Halitosis: etiology, prevention, and the role of microbiota

Clin Oral Investig. 2023 Nov;27(11):6383-6393. doi: 10.1007/s00784-023-05292-9. Epub 2023 Oct 16.


Objectives: This study aims to review halitosis research, discuss its various causes, and propose effective interventions based on the underlying etiologies and mechanisms. The main research question is to identify the primary factors contributing to halitosis and appropriate strategies to address them.

Materials and methods: A comprehensive literature review was conducted on halitosis and its associated causes, including oral pathological factors, oral microbial influences, microbial metabolic pathways, gastrointestinal diseases, and gut microbiota dysbiosis.

Results: Unhealthy eating habits and an imbalance of microorganisms in the oral cavity and gastrointestinal tract were identified as primary causes of halitosis. Dental caries, periodontal disease, xerostomia, and digestive disorders like gastritis and irritable bowel syndrome were also found to be related to the development of halitosis. Due to poor oral hygiene or antibiotic use, disruption of microbial communities can result in dysbiosis, inflammation, and halitosis.

Conclusions: Halitosis is a multifactorial condition with various underlying causes, including oral and systemic diseases. Effective interventions should be tailored based on the specific etiologies and mechanisms involved.

Clinical relevance: Understanding the factors contributing to halitosis is crucial for developing appropriate treatment strategies. Enhancing oral hygiene habits, using antimicrobial drugs, or administering probiotics may help regulate oral or intestinal flora, thereby improving halitosis and overall oral health.

Keywords: Halitosis; Microbiota; Oral health; Oral malodor; Volatile sulfur compounds.

Publication types

  • Review

MeSH terms

  • Dental Caries* / complications
  • Dysbiosis / complications
  • Halitosis* / prevention & control
  • Humans
  • Microbiota*
  • Oral Hygiene