Individuals who have drug-related halitosis may need to take additional steps to prioritize oral health before intimate encounters.
Halitosis can be broken into two categories: intra-oral halitosis, originating from oral tissue and related to gram-negative anaerobic bacteria responsible for oral health issues like periodontitis and gingivitis, and extra-oral halitosis, arising from the nasal, paranasal, and laryngeal regions as well as the pulmonary or upper digestive tract. Halitosis is a known adverse effect caused by certain drugs, but it can also be detrimental to social, psychological, and emotional well-being; self-esteem; mental health; as well as relationships — dating in particular. Current estimates place the prevalence of halitosis anywhere between around 2.4% to 78%. However, systematic reviews place this figure closer to one-third of the population. Because individuals with halitosis may sometimes be unaware that they have the condition, it can be important for them to know which drugs put them at risk and what steps they can take to manage their halitosis effectively.
In a narrative review, investigators used the PubMed and EMBASE/OVID databases to identify systematic reviews and literature published between 2020 and 2025 focused on drugs listing pathologic intra- and extra-oral halitosis as a potential adverse effect. They conducted a thematic analysis to uncover which drugs induce halitosis and what mechanisms lead to this adverse effect.
The investigators found that drugs causing xerostomia and medication-related osteonecrosis of the jaw included a risk of halitosis — including anticholinergic drugs like 5 to 15 mg per day of oxybutynin and 40 to 175 µg per day of glycopyrrolate; antidepressants such as tricyclic antidepressants, nonadrenaline reuptake inhibitors, paroxetine, opipramol, trazodone, buproprion, desvenlafaxine, duloxetine, escitalopram, fluvoxamine, levomilnacipran, reboxetine, sertraline, venlafaxine. Other drugs, including appetite suppressants; systemic retinoids; anti-viral drugs; and those used to treat anxiety, hypertension, pain, allergic conditions, congestion, and muscle pain are known to carry a risk of xerostomia. In addition, antiresorptives like the bisphosphonates zoledronate and pamidronate; RANK-L inhibitors such as denosumab; and antiangiogenic agents, including bevacizumab, aflibercept, sunitinib, cabozantinib, sorafenib and dasatinib can result in medication-induced osteonecrosis of the jaw.
Further, drugs such as ranitidine, cysteamine, antifungals, peppermint oil, aspirin and other nonsteroidal anti-inflammatory drugs, PX-12, silybin, disulfiram, suplatast tosilate, dimethyl sulfoxide, levocarnitine, nitrates and nitrites, paraldehyde, chloral hydrate, and iodine-containing drugs could result in extra-oral halitosis.
“Prior knowledge of medications that are more likely to cause these conditions can help clinicians diagnose and manage the underlying causes of halitosis more effectively,” wrote study co-authors Mina Iranitalab and Aviv Ouanounou, DDS, MSc, both of the Faculty of Dentistry at the University of Toronto.
Dental evaluation may assist in identifying and managing intra-oral sources of halitosis before pursuing extra-oral explanations. Prior to date night would be a sound suggestion. For instance, dentists can tackle periodontal disease or dental decay, improve oral health, guide individuals on adequate oral hygiene techniques, provide treatments for xerostomia like more frequent hydration and saliva substitutes, and offer adjuncts like therapeutic mouthwashes containing antimicrobial ingredients. Further studies are needed to better understand the mechanisms behind drug-related halitosis. The investigators cited the few studies exploring halitosis as an independent drug-related adverse effect as a study limitation.
The study authors reported no conflicts of interest.
Source: International Dental Journal