Blood borne halitosis
(i) Systemic diseases
(ii) Metabolic diseases
(iii) Food
(iv) Medication
B. Non-blood borne halitosis
(i) Upper respiratory tract
(ii) Lower respiratory tractThe same authors also suggested that halitosis can be divided according to the character of the odour into 3 groups:
"Sulfurous or fecal" caused by volatile sulfur compounds (VSC), most notably methyl mercaptan, hydrogen sulfide and dimethyl sulfide. "Fruity" caused by acetone, present in diabetes. "Urine-like or ammoniacal" caused by ammonia, dimethyl amine and trimethylamine (TMA), present in trimethylaminuria and uremia.Based on the strengths and weaknesses of previous attempts at classification, a cause based classification has been proposed:
Type 0 (physiologic)
Type 1 (oral)
Type 2 (airway)
Type 3 (gastroesophageal)
Type 4 (blood-borne)
Type 5 (subjective)Any halitosis symptom is potentially the sum of these types in any combination, superimposed on the physiologic odour present in all healthy individuals. Management
Approaches to improve bad breath may include physical or chemical means to decrease bacteria in the mouth, products to mask the smell, or chemicals to alter the odour creating molecules. Many different interventions have been suggested and trialed such as toothpastes, mouthwashes, lasers, tongue scraping, and mouth rinses. There is no strong evidence to indicate which interventions work and which are more effective. It is recommended that in those who use tobacco products stop. Evidence does not support the benefit of dietary changes or chewing gum. Mechanical measures
Brushing the teeth may help. While there is evidence of tentative benefit from tongue cleaning it is insufficient to draw clear conclusions. A 2006 Cochrane review found tentative evidence that it might decrease levels of odour molecules. Flossing may be useful.
The 1550 BC Ebers Papyrus describes tablets to cure bad breath based on incense, cinnamon, myrrh and honey. Hippocratic medicine advocated a mouthwash of red wine and spices to cure bad breath. Alcohol-containing mouthwashes are now thought to exacerbate bad breath as they dry the mouth, leading to increased microbial growth. The Hippocratic Corpus also describes a recipe based on marble powder for females with bad breath. The Ancient Roman physician Pliny wrote about methods to sweeten the breath.Ancient Chinese emperors required visitors to chew clove before an audience. The Talmud describes bad breath as a disability, which could be grounds for legal breaking of a marriage license. Early Islamic theology stressed that the teeth and tongue should be cleaned with a siwak, a stick from the plant Salvadora persica tree. This traditional chewing stick is also called a Miswak, especially used in Saudi Arabia, an essentially is like a natural toothbrush made from twigs. During the Renaissance era, Laurent Joubert, doctor to King Henry III of France states bad breath is "caused by dangerous miasma that falls into the lungs and through the heart, causing severe damages".In B. G. Jefferis and J. L. Nichols "Searchlights on Health" (1919), the following recipe is offered: "[One] teaspoonful of the following mixture after each meal: One ounce chloride of soda, one ounce liquor of potassa, one and one-half ounces phosphate of soda, and three ounces of water." In the present day, bad breath is one of the biggest social taboos.