1. Introduction
Halitosis, commonly referred to as oral malodor, mouth odor, bad breath or bad mouth odor, is characterized by unpleasant odors emanating from an individual’s oral cavity. [ 1 ] As a general health problem, halitosis originates from the mouth, nasal cavity, upper respiratory tract, and upper digestive tract, [ 2 ] which may be associated with a variety of oral and systemic diseases and can be categorized into genuine halitosis, pseudo-halitosis, and halitophobia halitosis. [ 3 ] Halitosis is highly prevalent in the general population, and 25% to 50% of the general population has halitosis. [ 4 ] Facilitating the prevention and treatment of halitosis can assist individuals with halitosis in overcoming social barriers and improving their quality of life.
There are plenty of existing reports regarding the etiology and management of halitosis and its effects on the quality of life of patients. [ 5 ] At present, research on halitosis has made progress in many aspects, but it still faces some challenges. In terms of epidemiology, there are differences in the prevalence of halitosis in distinct regions and populations, and many factors are related to halitosis, such as oral health, chronic tonsillitis, smoking, systemic diseases, etc. [ 6 ] This requires further in-depth research to clarify the specific action mechanism of each factor. Previous scholars have conducted bibliometrics on the 100 most cited papers on halitosis, but failed to comprehensively analyze all the literature on halitosis and its research hotspots and trends. [ 7 ] Additionally, current reviews on halitosis pay more attention to oral health [ 8 , 9 ] and pay less attention to other aspects of halitosis. Therefore, strengthening research on halitosis so that halitosis can be effectively alleviated is of great significance for improving patients’ quality of life.
Bibliometric analysis is a literature and information mining method based on mathematical statistics. [ 10 ] Bibliometric analysis can be used to understand research trends and hot topics in different research fields. [ 11 ] This study used the PubMed database to systematically review the global research literature related to halitosis published from 2010 to 2025 through bibliometrics, aiming to discover research trends, hot spots and development trends in the field of halitosis, and provide a reference for future halitosis-related research.
2. Methods
2.1. Source of literature and search strategy
A literature search was conducted through the Medpulse ( www.medpulse.cn ), which was developed based on the PubMed ( https://pubmed.ncbi.nlm.nih.gov/ ), and could retrieve the titles, abstracts and keywords of the documents included in PubMed. By using Medpulse, a comprehensive search was conducted for relevant literature published by scholars worldwide on halitosis. The retrieval strategy is illustrated as follows: Title/Abstract: “halitosis” or Title/Abstract: “oral malodor” or Title/Abstract: “mouth odor” or Title/Abstract: “bad breath” or Title/Abstract: “bad mouth odor” or MeSH Major Topic: “halitosis.” A comprehensive retrieval strategy is described in Table S1, Supplemental Digital Content, https://links.lww.com/MD/R37 . There is no limit to the literature type. The search time is from January 1, 2010, to July 9, 2025, and the language is limited to English. In order to understand the trends and hotspots of research as comprehensively as possible, no other exclusion criteria were established in this study.
2.2. Bibliometric analyses
Bibliometric analyses were conducted through the use of Medpulse. [ 12 ] In this study, bibliometric analysis included thematic map and evolution, co-occurrence network analysis of keywords, and statistics of journals, institutions, authors and keywords. All statistical analysis in this research was completed by the R package “bibliometrix” ( https://www.bibliometrix.org ) in the Medpulse database. As it was a bibliometric analysis, the study did not need ethics committee approval.
3. Results
3.1. The trend of publishing papers
There were 1634 articles involving halitosis from January 2010 to July 2025, and the average annual number of articles published from 2010 to 2024 was approximately 102 articles, the result of the database search and screening process is detailed in the PRISMA flow diagram (Fig. S1, Supplemental Digital Content, https://links.lww.com/MD/R37 ). As shown in Figure 1 , research on halitosis showed a fluctuating upward trend, and the publication number was 145 in 2024, which was double that of 2010.
For the global literature involving halitosis from January 2010 to July 2025, the Sankey diagram is used to show the flow and relationship of the 3 fields: author – affiliated institution, journal source (Fig. 2 ). Among them, the author has the most flow to Fukuoka Dental College, indicating that Fukuoka Dental College may play an important role in halitosis-related fields. Journals such as “Archives of Oral Biology” and “Journal of Breath Research” have published relevant papers collaborated by authors from different institutions, indicating that scholars from different institutions have completed more comprehensive research through cooperation.
3.2. Distribution of journals
In the last 15 years, a total of 452 journals have been found in the global literature related to halitosis. The top 10 highest publishing journals are shown in Figure 3 A. “Journal of Breath Research” was the most publishing journal with 71 publications, “BMC Oral Health” ranks second with 39 publications, and “Oral Diseases” ranks third with 34 publications. Moreover, the number of literature publications in the top 5 journals showed an upward trend in different years (Fig. 3 B).
3.3. Distribution of authors and institutions
From January 2010 to July 2025, a total of 6818 authors were included in the global literature related to halitosis, and the top 10 productive authors are displayed in Figure 4 . Among them, Suzuki Nao ranked first (22 publications), Bussadori Sandra Kalil ranked second (21 publications), and Yone Da Masahiro (20 publications). The productive authors have played a certain role in promoting the development of the field of halitosis.
In terms of the country distribution of corresponding authors, the corresponding authors in the field of halitosis in the past 15 years mainly come from 19 countries. The ranking of the publication volume of correspondents from different countries is shown in the bar chart in Fig. 5 A. The blue column represents the publication volume of a single country, and the green column represents the publication volume of multiple countries. Moreover, the country with the most publications is China (total: 129; multiple countries: 12; single countries: 117), the USA ranked second (total: 91; multiple countries: 14; single countries: 77), and India ranked third (total: 86; multiple countries: 9; single countries: 77). Further statistics on the national distribution of authors show that the authors cover a total of 81 countries, and the top 3 rankings in the number of publications are China (n = 350, 13.21%), Japan (n = 294, 11.09%) and Brazil (n = 287, 10.83%) (Fig. 5 B).
The highest productivity of the corresponding authors’ publishing institutions in the field of halitosis is shown in Figure 6 . Furthermore, Fukuoka Dental College appeared most frequently (50 times), King Saud University ranked second (36 times), and Nove De Julho University ranked third (35 times). Since 2015, the number of publications in the field of halitosis by all institutions around the world has steadily increased. Among them, Nove De Julho University has increased rapidly since 2019 and maintained a high level of publication, while Fukuoka Dental College has always been in a leading position. The information of top 10 countries, journals and institutions with publication counts is displayed in Table S2, Supplemental Digital Content, https://links.lww.com/MD/R37 .
3.4. Word-frequency and topic trend analyses
All publications contained a total of 2586 keywords, and the top 50 keywords with frequency are displayed through the word cloud (Fig. 7 ). The key words with higher frequency are halitosis (383 times), oral health (93 times), oral malodor (59 times), periodontitis (59 times), probiotics (43 times), oral hygiene (40 times), volatile sulfur compounds (35 times), bad breath (34 times), periodontal disease (31 times), and quality of life (30 times). The analysis of word frequency revealed that the cause, mechanism, and impact on life of halitosis may still be worthy of study.
The main research topics and evolution trends of relevant literature in the field of halitosis in the past 15 years were further analyzed. The research topics of “probiotics” and “quality of life” have maintained a high frequency from 2018 to 2023, indicating that they have always been key research areas. Research on “quality of life” has increased since 2018, with the median year being 2022, and research was still active in 2023, indicating that quality of life is playing an increasingly important role in halitosis-related fields. The topic of oral diseases appears frequently, which is related to the fact that the main cause of halitosis is oral diseases (Fig. 8 ).
3.5. Co-occurrence network analysis of keywords
The results of co-occurrence network analysis of keywords in the literature related to halitosis are shown in Figure 9 A, where nodes represent keywords, and connections represent co-occurrence relationships or citation relationships between keywords. In the co-occurrence network, “halitosis” was the most important node, with the highest Betweenness (963.64), PageRank (0.2607), and relatively high Closeness (0.0204), which was a bridge connecting different research topics, and “volatile sulfur compounds” and “periodontitis” were also important nodes and played an important role of transmission in the network. The interactions between keywords are also displayed through a density plot, where darker areas indicate higher co-occurrences or stronger relationships (Fig. 9 B). In the density plot, “oral health,” “oral hygiene,” “epidemiology,” “prevalence,” “diagnosis,” and “dental students” showed darker colors in the high-density area, indicating that these key words played an important role in halitosis-related research.
3.6. Thematic map and evolution analyses
Thematic maps can show the spatial distribution of different topics or research directions. As shown in Figure 10 A, terms such as “chlorhexidine,” “malodor,” “probiotics,” “dental,” “caries,” “periodontal diseases,” “halitosis,” “bad breath,” and “periodontitis” are between Q1 and Q4, indicating that these topics have been sufficiently developed and can be used to build research areas. In addition, “maggots,” “oral myiasis,” “oral health-related quality of life,” “organoleptic,” “diagnosis,” and “tonsillectomy” in Q2 imply highly developed and isolated internal linkages, which may become the next hot spot for research if further links with “halitosis” are further strengthened. In terms of theme evolution, the topic word trend changed at the time point in 2019, and the key themes have shifted from “diagnosis,” “probiotics,” “quality of life,” “dentistry” and “chlorhexidine” between 2010 to 2018 into “dental caries,” “tonsillectomy,” “children,” “tongue coating” and “periodontal disease” between 2019 to 2025.
4. Discussion
Halitosis, bad breath or malodour, emitted from the oral cavity, is often linked to poor oral hygiene, diet, and underlying health issues. [ 13 ] Diagnosing and treating halitosis is challenging due to its complex causes and lack of standardized guidelines. Understanding current research on halitosis is crucial for effective prevention and control. Currently, bibliometrics has been widely used in the medical field. Bibliometrics is not only used to evaluate the contributions of countries, institutions, authors and journals to a research field, but also provides a way to objectively measure hot spots and trends in the research field. [ 14 ] In this study, relevant literature in the field of halitosis was analyzed by the visualizing bibliometric method.
The bibliometric analysis indicates an upward trend in the volume of literature concerning halitosis, although a slight decrease in publications during certain years may be attributed to the relatively narrow scope of research in this area. The Sankey diagram illustrating the connections among authors, institutions, and journals reveals the interrelationships within the field of halitosis research. Currently, numerous Japanese institutions and authors are notably active, with their frequent publications enhancing their influence and prominence in this domain. Furthermore, the majority of this literature is published in journals focused on oral health. From the perspective of publication volume, Fukuoka Dental College in Japan appears to play a significant role in halitosis-related research. The concept of health literacy has become increasingly significant within the realm of oral health. In Japan, curative dental care is typically encompassed by universal health coverage. [ 15 ] Additionally, the “8020” campaign, which serves as a long-term oral health promotion strategy in Japan, may have prompted Japanese researchers to focus more intensively on halitosis research. [ 16 ] According to the countries/regions distribution analysis, China contributed the most publications, followed by the USA, India, Japan, Brazil, Korea, and Turkey. This suggests that both developed and developing nations are investing considerable attention in the study of halitosis. Additionally, these productive countries have contributed to advancing research in this field. The 3 countries exhibiting the highest levels of international collaboration in research are China, the United States, and Brazil, suggesting that international cooperation in halitosis-related research may become a significant trend in the future.
The word cloud effectively visualizes the prominent topics related to halitosis, highlighting the most frequently occurring terms in the literature. Core vocabulary includes terms such as “probiotics,” “oral hygiene,” “volatile sulfur compounds,” “periodontal disease,” and “quality of life.” Topic trend analysis further indicates that oral diseases constitute a major focus within the field of halitosis research. Notably, “probiotics” and “quality of life” have emerged as key areas of interest in recent years, with the increasing emphasis on “quality of life” underscoring the growing recognition of halitosis’s impact on daily living. It can be seen that the pathogenesis, diagnosis and treatment of halitosis are still future research directions. The co-occurrence network can facilitate the identification of co-occurrence relationships of keywords in the literature. The density graph illustrates the interconnectedness of keywords within the network, aiding in the comprehension of network cohesion. In addition to “halitosis,” terms such as “volatile sulfur compounds,” “periodontitis,” “oral health,” “oral hygiene,” “epidemiology,” “prevalence,” “diagnosis,” and “dental students” serve as significant nodes, underscoring their pivotal roles in halitosis research. Theme evolution is employed to analyze the progression of topics over time and can aid in identifying emerging trends within the research domain. Thematic evolution analysis has revealed that oral diseases and children continue to be promising directions for future research.
Oral diseases affect quality of life and are known to decrease productivity. [ 17 ] Public health policy reform has attracted attention and research on oral health, [ 18 ] and an increasing body of research on oral health has been published. Despite ongoing efforts, research on halitosis remains insufficient. A common misconception is that halitosis is merely a personal hygiene issue, leading to its potential association with systemic diseases being overlooked and resulting in delayed medical consultation. For instance, current research trends inadequately address gastrointestinal diseases. Investigating the relationship between halitosis and gastrointestinal disorders could enhance understanding of the etiology of halitosis, facilitate its prevention and treatment, assist individuals with halitosis in overcoming social barriers, and improve their quality of life. Because of the fact that only a human can judge the objectionability of an odor, organoleptic examination was used as a reference standard of halitosis measurement. However, the diagnostic value of organoleptic examination is questionable. [ 19 ] At present, few standard methods available for diagnosing halitosis include high-performance liquid chromatography, atomic absorption spectrometry, ultraviolet-visible, and portable gas chromatography are often expensive, time-consuming, and equipment-dependent. [ 20 ] Thus, there are still many unresolved issues regarding the management of halitosis.
Halitosis is primarily caused by volatile sulfur compounds produced by anaerobic bacteria like Porphyromonas gingivalis and Treponema denticola in the mouth. [ 21 ] In the investigation of pathological mechanisms, although there is a foundational understanding of the relationship between oral microbial metabolism and halitosis, the intricate interactions among oral microbials require further elucidation through comprehensive research. [ 22 ] It was reported that hTAS2R38 polymorphisms may influence halitosis development and treatment by affecting oral microbiota, [ 23 ] though the genetic role remains unclear, requiring further study. While antibiotics were once common for treatment, their side effects and impact on the oral microbiome have reduced their use. Research now focuses on probiotics, [ 24 ] which aim to curb harmful bacteria through glucose and phosphorus metabolism rather than direct inhibition. [ 25 ] Though early studies show promise, probiotic use for halitosis is still being explored.
Regarding treatment, although traditional treatment methods such as herbal medicine [ 26 ] and oral hygiene knowledge [ 27 ] are still widely used, and modern treatment technologies such as probiotic therapy [ 28 ] and photodynamic therapy (PDT) [ 29 ] have also shown certain potential, there is still a lack of unified and standardized treatment protocols. Current treatment methods are mostly aimed at alleviating symptoms, making it difficult to solve the problem of halitosis fundamentally. [ 29 ] Evidence suggests that Helicobacter pylori infection is associated with halitosis, and eradication of Helicobacter pylori may help alleviate halitosis in individuals with refractory cases. [ 30 ] A meta-analysis has shown that PDT is effective in treating halitosis in the short term. [ 29 ] However, a randomized clinical trial indicated that performing only PDT on the tongue dorsum may not contribute to reducing halitosis. [ 31 ] Additionally, some antibacterial treatments may cause an imbalance in the oral microbiome, leading to other oral health issues. Thus, the efficacy and scope of application of different treatment methods necessitate further validation through rigorous, high-quality studies. In terms of diagnosis, although numerous testing methods exist, an accurate and convenient gold standard remains elusive. Enhancing the consistency of results across different testing methodologies is imperative, as some diagnostic technologies are complex and costly, thereby restricting their clinical and large-scale screening applications. [ 32 ]
Future research on halitosis should focus more on children and multidisciplinary collaboration. Halitosis negatively impacts overall health and self-esteem, which is the most important condition that can create a wrong first impression on others. [ 33 ] Halitosis significantly impacts the quality of life in children and adolescents, and suitable preventive and control interventions for halitosis should be considered to improve oral health-related quality of life by addressing the risk factors in children. [ 34 ]
Oral complications (including halitosis) following childhood cancer treatment are prevalent in childhood cancer survivors. [ 35 ] Moreover, multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region and can cause halitosis. [ 36 ] Sleeve gastrectomy may lead to increased halitosis 1 month post-surgery. [ 37 ] This highlights the need for oral health professionals in multidisciplinary teams. Collaborative studies across various fields will deepen understanding of halitosis and aid in developing better treatments.
Nevertheless, as a bibliometric study, there are some shortcomings in this paper. Initially, we only extracted English-language literature pertaining to halitosis from the PubMed via the Medpulse. Articles that were unpublished or published in languages other than English were excluded from the analysis. Furthermore, the literature search was restricted to articles containing the term halitosis within their titles, abstracts, or keywords, which may have resulted in a dataset that lacks comprehensive coverage.
5. Conclusion
Bibliometric analysis indicates that the diagnosis and treatment of halitosis, along with research focused on pediatric populations and multidisciplinary approaches, have emerged as recent research hotspots and directions in the field. However, research on halitosis remains insufficient, and the potential link between halitosis and systemic disease has been overlooked.
Author contributions
Conceptualization: Zhulin Wu, Fen Liu.
Data curation: Zhulin Wu, Wanjun Tan, Tingting Wang, Fen Liu.
Formal analysis: Zhulin Wu, Wanjun Tan, Tingting Wang, Tong Ke, Fen Liu.
Investigation: Zhulin Wu, Wanjun Tan, Fen Liu.
Methodology: Wanjun Tan, Tong Ke, Fen Liu.
Software: Tingting Wang.
Supervision: Tingting Wang.
Validation: Fen Liu.
Writing – original draft: Zhulin Wu, Fen Liu.
Writing – review & editing: Fen Liu.
Supplementary Material
Abbreviation: PDT photodynamic therapy
This study was supported by the Scientific Research Projects of Medical and Health Institutions of Longhua District, Shenzhen (2023023).
The authors have no conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are publicly available.
Supplemental Digital Content is available for this article.
How to cite this article: Wu Z, Tan W, Wang T, Ke T, Liu F. Trends and hotspots in global halitosis research: A bibliometric analysis from 2010 to 2025. Medicine 2025;104:52(e46830).
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