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2nd. Edition

Malodor of Non-Oral Etiologies

The nasal passages constitute, in my opinion, the second most frequent source of bad breath, after the mouth itself (Finkelstein, chapter 11, this volume). Frank nasal odor may lead to discovery of sinus and other infections, obstructions, foreign bodies, etc., but, interestingly, many instances are often unaccompanied by pathological findings. Furthermore, the nasal passages may have a greater role than has been previously imagined. Many foul smelling samples scraped from the posterior part of the tongue dorsum bear a physical resemblence to nasal mucus (Rosenberg and Leib, this volume). Could post-nasal drip thus constitute a major source of oral malodor? Another area of uncertainty involves the potential role of tonsils in bad breath (Finkelstein, chapter 11,this volume). Patients with craniofacial anomalies (e.g., cleft palate) may be prone to oral and nasal malodor (Finkelstein, chapter 12, this volume). I would not be surprised if rhinoplasty predisposes individuals to bad breath. Hopefully, oral malodor research clinics, such as that recently established in Leuven, Belgium, will shed light on these and other issues. Although many systemic diseases may lead to bad breath (Attia and Marshall, 1982), they account for only a small fraction of cases. The work underway in the laboratory of George Preti and coworkers (this volume) may lead to recognition of the metabolic disorder, trimethylaminuria, as a more significant contributor to perceived or real oral malodor than previously recognized.