Management

Patients should be investigated and managed for any systemic (non-oral) cause of halitosis (1)

In patients with no underlying systemic cause t he most effective management of halitosis is aimed at reducing the bacterial flora of the mouth, especially the anaerobes.

• give advice on good oral hygiene - brushing teeth, interdental flossing, tongue brushing
• eating regularly, avoiding foods and drinks which may cause transient halitosis
• use of antimicrobial toothpastes and mouthwashes
  • 0.2% aqueous chlorhexidine gluconate mouthwash
  • oil-water rinse
  • triclosan/co-polymer/sodium fluoride toothpaste
  • hydrogen peroxide mouthwash - especially in cases of gingivitis (1,2)

Antibiotics are rarely used except in cases of post- operative halitosis.

Psychological evaluation and treatment may be necessary in patients with halitophobia (1).

Reference:

• (1) Porter S.R, Scully C. Oral malodour (halitosis). BMJ 2006;333(7569):632–635
• (2) Coventry J et al. ABC of oral health: periodontal disease. BMJ 2000;321(7252),36-39