As halitosis or halitosis is called (unpleasant) bad breath that occurs often or persists. Pathophysiology The most common cause sulfurous gases such as (hydrogen sulphide) sulfide and methyl mercaptan to bad breath, which form at the decomposition (fermentation) of food components by gram-negative anaerobic bacteria in the mouth. Also bacteria in periodontal disease sites may be the trigger, especially if there are ulcerated or necrotic areas. The causative pathogen are deep into the periodontal pockets around the teeth. In patients with healthy periodontal tissues, these bacteria can proliferate behind on the tongue. To bacterial overgrowth reduced salivation (z. B. at parotitis, Sjogren’s syndrome or use of anticholinergics), saliva retention and an increased salivary pH can contribute. Certain foods or spices give after digestion the smell of these substances into the lungs; the exhaled breath can be unpleasant for others. For example, the smell of garlic is perceived in the breath by other 2 or 3 hours after consumption, long after it has disappeared from the mouth. Etiology In 85% of cases the cause is in the mouth, the other can be explained by systemic and extra-oral disorders (see Table: Some causes of bad breath). overall, the most common causes are the following: gingival or periodontal disease smoking Recorded food that has a volatile component Gastrointestinal disorders rarely cause bad breath because the esophageal sphincter closes normally. That the breath odor digestive condition and bowel function reflect, is a fallacy. Other breath odors With several systemic diseases may be detectable volatile substances in the breath, the smell is not so unpleasant or pungent, how to understand it commonly under halitosis. Diabetic ketoacidosis leads to a sweet and fruity (fruit-like) odor of acetone. Liver failure leading to a musty or slightly sulfurous smell sometimes. And renal insufficiency caused a urine or ammonia smell. Some causes of bad breath cause Typical findings diagnostic approach Oral states bacteria on dorsum evil smelling tongue swab, healthy oral mucosa Clinical Evaluation Gingival or periodontal disease oral disease, often accompanied worse with bleeding and / or purulent exudate recognizable during the examination often result oral hygiene Klini specific evaluation Dental examination Necrotic mouth carcinoma (rare-usually diagnosed before becoming necrotic) lesion, usually detected in the study in elderly patients, who often have long consumed alcohol, tobacco, or both biopsy, CT scan or MRI Extraoral disorders Nasal foreign bodies * usually in children purulent or bloody nasal discharge visible in the investigation Clinical evaluation Sometimes imaging NEKR otisches nasopharyngeal carcinoma * trouble swallowing Clinical evaluation Necrotic pulmonary infection (eg. B. lung abscess, bronchiectasis, foreign body) Productive cough fever chest x-ray Sputum Sometimes CT or bronchoscopy psychogenic halitosis Bad smell, which is not perceived by others Often a number of other hypochondriacal complaints Clinical evaluation sinusitis * purulent nasal discharge facial pain, headache, or both Clinical evaluation Sometimes CT Zenker’s diverticulum Gastroesophageal reflux disease (GERD) Regurgitation of undigested food when lying down or prevent swallowing of barium for recording or upper GI endoscopy Recorded substances Alcoholic beverages, garlic, onions, tobacco use is * Bad smell usually more starting by history seen Clinical evaluation test prevention of the nose as from the mouth. Typically includes a Ausschlussdiganose made after an investigation of other causes. Assessment history The current disease should the duration and severity of bad breath confirm (including, if other people notice it or have complained), whether the patient runs a proper oral hygiene and to what extent the inclusion-causing food is responsible for bad breath (see table: some causes of bad breath). In the evaluation of symptoms symptoms should (pneumonia) and regurgitation of undigested food when lying down or Bending Over (Zenker’s diverticulum) flow-causing diseases, including nasal discharge and facial or headache (sinusitis, nasal foreign bodies), productive cough and fever. Predisposing factors such as dry mouth, dry eyes, or both (Sjogren’s syndrome) should be observed. The history should check the duration and amount of alcohol and smoking. A drug history should specifically about the use of drugs that can cause dry mouth (eg those with anticholinergic effects-see table. Some causes of xerostomia) erbringen.Körperliche investigation vital signs are checked, and in particular the presence of fever. The nose is examined for discharge and debris. The mouth is examined for signs of periodontal disease, dental infections and cancer. Signs apparent dryness be noted (for. Example, if the mucosa is dry, sticky or wet, whether the saliva of foamy, stringy or normal appearance is). The throat is for signs of infection and cancer untersucht.Schnüffeltest The breathing air a smell test is subjected. An unpleasant and pungent odor generally indicates to oral disorder causes, while systemic diseases cause subtle changes in odor. Ideally, the patient (if possible even 48 hours) should avoid before the study on garlic and onions and not eat 2 hours before the deadline and drink, not even chew gum gargle or rinse your mouth and do not smoke. During exhalation, the patient breathes in 10 cm distance to the nose of the examiner first through the mouth and then (with the mouth closed) through the nose. Bad smell, which is perceived from the mouth, indicates an oral etiology, bad smell, which is perceived from the nose Coming, indicates a nasal or sinus etiology. Bad smell in both oral and nasal breathing suggests a systemic or pulmonary cause. If the source is unclear, the rear part of the tongue is scraped off with a plastic spoon. After 5 s, the spoon is sniffed from a distance of 5 cm from the nose of the examiner; a bad smell indicates bacteria on the tongue as the cause hin.Warnzeichen The following results are of particular importance: Fever purulent nasal discharge or purulent sputum visible or palpable lesions oral interpretation of the results, since oral causes are the most common by far, any visible oral disease can be suspected in patients without extra-oral symptoms or signs as a cause and a dentist should be consulted. If other faults are involved, clinical findings suggest often a diagnosis (see table: Some causes of bad breath). In patients whose symptoms are related to the intake of certain foods or beverages and have no other findings, an attempt to avoid (followed by a sniff test), the clarification bringen.Tests Only if evidence of an underlying from history or physical examination resulting disease, a more extensive diagnostics should be done (see table: Some causes of bad breath). The determination of the concentration of sulfur with portable measuring instruments, gas chromatography and chemical analyzes of the tongue swabs should be left better research groups or certain dental offices who specializes in the assessment and treatment of bad breath. Therapy Regular oral hygiene and dental care cause treats the underlying diseases are treated causally. In an oral cause patients should go to the dentist and have a professional teeth cleaning, gum and tooth decay treatment making. At home they can (brush teeth and remove tongue coating with a toothbrush or a tongue scraper) itself contribute to better oral hygiene through proper use of dental floss and toothbrush. Mouthwashes are of limited use, but those that contain oxidants (usually chlorine dioxide), have better short-term results shown. If the patient has a history of alcohol abuse, non-alcoholic mouthwashes should be used. In psychogenic halitosis may the advice of a psychiatrist should be sought. Basics of Geriatrics Elderly patients take more of a medication that causes dry mouth, which leads to difficulty in oral hygiene and bad breath, but then is with them bad breath no more likely than others. And oral cancers are more common in old age and are more often in elderly patients a cause for concern than in younger. Important points bad breath is mostly a result of the fermentation of food waste by anaerobic gram-negative bacteria, which are located around the teeth and on the tongue back. Extra-oral disorders can cause bad breath, but are often accompanied by suggestive findings. That the breath odor digestive condition and bowel function reflect, is a fallacy. Mouthwashes bring only short-term improvement.