Breath odor

• Alternative Names

  Bad breath; Halitosis

• Considerations

  Some disorders will produce specific, characteristic odors to the breath.

  A fruity odor to the breath occurs as the body attempts to get rid of excess acetone through the breathing. This is a sign of ketoacidosis, which may occur in diabetes. It is a potentially life-threatening condition.

  Breath that smells like feces can occur with prolonged vomiting, especially when there is a bowel obstruction. It may also occur temporarily if a person has a tube placed through the nose or mouth to the stomach to drain the stomach contents (nasogastric tube) in place.

  The breath may have an ammonia-like odor (also described as urine-like or "fishy") in people with chronic kidney failure.

• Common Causes

  If previously normal breath turns into halitosis, causes could include:

  • Abscessed tooth
  • Alcoholism
  • Cavities
  • Dentures
  • Drugs
    • Paraldehyde
    • Triamterene and inhaled anesthetics
    • Insulin - injection
  • Food or beverages consumed (such as cabbage, garlic, raw onions, or coffee)
  • Foreign body in the nose (usually in children)
    • Often (but not always) there is a white, yellowish, or bloody discharge from one nostril
  • Gum disease (gingivitis, gingivostomatitis)
  • Impacted tooth
  • Lung infection
  • Poor dental hygiene
  • Sinusitis
  • Throat infection
  • Tobacco smoking
  • Vitamin supplements (especially in large doses)

  Diseases that may be associated with breath odor (not presented in order of likelihood -- some are extremely unlikely):

  • Acute necrotizing ulcerative gingivitis
  • Acute necrotizing ulcerative mucositis
  • Acute renal failure
  • Bowel obstruction (can cause breath to smell like feces)
  • Bronchiectasis
  • Chronic renal failure (can cause breath to smell like ammonia)
  • Diabetes (fruity or sweet chemical smell with ketoacidosis)
  • Esophageal cancer
  • Gastric carcinoma
  • Gastrojejunocolic fistula (fruity-smelling breath)
  • Hepatic encephalopathy
  • Diabetic ketoacidosis
  • Lung abscess
  • Ozena, or atrophic rhinitis
  • Periodontal disease
  • Pharyngitis
  • Zenker's diverticulum
• Home Care

  Use proper dental hygiene (especially flossing), and remember that mouthwashes are not effective in treating the underlying problem.

  Fresh parsley or a strong mint are often effective ways to fight temporary bad breath. Avoid smoking. Otherwise, follow prescribed therapy to treat the underlying cause.

• Call your health care provider if
  • Breath odor persists and there is not an obvious cause (such as smoking or eating odor-causing foods).
  • You have breath odor and signs of a respiratory infection, such as fever, cough, or face pain with discharge from the nose
• What to expect at your health care provider's office

  Your doctor will take a medical history and perform a physical examination.

  You may be asked the following medical history questions:

  • Is there a specific odor?
  • Is there a fishy smell?
  • Does the breath smell like ammonia or urine?
  • Does the breath smell like fruit or is there a sweet-chemical smell?
  • Does the breath smell like feces?
  • Does the breath smell like alcohol?
  • Have you recently eaten a spicy meal, garlic, cabbage, or other "odorous" food?
  • Do you take vitamin supplements?
  • Do you smoke?
  • Does good oral hygiene improve the odor?
  • What home care measures have you tried? How effective are they?
  • Is there a recent sore throat, sinus infection, tooth abscess, or other illness?
  • What other symptoms do you have?

  The physical examination will include a thorough examination of the mouth and the nose. A throat culture may be taken if you have a sore throat or mouth sores.

  In rare cases, diagnostic tests that may be performed include:

  • Blood tests to screen for diabetes or kidney failure
  • Endoscopy (EGD)
  • X-ray of the abdomen
  • X-ray of the chest

  Antibiotics may be prescribed for some conditions. For an object in the nose, the doctor will use an instrument to remove it.

Review Date: 4/24/2008

Reviewed By: Michael Kapner, D.D.S., General and Cosmetic Dentistry, New Rochelle, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, M.D., MHA, Medical Director, A.D.A.M., Inc.