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Halitosis: etiology, prevention, and the role of microbiota

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Abstract

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.

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Funding

The work was supported by the National Natural Science Foundation of China (81771127), the Natural Science Foundation of Xinjiang Uygur Autonomous Region (2022D01C15), the Medical Engineering Cross Foundation of Shanghai Jiao Tong University (YG2015MS06), and the Seed Foundation of the Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (JYZZ196). Stomatology Clinical Research Project of Nation Clinical Center for Oral Diseases (NCRCO202330).

Author information

Author notes

  1. Zhengrui Li

    Present address: Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, China

  2. Jing Li

    Present address: Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China

  3. Zhengrui Li and Jing Li contributed equally to this work.

Authors and Affiliations

  1. Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  2. College of Stomatology, Shanghai Jiao Tong University, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  3. National Center for Stomatology, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  4. National Clinical Research Center for Oral Diseases, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  5. Shanghai Key Laboratory of Stomatology, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  6. Shanghai Research Institute of Stomatology, Shanghai, China

    Zhengrui Li, Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

  7. Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, China

    Rao Fu, Ji’an Liu, Xutao Wen & Ling Zhang

Authors
  1. Zhengrui Li
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Contributions

ZL and JL composed the initial draft of the manuscript; JL and RF applied the statistical analysis; ZL, JL, and XW prepared Fig. 1–3 and Tables 1–4; LZ reviewed and edited/revised the final manuscript.

Corresponding author

Correspondence to Ling Zhang.

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Li, Z., Li, J., Fu, R. et al. Halitosis: etiology, prevention, and the role of microbiota. Clin Oral Invest 27, 6383–6393 (2023). https://doi.org/10.1007/s00784-023-05292-9

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  • DOI: https://doi.org/10.1007/s00784-023-05292-9

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