Breath odor

Considerations

Some disorders will produce specific, characteristic odors to the breath.

Bad breath related to poor oral hygiene is most common and caused by release of sulphur compounds by bacteria in the mouth.

A fruity odor to the breath occurs as the body attempts to get rid of excess acetone through the breathing. This is a sign of ketoacidosis, which may occur in diabetes. It is a potentially life-threatening condition.

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

The breath may have an ammonia-like odor (also described as urine-like or "fishy") in people with chronic kidney failure.

Causes

Bad breath can be caused by:

• Abscessed tooth
• Alcoholism
• Cavities
• Dentures
• Eating certain foods, such as cabbage, garlic, or raw onions
• Drinking coffee and other beverages
• Object stuck in the nose (usually happens in kids); often a white, yellow, or bloody discharge from one nostril
• GERD 
• Gum disease (gingivitis, gingivostomatitis)
• Impacted tooth
• Lung infection
• Poor dental hygiene
• Sinusitis
• Throat infection
• Tobacco smoking
• Vitamin supplements (especially in large doses)
• Use of certain medications, including insulin shots, triamterene, and paraldehyde

Diseases that may be associated with breath odor:

• Acute necrotizing ulcerative gingivitis
• Acute necrotizing ulcerative mucositis
• Acute renal failure
• Bowel obstruction (can cause breath to smell like feces)
• Bronchiectasis
• Chronic kidney 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.

When to Contact a Medical Professional

• 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 fever, cough, or face pain with discharge from the nose

What to Expect at Your Office Visit

Your doctor will take a medical history and perform a physical examination.

You may be asked the following medical history questions:

• 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?
• Have you recently eaten a spicy meal, garlic, cabbage, or other "odorous" food?
• Do you take vitamin supplements?
• Do you smoke?
• Does good oral hygiene improve the odor?
• What home care measures have you tried? How effective are they?
• Is there a recent sore throat, sinus infection, tooth abscess, or other illness?
• What other symptoms do you have?

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

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

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

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

Alternative Names

Bad breath; Halitosis

Update Date: 2/22/2012

Updated by: Paul Fotek, DMD, Florida Institute for Periodontics & Dental lmplants, West Palm Beach, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.