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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 characteristic sign of ketoacidosis (such as diabetic ketoacidosis), a potentially life-threatening condition.

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

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:

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

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 documented fever, cough, or facial pain with nasal discharge

What to expect at your health care provider's office
The medical history will be obtained, and a physical examination performed.

Medical history questions documenting breath odor in detail may include:

• Quality
  • 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?
• Aggravating factors
  • Has the person recently eaten a spicy meal, garlic, cabbage, or other "odorous" food?
  • Does the person take vitamin supplements?
  • Does the person smoke?
• Relieving factors
  • Does good oral hygiene improve the odor?
  • What home care measures have been tried? How effective are they?
• Medical history
  • Is there a recent sore throat, sinus infection, tooth abscess, or other illness?
• Other
  • What other symptoms are also present?

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

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

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

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

After seeing your health care provider:
You may want to add a diagnosis related to breath odor to your personal medical record.

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