in
mouth air. The reduction in malodour observed was
Akaji et al
Vol 12, No 4, 2014 301
Table 3 Summary of some interventional data on prevention and control of halitosis
Authors/
year Study design Strategy used Results
Effectiveness of the
method
Odai et al,
201055
Prospective study of 41
consecutive patients
given clinical interven-
tions
Scaling and polishing;
restorations of cavities and
replacement of dentures
Reduced bacterial load in
patients’ mouth
Satisfactory outcome in 90.2%
of cases
Rösing et
al, 200970
Double blind crossover
study involving 14
subjects (20–35 years)
with healthy periodon-
tium
Use of 2 chewing gums as
masking agents measured in 2
series: 1st without and 2nd
after a mouthrinse c ontaining
cysteine
VSCs production was same for
both over time in the 2 series,
largest reduction (71% to 52%)
observed after 5 and 15 min
VSCs production diminished
after chewing gum; reduction
enhanced by cysteine rinses.
Effect was not sustained; only
served as a temporary
measure
Faveri et
al, 200625
Blinded crossover
study involving 19
volunteers
Tongue scraping and interdental
cleaning done thrice a day for 7
days, then washouts
Reduced VSCs in morning
breath in subjects with healthy
periodontium
In periodontally healthy
subjects, tongue scr aping was
an impor tant method of
reducing halitosis
Pedrazzi
et al,
200456
Crossover trial
involving 10 healthy
subjects (20–50 years)
Efcacy of 2 methods for tongue
cleaning – toothbrush and tongue
scraper were compared through
a handheld sulde monitor
The tongue scraper yielded a
75% reduction in VSCs, while
the toothbrush only achieved a
45% reduction in VSCs
Tongue scraper performed
better in reducing the
production of VSCs
Quirynen
et al,
200260
Experimental study
involving 16 dental
students who rinsed
with one of the 3
solutions in a
randomised order
Rinsing with CHX-Alc, CHX-CPC-
Zn, or AmF/SnF2 mouthrinse,
used twice daily for 1 week
Zinc cations added to CHX
mouthrinse yielded 40%
reduction in VSC, 80%
reduction in organoleptic
expired ratings
Sulfur binding to zinc produced
an enhanced effect of halitosis
reduction
Carvalho
et al,
200417
Randomised double-
blind crossover study
involving 12 dental
students
Use of 4 different mouth rinses
twice daily without mechanical
plaque control
Reduced VSCs formation. Best
result using 0.2% CHX, then
0.12% CHX + triclosan+
essential oils then CPC
Benecial impact of mouth
rinses on VSCs even in
absence of mechanical plaque
control
Van
Steen-
berghe et
al, 200192
Double-blind ran-
domised study
involving 12 (aged
21–23 years) medical
student volunteers
Randomised daily rinse with 1
of the following: CHX, CHX- NaF
or HX-CPC-Zn
CHX-CPC-Zn was more
effec tive in reducing organo-
leptic scores and sulde
monitoring readings
Benecial effect on halitosis
althoug h the mode of action
was unclear
Shinada
et al,
201078
Randomised double-
blind crossover,
placebo-controlled trial
involving 15 male volun-
teers (19–38 years)
Divided subjects into 2 groups
that rinsed with either mouth-
wash cont aining chlorine dioxide
(ClO2) or placebo mouthwash
without ClO2 for 7 days
Concentrations of VSCs
decreased for those who used
the experimental mou thwash
for 7 days; plaque and tongue
coating also decreased
Further investigations on
long-term effects of ClO2 and
its effect on periodontal
diseases and plaque accumula-
tion are needed
Feng et
al, 201027
Randomised con-
trolled, single-blind,
3- or 4-period
crossover investigation
involving 100 subjects
aged 19–62 years
Brushing with stannous- contain-
ing sodium uoride (NaF )
dentifrice in 4 independent
trials
The stannous-containing NaF
dentifrice showed greater
breath benets through
reduction of VSCs compared
to the negative control
dentifrice
Halitosis reduced at all three
points analysed, stannous-
containing NaF dentifrice
provided additional, simultane-
ous cosmetic and therapeutic
oral health benets
Burton et
al, 200616
Recruitment of 23
subjects (18–69 years)
from a population who
asserted they had
halitosis
Replacement of bacteria implicat-
ed in halitosis by S . salivarius
K12. A 3-day CHX mouthrinsing
followed at intervals with
lozenges containing S. salivarius
or a placebo
85% and 30% of S. salivarius
and placebo groups,
respectively, showed
substantial reduction of the
implicated bacteria.
Bacteriocin-producing S.
salivarius given after mouth-
wash treatment reduced VSCs
levels – randomised clinical
studies needed to validate the
result
Iwamoto
et al,
201032
Recruitment of 20
patients who
complained of halitosis
at the clinic within a
period of 14 months
2.01 x 109 Lactobacillus
salivarius WB21 and 840m g
xylitol t ablets were dissolved in
the mouth daily. Evaluation af ter
2 to 4 weeks was done at the
same time of day for each
subject
Oral malodour parameters
signicantly decreased at 2
weeks in the subjects with
physiological halitosis. The
scores of an organoleptic test
and bleeding on probing
decreased at 4 weeks the
subjects with oral pathologic
halitosis
Oral administration of probiotic
lactobacilli primarily improved
physiological halitosis and also
showed benecial effects on
bleeding on probing from the
periodontal pocket
Abbreviations: CHX = chlorhexidine (0.2%); CHX-Alc = 0.2% chlorhexidine- alcohol mouthrinse; CH X-CPC-Zn = 0.05% CHX + 0.05% cetylpyridinium
chloride + 0.14% zinc lactate mouthrinse; AmF/SnF = an amine uoride/stannous uoride (125 ppm F-/125 ppm F -) containing mouthrinse; CPC
= cetylpyridinium chloride; CHX-NaF = 0.12% chlorhexidine + 0.05% sodium uoride; CHX-C PC-Zn = 0.05% chlorhexidine + 0.05 cetylpyridinium
+ 0.14% zinc lactate; VSCs = volatile sulfur compounds.
Akaji et al
302 Oral Health & Preventive Dentistry
linked to the ability of the green tea catechins to
transform VSCs to non-odorigenic substances;
they were especially anti-microbially active against
P. gingivalis.62 Other herbal agents, such as Euca-
lyptus extract in chewing gum and extracts of me-
dicinal herbs – e.g. Scutellariae radix, Phellodendri
cortex, Moutancortex and Magnoliae cortex – had a
masking effect on oral malodour.31,86 Each of these
has been used to develop a gargle solution which
produced a positive outcome on halitosis. Palatal
muco-adhesive formulations containing herbal ex-
tracts also alleviated oral malodour for few hours
up to one day.81,83 These muco-adhesive formula-
tions reduced VSC scores to an extent comparable
to that of chlorhexidine and zinc mouthrinses.
Finally, it is advised that diagnosis of pseudo-hali-
tosis or halitophobia be made with caution; abnor-
mal oral deposits, carious teeth and other oral con-
ditions which suggest genuine halitosis must rst be
ruled out.5,23 Evaluation of the psychological predis-
position of such patients is invaluable; thus, the
TN-5 regimen is advised.94 For halitosis from non-
oral sources, a multi-disciplinary approach is indicat-
ed as prescribed by TN-3.50,94 Referrals to special-
ists such as otolaryngologists, gastroenterologists
or mental health specialists should be done once
possible oral contributors are excluded.5,21,41 Since
existing data show that patients’ response to treat-
ment is enhanced by educating the public and
healthcare personnel (especially dental clinicians),21
it is imperative to convey correct information on hali-
tosis both at the individual and public level. Undoubt-
edly, this will dispel some myths about halitosis and
aid in the prevention and control of the condition.
Some interventional studies on prevention and con-
trol of oral malodour are summarised in Table 3.
CONCLUSIONS
Halitosis is a public health issue which leads to social
embarrassment as well as decreased quality of life
and may be an indication of systemic diseases or seri-
ous conditions in the nasopharynx, oropharynx, hy-
popharynx, larynx and oesophagus. However, the ma-
jority of cases are of oral origin. It is prevalent worldwide,
affecting the individual and society, but in most cases
it can be controlled. Due to the associated social and
psychological effects on the individual, halitosis needs
to be handled with great care and should be taken seri-
ously by the dentist and dental hygienist. Where neces-
sary, interdisciplinary management should be initiated
as early as possible after the diagnostic process.
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