Halitosis: Types / Classifications

- The type of breath problem a person has must first be identified before it can be successfully treated.

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Link to tongue debris graphic.
Link to postnasal drip graphic.

When a dental professional initiates a patient's treatment, they must first make an assessment of the type of breath condition from which they are suffering. This is important because the needed solution for different types of conditions varies significantly.

The three major classifications of breath problems are:

  • Genuine halitosis
  • Pseudo-halitosis
  • Halitophobia

A) Genuine Halitosis

This category refers to bad breath that can be readily detected by organoleptic testing (just smelling the person's breath with your nose) or by the use of some type of testing apparatus that can detect the compounds typically associated with bad breath (volatile sulfur compounds).

There's an obvious malodor and it has an intensity that lies beyond what's generally considered socially acceptable. And as such, it tends to affect personal relationships.

B) Pseudo-halitosis

This classification refers to a situation where an odor problem does not exist (cannot be detected by smell or scientific testing) but the patient still feels that they have bad breath. Since no real breath problem exists, treatment consists of counseling the patient about their misconception.

A study by Quirynen (2009) determined that pseudo-halitosis represents about 15% of cases. [page references]

C) Halitophobia

A situation where a patient's perception of a breath problem continues to exist despite the successful treatment of their genuine halitosis condition or, in the case of pseudo-halitosis, after receiving counseling. At this point, treatment for the patient's condition needs to be referred to a medical professional who can provide appropriate psychological counseling.


Bacterial accumulation on the back part of the tongue.

The most common cause of genuine halitosis.

The subcategories of Genuine Halitosis.

Medical professionals subdivide the genuine halitosis category (see above) into two further classifications, "physiologic" and "pathologic" halitosis.

1) Pathologic Halitosis

The person's breath odor is a symptom of a disease or other pathologic condition, or aggravated by it.

2) Physiologic Halitosis

This category refers to those situations where the person's malodor is attributable to putrefaction processes taking place in their oral cavity, frequently within the white-colored coating found on the posterior portion of their tongue (see illustration).

This is the most common form of bad breath, the type that 90% of cases involve. (Bartold 2016)

In most cases this type of condition can be resolved with improved oral home care, especially if tongue cleaning is included.

This classification of bad breath is considered to be transient, in the sense that its presence comes and goes (as determined by temporary localized conditions in the mouth) and that it can be relatively easily resolved.


The subcategories of Pathologic Halitosis.

The "pathologic" halitosis category is further divided into subcategories, based on the location of the disease process that is associated with the patient's breath problem.

1) Oral Pathologic Halitosis

This category includes situations where the person's odor problems are caused, or aggravated, by disease or other pathologic conditions associated with tissues inside the mouth.

As a primary example, the level of malodor experienced can be aggravated by the presence of periodontal disease (gum disease). Co-factors (such as dry mouth, smoking or teeth in need of repair) can play a role too.

2) Extraoral Pathologic Halitosis

Source of postnasal drip.

Sinus issues can be the cause of breath odors.

With this classification, the person's breath malodor originates from a disease or a pathologic condition involving body tissues other than in the mouth. The odor may originate from:

  • The nasal, paranasal or laryngeal areas (upper respiratory tract).

    Possible conditions: postnasal drip, chronic sinusitis, acute viral or bacterial infection, tonsillitis, tonsilloliths, deep tonsillar crypts.

  • The lower respiratory tract (lungs) or upper digestive tract.

    Possible conditions: chronic bronchitis, bronchiectasis, hiatus hernia, Helicobacter pylori infection, malabsorption conditions.

  • Disorders anywhere else in the body. In these cases, compounds produced by the disease process are blood borne and a state of breath malodor is created when they are exhaled from the lungs.

    Possible conditions: diabetes, liver cirrhosis, uremia, kidney insufficiency, menstral cycle, internal bleeding.

The patient will need to be referred to a physician or medical specialist for treatment before their breath problem can be fully resolved.

Our next page explains what the odors you smell are and where they come from. Once you know that, you'll know how to cure your problems.

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