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402 Halitosis

Halitosis Client Education
Sheet
VetBooks.ir Etiology and Pathophysiology

BASIC INFORMATION
ketoacidosis) or prior to anesthesia
Intraoral causes: cause (e.g., rule out azotemia, diabetic
Definition • Plaque and calculus accumulation, gingivitis, • Viral testing: FeLV, FIV, +/− calicivirus in
An offensive odor emanating from the oral periodontitis, stomatitis cats
cavity, which may arise from intraoral or • Cheilitis, lip fold pyoderma • General anesthesia, oral exam, and biopsy
extraoral causes • Osteomyelitis, osteonecrosis of suspicious lesions
• Oral tumors, particularly those that outgrow • Case-specific advanced diagnostics centered
Epidemiology their blood supply and become necrotic (e.g., on the mouth and upper airway when an
SPECIES, AGE, SEX malignant melanoma, osteosarcoma) intraoral cause is suspected (e.g., dental
Any species, age, and either sex may be affected. • Foreign bodies, oral implants radiography, CT, thoracic radiographs
• Oronasal communications for metastasis screening of suspected oral
RISK FACTORS Extraoral causes: see Differential Diagnosis neoplasms) and systemic evaluations when
Dental disease (e.g., periodontal disease, caries), below. an extraoral diagnosis is suspected
oral mucosal diseases (e.g., ulcerative stomatitis), • Organoleptic measurements and a halimeter
oral tumors, foreign bodies, hyposalivation, DIAGNOSIS can be used to detect the most common
dental appliances (e.g., splints, orthodontic causative agents of oral malodor (i.e.,
devices), gastrointestinal (GI) diseases, respira- Diagnostic Overview hydrogen sulfide, methyl mercaptan, and
tory diseases, metabolic diseases, perioral skin Physical exam helps differentiate intraoral dimethyl sulfide).
diseases, diet, certain medications. Although from extraoral causes; further diagnostic tests
halitosis has multifactorial origins, the source are selected accordingly. TREATMENT
in > 90% of cases is the oral cavity.
Differential Diagnosis Treatment Overview
Clinical Presentation The DAMNIT scheme can be used as a guide The goal of treatment is to control halitosis by
HISTORY, CHIEF COMPLAINT to differential diagnosis: addressing its underlying causes. For intraoral
Important components of the history include • Developmental, degenerative: congenital causes, primary treatment is often followed
diet, treats, toys, home oral hygiene, profes- and acquired palate defects/oronasal by preventive care. For extraoral causes, treat-
sional oral care, pertinent medical history, and communications ment of the underlying disorder is the basis of
medications. Bad breath is a common complaint • Autoimmune, anatomic, allergic: pemphigus therapy.
for patient presentation. vulgaris, bullous pemphigoid, systemic lupus
erythematosus, erythema multiforme, drug Acute General Treatment
PHYSICAL EXAM FINDINGS eruption; mouth breathing associated with Improve oral hygiene by professional dental
• Most intraoral disorders that cause halitosis brachycephalic head conformation cleaning and periodontal therapy, with specific
are apparent on oral exam. Extraoral causes • Metabolic, mechanical: diabetic ketoacidosis, attention to treatment of oral disease associated
may be identified with additional diagnostics. uremia, hepatic dysfunction causing hyper- with halitosis (e.g., extraction of teeth with
• Distinguishing between nasal and oral odor ammonemia, retention of food debris and/ severe periodontitis). Specific treatment for
is important. Smell emanating only from the or saliva halitosis caused by extraoral disorders is directed
nose can indicate nasal disease (e.g., nasal • Nutritional, neoplastic: gastroesophageal toward the underlying disorder.
tumor), and combined nasal and oral odor reflux; oral, pharyngeal, esophageal, gastric
may indicate a communication between the neoplasia; dietary indiscretion/consumption Chronic Treatment
cavities (i.e., oronasal fistula). of spoiled food • Maintain a healthy periodontium by routine
• Physical exam findings depend on the under- • Infectious, inflammatory, or idiopathic: home oral hygiene (daily toothbrushing;
lying disease process. For example, rare but dental plaque/calculus (oral bacteria), peri- application of chlorhexidine products to teeth
possible oral manifestations of leptospirosis odontal disease (gingivitis and periodontitis), and gums; use of diets, treats, and chew
(depending on the serovar) include halitosis, gingival hyperplasia, contact mucositis and toys that help control plaque and calculus
petechiae, oral hemorrhages, ulceration, contact mucosal ulceration, stomatitis; lep- accumulation) to maintain oral health
glossitis with necrosis, and sloughing of the tospirosis; local and systemic fungal diseases; between regularly scheduled professional
tongue. cheilitis and lip fold pyoderma; bronchitis, dental cleanings and periodontal therapy.
• Evidence of periodontal disease may be pneumonia; infection with feline leukemia • An oral topical gel with essential oils and
noted, including gingivitis, gingival recession, virus (FeLV), feline immunodeficiency virus polyphenolic antioxidants applied twice daily
root exposure, tooth mobility, and accu- (FIV), feline calicivirus (FCV), or feline after an initial professional dental cleaning
mulation of plaque and calculus. Odorous, herpesvirus (FHV) decreased oral malodor in dogs.
volatile sulfur compounds are produced by • Toxic, traumatic: toxic epidermal necrolysis, • Control underlying diseases that are extraoral
bacteria associated with periodontal disease. trauma from malocclusion, tooth fracture, causes of halitosis.
Stomatitis or oral masses may also be found. jaw fracture, non-healing oral wounds, oral
Close attention should be paid to the sub- foreign body, chemical or electric burns Nutrition/Diet
lingual region in cats and the oropharynx Home oral hygiene products, diets, treats, and
in dogs for the presence of tumors or Initial Database toys proved to control plaque and calculus
foreign bodies. Sensory evaluation and complete physical exam accumulation (see the Veterinary Oral Health
• Visual inspection of the prepuce/vulva (including oral exam in the conscious patient) Council website: http://vohc.org/)
and palpation of the anal sacs is important
because licking of these areas or their secre- Advanced or Confirmatory Testing Recommended Monitoring
tions is a recognized cause of halitosis in • CBC, chemistry panel, urinalysis: if history Follow-up as indicated for routine management
dogs and cats. and physical exam suggest an extraoral of underlying intraoral or extraoral cause

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