Foetor
Overview
- The patient's breath may reveal information about their oral hygiene, or suggest the presence of metabolic disease.
Halitosis
- Halitosis is also known as foetor ex ore, oral malodour and 'bad breath'. The term refers to an offensive odour that may resemble rotten eggs / meat / fish or faeces.
- This finding is suggestive of bacterial colonisation in the mouth, pharynx, respiratory or gastrointestinal tracts.
Causes of Halitosis
Oropharyngeal
- Xerostomia (dry mouth)
- Poor oral hygiene
- Mouth ulcer
- Dental caries
- Gingivitis
- Tongue colonisation
- Tonsilitis
- Sinusitis
Gastrointestinal
- Reflux
- H pylori infection
- Crohn's disease
Respiratory
- Bronchiectasis
- Bronchial tumour
Systemic
- Cirrhosis
- Ketosis
- Alcohol
- Uraemia
Foetor Hepaticus
- Foetor hepaticus is a musty smell, sometimes described as a mix between rotten eggs and garlic.
- This is associated with severe liver cirrhosis, likely due to sulphur compounds such as methyl mercaptan and dimethylsulphide.
Acetone Breath
- Acetone breath manifests as a fruity smell, similar to nail polish remover; this is a reliable indicator of plasma ketosis.
Causes of Ketosis
- Diabetic ketoacidosis
- Alcoholic ketoacidosis
- Starvation-induced ketosis
- Ketogenic diet - high fat, high protein, low carbohydrate
- Toxicity - isopronanol, acetone, propylene glycol, aspirin, isoniazid
Alcoholic Foetor
- The smell of alcohol on the breath suggests alcohol ingestion, which may indicate acute intoxication and may be present in patients with alcoholism.
Uraemic Foetor
- Uraemic foetor manifests as the smell of ammonia, or a urine-like odour. This occurs in patients with end-stage renal failure.
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