Clinical Evaluation of Halitosis

 

Clinical examinations:

(1) whole mouth breath

(2) breath odor while speaking (counting to 20)

(3) odor from anterior dorsum of tongue (wrist lick)

(4) odor from posterior dorsum of tongue

(5) nasal odor

(6) malodor of dental floss passed through the interdental areas

 

Whole mouth breath test:

(1) The patient exhales briefly through the mouth at a distance of 10 cm from the nose of the judge.

(2) Malodor is scored using the table below.

 

Breath odor while speaking (counting to 20):

(1) The patient is instructed to count from 1 to 20 at a distance of 10 cm from the nose of the judge.

(2) The first number at which bad breath is detected is recorded.

 

Odor for anterior dorsum of tongue:

(1) The patient is asked to lick his or her wrist with tongue extended.

(20 5 seconds later the observer holds the wrist at 5 cm and assesses the odor.

(3) Malodor is scored using the table below.

 

Odor from posterior dorsum of tongue:

(1) The posterior of the tongue is scraped with a plastic spoon or spatula.

(2) 5 seconds later the observer holds the scraper at 5 cm and assesses the odor,

(3) Malodor is scored using the table below.

 

Nasal odor:

(1) The patient exhales briefly through the nose at a distance of 10 cm from the nose of the judge.

(2) Malodor is scored using the table below.

 

Malodor of dental floss passed through the interdental areas:

(1) Unwaxed floss is passed between the posterior teeth.

(2) The observer holds the floss at a distance of 3 cm and inhales.

(3) Malodor is scored as present/positive or absent/negative.

Observer Scoring of Malodor	Points
no appreciable odor	0
barely noticeable odor	1
slight but clearly noticeable odor	2
moderate odor	3
strong odor	4
extremely foul odor	5

 

Limitations:

• Grading of malodor varies between observers.

• A single observer may show variability in grading.

• Scoring of intermediate grades of malodor may be inconsistent.

• Extremely foul odor may be hard to characterize.

• Variability in malodor with time of day, time in menstrual cycle, diet and other factors.