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07-5631-19009: Halitosis: A Clinical Review

Course Abstract:

Contact Hours (CE): The Academy of Dental Learning and OSHA Training, LLC, designates this activity for 7 continuing education credits (7 CEs).
Questions? Contact Us: Phone: 800-522-1207, Fax: 800-886-3009, or Email:
Published: May 2005
Updated: February 2020
Expires February 2023
Pages: 52
Course Instructors: Mary Oeding, RDH, M.Ed.
Health Science Editor Megan Wright, RDH, MS
No conflicts of interest are reported by the author or by educational planning committee members.

Educational Objectives

Upon completion of this course, the student will be able to:

  1. Describe effective methods for diagnosing causes of halitosis.
  2. Name compounds responsible for odors in the mouth.
  3. Describe medical conditions that cause or contribute to mouth odor.
  4. Explain an effective home-care routine that reduces or eliminates most halitosis originating in the mouth.

Course Description

This course is a comprehensive overview of the common issue in dentistry of halitosis.

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.

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.

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.

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. 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.
People who suffer from persistent uncontrollable halitosis may have an underlying pathology including:

  • Gastrointestinal ulcers
  • Gastric reflux
  • Respiratory tract infections
  • Internal bleeding
  • Hiatal hernia
  • Diabetes mellitus
  • Hepatic cirrhosis
  • Leukemia
  • Uremia

Oral malodor appears linked to periodontal disease in some studies, 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 suicide . If a patient complains of bad breath, (repeatedly) that is not detectable, refer them to a mental health care professional.

About the Author

Ms. Wright is a continuing education editor and writer as well as a Temp PRN with agencies in the Washington State area. Ms. Wright earned her MS at the UNM and Pierce College of Washington State in 1997 and certification in Utilization of the 970 Diode Laser and Safety in Dentistry in February of 2015. Ms. Wright works to implement Dental Education seminars as a Hospital-Dental Liaison building collaborative, mutual efforts to promote patient wellness between medical practitioners and dentists while prioritizing care for untreated, medially compromised patients.

How to Take This Course

Click on the logo below to open the course book. Study the course then return to this page and click to Take the Exam. Upon successful completion of the exam you will be asked to register and pay over a secure connection. Your exam will grade automatically and your certificate will display for you to save and/or print for your records.

Contact Hours: 7.00
Price: $70.00

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