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Home > BNSSG ICB > Development Area >

Halitosis - Draft

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Overview

Halitosis refers to noticeably unpleasant breath odor. It may be:

  • physiological (e.g., "morning breath")
  • pathological, due to local causes
  • patholiogical due to systemic causes
  • psychogenic

Who to Refer

Investigation or referral is usually not required if there is an oral cause (dental hygiene and regular dental check ups are more appropriate).

If oral causes have been excluded then consider the following and investigate and manage as appropriate:

  • ENT causes : post-nasal drip, chronic rhinosinusitis, tonsilloliths, nasal obstruction, naso-pharyngeal tumours.
  • GI causes : dyspepsia or reflux
  • Systemic : diabetes mellitus, renal failure, liver failure
  • Medications : e.g. anticholinergics, antihistamines, TCAs
  • Lifestyle : diet, smoking, alcohol
  • Psychogenic halitosis : patient reports bad breath but no objective evidence

Red Flags

Consider nasopharyngeal tumours in patients with red flags such as:

  • unilateral nasal obstruction
  • cacosmia (perceived malodorous smell within the nose)

See Rhinosinusitis & Nasal Polyps (Remedy BNSSG ICB) for a fuller list. Refer using the Head & Neck incl. Thyroid - USC (2WW) pathway.

Referral

Referral to secondary care is not usually required.

Referrals to dental hospital should only be made by a general dental practitioner.


Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.