Halitosis: Types / Classifications

Before a dental professional initiates a patient's treatment for halitosis, they must first make an assessment of the type of breath condition from which they are suffering.

This is an important step 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 cases where the person's bad breath can be readily detected by:

• Organoleptic testing, which means just smelling the person's breath with your nose.
  
• Or via the use of some type of testing apparatus that can detect the types of smelly compounds typically associated with bad breath (volatile sulfur compounds).

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

The category of Genuine halitosis is further broken down into the subcategories: Pathologic and Physiologic halitosis.

B) Pseudo-halitosis

This classification refers to the situation where the patient does not have an actual breath odor problem (nothing can be detected by smell or scientific testing) but they are still certain that they do have bad breath. Since no real breath problem exists, treatment consists of counseling the patient about their misconception.

Pseudo-halitosis represents about 15% of cases.

▲ Section references - Quirynen

C) Halitophobia

This category refers to the 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.

The subcategories of Genuine Halitosis.

Medical professionals subdivide the genuine halitosis category (the situation where an actual breath odor problem can be detected by testing) into two further classifications, "physiologic" and "pathologic" halitosis.

1) Pathologic Halitosis

This condition refers to the situation where the person's breath odor is a result of disease or other pathologic condition, or aggravated by it.

The category of Pathologic halitosis is further broken down into the subcategories: Oral and Extraoral halitosis.

The most common cause of Genuine halitosis is debris on the posterior portion of the tongue.

2) Physiologic Halitosis

This category refers to the situation where the person's malodor is due to putrefaction (the decay or rotting of organic matter) taking place in their oral cavity, frequently within the white-colored coating found on the posterior (rear most) portion of their tongue (see picture).

This is the most common form of bad breath and involves 90% of cases. (Bartold)

A patient is usually able to resolve their physiologic halitosis by improving their 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 which can be resolved relatively easily.

▲ Section references - Bartold

The subcategories of Pathologic Halitosis.

The subdivisions of the pathologic halitosis category are based on the location of the disease process that's 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, a person's malodor may be due to, or aggravated by, the presence of periodontal disease (advanced gum disease). Co-factors (such as dry mouth, smoking or teeth in need of repair) can play a role in pathologic halitosis too.

2) Extraoral Pathologic Halitosis

Sinus discharge can be the cause of breath odors.

With these cases, 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.

▲ Section references - Primary reference sources for this entire page. - Quirynen, Yaegaki, Bartold

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.

Update log -

05/28/2019 - Minor content revision. Reference links added.

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Topic Menu ▶  Bad Breath / Halitosis

• Bad breath testing -
  
  • Ways to self-test for halitosis. - At-home methods.
  • Ways dentists test for halitosis. - Scientific methods.
  • Halitosis classifications. - Types / Categories
• Causes -
  
  • What actually causes bad breath? - Oral bacteria / Volitile sulfur compounds.
  • Halitosis Co-factors & Risks. - Smoking, gum disease, dry mouth, medical conditions.
• Solutions and remedies -
  
  • How to cure halitosis. - The simple steps you need to take.
  • Tongue cleaning - Scraping / Brushing.
  • Chemical treatments.
    
    • Research proven mouthwashes.
    • Ingredients/Compounds effective for halitosis.
    • Treatment adjuncts- mints, lozenges, sprays, drops, gum, toothpaste, probiotics
      
  • Denture breath - Testing for it. / Curing it.

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