Which Specialist Should I See for Persistent Bad Breath? - Family Medicine

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Hello Lareau,
Persistent bad breath, or halitosis, can indeed be a frustrating issue, especially when it affects your professional and social interactions. Since you've already consulted with a dentist and an ENT (ear, nose, and throat) specialist without finding a resolution, it may be time to explore other avenues.

First, it’s important to understand that bad breath can stem from various causes, including oral hygiene issues, underlying medical conditions, or even dietary factors. Here are some potential steps you can take:
1. Consult a Gastroenterologist: Since you've ruled out dental and ENT issues, the next logical step is to see a gastroenterologist. Bad breath can sometimes be linked to gastrointestinal problems, such as acid reflux, gastroesophageal reflux disease (GERD), or other digestive disorders. These conditions can lead to the release of foul-smelling gases that can be exhaled.

2. Consider a Periodontist: If you haven’t already, visiting a periodontist might be beneficial. Periodontists specialize in the treatment of gum disease, which can also contribute to bad breath. They can assess the health of your gums and the underlying structures of your teeth.

3. Explore Systemic Conditions: Sometimes, persistent bad breath can be a sign of systemic conditions such as diabetes, liver disease, or kidney issues. If you have other symptoms or risk factors associated with these conditions, it may be worth discussing them with your primary care physician, who can perform a comprehensive evaluation and possibly refer you to an appropriate specialist.

4. Review Your Medications: Certain medications can cause dry mouth (xerostomia), which can lead to bad breath. If you are taking any medications, review them with your doctor to see if they might be contributing to your issue.

5. Dietary Considerations: Sometimes, dietary habits can play a significant role in bad breath. Foods such as garlic, onions, and certain spices can contribute to halitosis. Additionally, a diet low in carbohydrates can lead to ketosis, which can also cause a distinct odor. Keeping a food diary may help identify if certain foods are triggering your symptoms.

6. Oral Hygiene Practices: While you may have already addressed this with your dentist, ensuring that you have a robust oral hygiene routine is crucial. This includes brushing your teeth at least twice a day, flossing daily, and using an antibacterial mouthwash. Additionally, cleaning your tongue can help remove bacteria that contribute to bad breath.

7. Hydration: Staying well-hydrated is essential for maintaining saliva production, which helps wash away food particles and bacteria in the mouth. If you are experiencing dry mouth, consider using saliva substitutes or discussing this with your healthcare provider.

In summary, since you have already seen a dentist and an ENT specialist, I recommend consulting a gastroenterologist next. They can evaluate for any gastrointestinal issues that may be contributing to your bad breath. Additionally, consider seeing a periodontist to rule out any gum disease. It may also be helpful to keep track of your diet and any medications you are taking, as these can influence your oral health and breath.

I hope this information helps you find the right path to addressing your persistent bad breath. Don't hesitate to reach out to healthcare professionals who can assist you further in identifying the underlying cause and finding an effective treatment. Best of luck!