Halitosis associated with periodontal disease - how to help your patients

Bad breath... a taboo? Talking to your patients about bad breath, or halitosis, can be difficult and many people can be very sensitive or embarrassed about it. As dental professionals, we can help and we should feel confident when going about these often tricky conversations.

What causes halitosis?

Halitosis, or fetor oralis are used to describe any noxious smell arising from the oral cavity when breathing or speaking. The causes of halitosis can be complex, including systemic medical issues. However, 80-90% of the time, halitosis originates from the oral cavity. One of the most common sites for halitosis to originate from is periodontal tissues and the posterior dorsum of the tongue is another source.

The malodor is caused by microorganisms degrading sulfur-containing and non-sulfur containing amino acids which are derived from proteins in exfoliated human epithelial cells, white blood cells, or cells present in plaque, saliva, blood and tongue coatings. The microorganisms most commonly active in these processes are Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia.

Having the conversation

When dealing with these difficult conversations, dental professionals must remain sensitive and kind, listening to a patient's concerns. But how should the topic be discussed in a sensitive manner?

Some patients will present to a dental professional and openly disclose that bad breath is the reason (or one of the reasons) why they attended; others will not say anything. This might be because they are not as aware of the issue, but many are just embarrassed to say anything! Having posters and other educational materials in the practice waiting room, website and in the dental office about managing bad breath and the causes for it can be a conversation starter for these patients.

Dental professionals can ask questions that are broad for patients that do not volunteer information or complain of halitosis. Asking questions can help patients open up about any concerns they have. One general question that can help uncover a problem is to ask 'is there anything I can help you with to improve the health of your mouth and teeth?' Sometimes more direct questions will help and can be used to screen for halitosis. For example, you might ask 'have you noticed any bad breath or tastes in your mouth?' A question can be added to a patient's medical or dental screening forms to ask about oral malodor, which can be a more discrete way for patients to inform dental professionals of any concerns they have about bad breath.

How to help patients with halitosis

Once halitosis has been discussed, helping patients understand why they have halitosis is key. Helping patients manage and resolve their halitosis will be one of their biggest priorities. Equipping patients with periodontal disease with information on the cause of their halitosis can also have a positive effect on compliance with recommended oral hygiene regimens, as well as treatment and maintenance visits.

Talking openly and non-judgmentally about bad breath will not only result in grateful patients, but potentially patients who will be more willing to comply with suggested dental treatment and home care recommendations and advice given by their dentist.