The 5 Types / Classifications of Bad Breath - Genuine Halitosis (3 subcategories) | Pseudo Halitosis | Halitophobia

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

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:

 

 

The classification Genuine halitosis is further subdivided into the following three types:  Pathologic (oral),  Pathologic (extraoral),  Physiologic.


A) Genuine Halitosis

Identification.

This category refers to cases where the person's bad breath can be readily detected by:

  • Organoleptic testing, which refers to the evaluation of the person's breath by smelling it (although under controlled/objective conditions).
  • 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).
Symptoms.

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.

As detailed below, the category of Pathologic halitosis is further broken down into the subcategories: Oral and Extraoral halitosis.


Image showing bacterial accumulation on the back part of the tongue.

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 (rearmost) portion of their tongue (see picture).
This is the most common form of bad breath and involves 90% of cases. (Bartold)
Treatment.
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 a 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

Illustration showing the source of 'postnasal drip.'

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 associated 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 associated 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 bloodborne and a state of breath malodor is created when they are exhaled from the lungs.

    Possible associated conditions: diabetes, liver cirrhosis, uremia, kidney insufficiency, menstrual 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.

 

 Page references sources: 

Bartold M. Update on Breath malodor.

Quirynen M, et al. Characteristics of 2000 patients who visited a halitosis clinic.

Yaegaki K, et al. Examination, Classification, and Treatment of Halitosis; Clinical Perspectives.

All reference sources for topic Bad Breath.

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