Halitosis
Halitosis describes any breath odor that’s unpleasant, disagreeable, or offensive. Certain types of halitosis characterize specific disorders — for example, a fruity breath odor typifies ketoacidosis. (See also specific breath odor types.) Other types of halitosis include putrid, foul, fetid, and musty breath odors.
Halitosis may result from a disorder of the oral cavity, nasal passages, sinuses, respiratory tract, or esophageal diverticula. It may also stem from a GI disorder and be associated with belching, regurgitation, or vomiting, or it may be an adverse effect of an oral or inhaled drug. Other causes of halitosis include cigarette smoking, ingestion of alcohol and certain foods (such as garlic and onions), and poor oral hygiene — especially in patients with an orthodontic device, dentures, or dental caries. Surprisingly, offensive skin odors — for example, from foot perspiration — may be absorbed locally and later expelled by the lungs, resulting in halitosis.
History
If you detect halitosis, try to characterize the odor. Does it smell fruity, fecal, or musty? If the patient is aware of it, find out how long he has had it. Does he also have a bad taste in his mouth? Does he have difficulty swallowing or chewing? Does he have reflux or regurgitation? Does he have pain or tenderness? Ask the patient if he has a problem with flatus and about his pattern and description of bowel movements.
Find out if the patient smokes or chews tobacco. Have him describe his diet and daily oral hygiene. Does he wear dentures? Complete the history by asking about chronic disorders and recent respiratory tract infection. If the patient reports a cough, find out if it’s productive.
Physical assessment
Begin the physical examination by examining the patient’s mouth, throat, and nose. Look for lesions, bleeding, drainage, obstruction, and signs of infection, such as redness and swelling. Check for tenderness by percussing and palpating over the sinuses. Then auscultate the lungs for abnormal breath sounds. Auscultate the abdomen for bowel sounds; percuss, noting any tympany. Finally, take vital signs.
Medical causes
Bowel obstruction
Halitosis is a late sign of both small- and large-bowel obstruction. With a small-bowel obstruction, vomiting of gastric, bilious, and then feculent material produces a related breath odor. Other findings include constipation, abdominal distention, and intermittent periumbilical cramping pain. With a large-bowel obstruction, fecal vomiting produces fecal breath odor. Abdominal pain is milder and more constant than that associated with a small-bowel obstruction and is usually located lower in the abdomen.
Bronchiectasis
Bronchiectasis usually produces foul or putrid halitosis, but some patients may have a sickeningly sweet breath odor. The patient typically also has a chronic productive cough with copious, foul-smelling, mucopurulent sputum. The cough is aggravated by lying down and is most productive in the morning. Associated findings commonly include exertional dyspnea, fatigue, malaise, weakness, and weight loss. Auscultation reveals coarse or moist crackles over the affected lung areas during inspiration. Digital clubbing is a late sign.
Common cold
A musty breath odor may accompany a common cold, which usually also causes a dry, hacking cough with sore throat, sneezing, nasal congestion with rhinorrhea, headache, malaise, fatigue, and aching joints and muscles.
Esophageal cancer
With esophageal cancer, halitosis may accompany classic findings of dysphagia, hoarseness, chest pain, and weight loss. Nocturnal regurgitation and cachexia are late signs.
Gastric cancer
Halitosis is a late sign of gastric cancer. Accompanying findings include chronic dyspepsia unrelieved by antacids, a vague feeling of fullness, nausea, anorexia, fatigue, pallor, weakness, altered bowel habits, weight loss, and muscle wasting. Hematemesis and melena are signs of associated gastric bleeding.
Gastrocolic fistula
With gastrocolic fistula, fecal vomiting is responsible for fecal breath odor, which is typically preceded by intermittent diarrhea.
Gingivitis
Characterized by red, edematous gums, gingivitis may also cause halitosis. The gingivae between the teeth become bulbous and bleed easily with slight trauma.
Acute necrotizing ulcerative gingivitis also causes fetid breath, a bad taste in the mouth, and ulcers — especially between the teeth — that may become covered with a gray exudate. Severe ulceration may occur with fever, cervical adenopathy, headache, and malaise.
Hepatic encephalopathy
A characteristic late sign of hepatic encephalopathy is fetor hepaticus, a musty, sweet, or mousy (new-mown hay) breath odor. Major late effects also include coma, asterixis (flapping tremor), and hyperactive deep tendon reflexes.
Lung abscess
A lung abscess typically causes putrid halitosis, but its major sign is a productive cough with copious, purulent, often bloody sputum. Other findings include fever with chills, dyspnea, headache, anorexia, malaise, pleuritic chest pain, asymmetrical chest movement, weight loss, and temporary clubbing.
Ozena
Ozena — a severe, chronic form of rhinitis — causes a musty or fetid breath odor as well as thick, green mucus and progressive anosmia.
Periodontal disease
With periodontal disease, halitosis occurs with an unpleasant taste. Typically, the patient’s gums bleed spontaneously or with slight trauma and are marked by pus-filled pockets around the teeth. Related findings include facial pain, headache, and loose teeth covered by calculi and plaque.
Pharyngitis (gangrenous)
Halitosis is a chief sign of gangrenous pharyngitis. The patient also complains of a foul taste in the mouth, an extremely sore throat, and a choking sensation. Examination reveals a swollen, red, ulcerated pharynx, possibly with a grayish membrane. Fever and cervical lymphadenopathy are also common.
Renal failure (chronic)
Chronic renal failure produces a urinous or ammonia breath odor. Among its widespread effects are anemia, emotional lability, lethargy, irritability, decreased mental acuity, coarse muscular twitching, peripheral neuropathies, muscle wasting, anorexia, signs of GI bleeding, ecchymoses, yellow-brown or bronze skin, pruritus, anuria, and increased blood pressure.
Sinusitis
Acute sinusitis causes a purulent nasal discharge that leads to halitosis. Besides a characteristic postnasal drip, the patient may exhibit nasal congestion, sore throat, cough, malaise, headache, facial pain and tenderness, and fever.
Chronic sinusitiscauses a continuous mucopurulent discharge that leads to a musty breath odor. Postnasal drip, nasal congestion, and a chronic, nonproductive cough may accompany the musty odor.
Other causes
Drugs
Drugs that can cause halitosis include triamterene, inhaled anesthetics, paraldehyde (which is excreted through the lungs), and any drugs known to cause metabolic acidosis such as nitroprusside.
Special considerations
If examination of the mouth and sinuses doesn’t reveal the cause of halitosis, prepare the patient for upper GI and chest X-rays or endoscopy.
Pediatric pointers
In children, halitosis commonly results from physiologic causes, such as continual mouth breathing and thumb or blanket sucking. Phenylketonuria — a metabolic disorder that affects infants — may produce a musty or mousy breath odor.
Geriatric pointers
Extensive dental caries, mouth dryness, and poor oral hygiene can cause halitosis in elderly patients.
Patient counseling
To help control halitosis, encourage good oral hygiene. If halitosis is drug-induced, reassure the patient that it will disappear as soon as his body completely eliminates the drug.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Body odor
Read excerpts from these other book chapters related to Body odor:
Medical Books Excerpts
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- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- "In A Page: Pediatric Signs and Symptoms" (2007)
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- Halitosis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Body odor
» Next page:
Breath with fecal odor (Nursing: Interpreting Signs and Symptoms)
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