Understanding Bad Breath

Date: March 2021

Author: Mandy Dennis, RDH

Did you know up to nearly half of the adult population has bad breath?  As hygienists, we tease out how we can detect periodontal disease when we walk in a room. It’s almost a sixth sense. For some of our patients, halitosis may be caused by periodontal disease. Other factors may contribute to malodor.  It is possible that a patient doesn’t realize they even have bad breath.  As a dental professional, having a serious conversation about their condition should happen.  It may be embarrassing for them to bring up, therefore being able to bring it up may be a relief in resolving their problem. 

Beginning the Conversation                                     

If up to half of the adult population experiences bad breath, this should be a pretty easy topic, right?  In fact, this topic can be a difficult one to bring up.  Asking simple questions can help to identify specific factors causing or contributing to halitosis. 

1. Have you noticed having a bad taste in your mouth?  Halitosis caused by periodontal disease or even poor oral hygiene habits alone can be noticed by an individual as a bad taste. 

2. Have you been experiencing dry mouth?  Your patient may answer that they have noticed a sticky feeling or the need to constantly chew gum or mints. 

3. Have you noticed having reflux, frequent hiccups or burping?  Diet is a major contributor to halitosis.  An unhealthy gut can cause gases to be expelled as malodor through the mouth.   

4. Do you suffer from frequent sinus infections?  Post-nasal drainage and infection meets the air you breathe. It is then transferred to the breath.

Getting to the Solutions

 As hygienists, we make recommendations not diagnoses.  As we explore the possibilities of things that could be contributing to our patient's problem, it is important we never transfer those recommendations as a conclusive solution. This is especially true in cases where the root problem is medically involved.  It is very common for us to see oral manifestations of whole body concerns.  Being an advocate for our patients and referring them to see their primary care physician is very important when needed. 

1.  Halitosis associated with periodontal disease or poor oral hygiene.  This is our specialty.  Discussing daily habits such as flossing, brushing, tongue scraping, mouth rinses and other oral health aids can be the solution for many of our patients. Starting with a periodontal examination, followed by periodontal therapy as indicated is a great start to reducing bacteria causing the malodor and bad taste when this is the cause. 

2. Dry mouth.  Xerostomia has been reported to affect up to 65% of people.  It can be caused by medication side effects, various disease states, head & neck irradiation, dehydration, surgery, smoking and mouth breathing.  Opening a conversation about dry mouth may lead to many other topics including dental caries, gingival discomfort, sleeping devices for sleep apnea or smoking cessation.  It’s important to remember that we may not be able to solve the problems causing dry mouth for a given patient, however we can make suggestions to help provide relief from dry mouth and help alleviate halitosis associated with it.  Mouth rinses such as Hydris can help by locking in hydration for up to 4 hours and can be used periodically during the day.  It’s also important to reiterate to those patients who are using mints and/or gum to look for xylitol as the sweetener and to avoid those containing sugar to help prevent dental caries. 

3.  Reflux.  Chronic reflux of gastric acid and bile can be associated with bad breath due to their odor.  Recommend that your patients see their primary care physician if they still have reflux after adjusting their diet and habits that may contribute to reflux. 

4. Sinus infections.  It is common for patients who experience sinus infections to present with bad breath. The odor results from mucus from the infected sinuses draining into the back of the throat and the odor reaches the breath. While rare, a patient may have tonsillolith or tonsil stones. This calcified material has a strong odor. These will typically work themselves out by gargling and many do not require treatment.  Some dental professionals are comfortable removing them.  If a patient continues to experience tonsil-related problems, it may be necessary to recommend that they see an ear, nose and throat specialist. 

Bad breath doesn’t have to be a constant problem.  Having an honest conversation with your patient can build trust and help them resolve a problem they weren’t aware of or when they were too embarrassed to ask.

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