Breath odor

Alternative names:

bad breath; halitosis

Definition:

An unpleasant, disagreeable, distinctive, or offensive breath odor.

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 eaten (such as raw onions, garlic, or cabbage)
• vitamin supplements (especially in large doses)
• poor dental hygiene
• cavities
• smoking
• alcoholism
• throat infection
• sinusitis
• lung infection
• Sjogren's syndrome
• 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 mellitus (fruity or "sweet chemical" smell with ketoacidosis)
• esophageal cancer
• gastric carcinoma
• gastrojejunocolic fistula (fruity-smelling breath)
• hepatic encephalopathy
• diabetic ketoacidosis
• lung abscess
• ozena
• periodontal disease
• pharyngitis
• Zenker's diverticulum

Note: There may be other causes of breath odor. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for breath odor, occurring alone or in combination with other problems.