How Family Medicine Can Help You Tackle Chronic Bad Breath Issues

How does family medicine address the issue of halitosis?

Hello Doctor, I have been experiencing bad breath for many years, and it has recently become more severe.
The odor primarily originates from my tongue and tonsils, and I have been aware of this issue for the past seven years.
Three years ago, I underwent a health check-up at my own expense, which included examinations of the nasal cavity, gastrointestinal endoscopy, liver and gallbladder ultrasound, as well as routine urine and blood tests.
The abnormal results included elevated white blood cell count, high cholesterol, ketones 3+, and elevated hs-CRP (the tests were done after fasting for 12 hours).
I also had additional evaluations in dentistry, otolaryngology, and thyroid function; there were no signs of periodontal disease, and both the nasal endoscopy and thyroid tests were normal.
Over the years, I have made significant efforts to improve my oral hygiene, brushing my teeth in the morning, after meals, and before bed, as well as brushing my tongue and using dental floss, but the bad breath issue has not changed at all.
My tongue consistently has a foul odor at all times.
I would like to ask the doctor if I should seek further evaluation from a family medicine physician, or if I would be referred to another specialty.
For example: 1.
Could my tongue and tonsils be infected with some bacteria or fungi? 2.
Is it possible that this is a congenital issue? Can these evaluations be performed in family medicine? Thank you for your response.

An, 20~29 year old female. Ask Date: 2024/05/20

Dr. Chen Bozhang reply Family Medicine

If you have maintained good oral hygiene and care but are still experiencing bad breath, it is important to determine whether it is caused by an underlying medical condition.
Based on your description, oral and nasal diseases have been ruled out, so you may want to consider conditions such as tonsillitis, kidney or liver diseases, or gastroesophageal reflux disease (GERD).
It is advisable to visit a family medicine clinic for further evaluation.
Please feel free to ask your physician any questions you may have during your appointment.
Thank you.

Reply Date: 2024/05/20

More Info

Chronic bad breath, or halitosis, can be a distressing condition that significantly impacts one’s quality of life. Given your detailed history and the various examinations you've undergone, it’s clear that you are seeking a comprehensive approach to address this issue. Family medicine can indeed play a pivotal role in diagnosing and managing chronic bad breath, especially when it involves multiple systems of the body.

Firstly, it’s important to understand that bad breath can stem from a variety of causes, including oral hygiene practices, systemic health issues, and even lifestyle factors. Since you have already been diligent about your oral hygiene—brushing your teeth and tongue, using dental floss, and maintaining regular dental check-ups—it may be beneficial to explore other potential underlying causes.

1. Infection or Inflammation: You mentioned that the odor seems to originate from your tongue and tonsils. Infections in these areas, such as tonsillitis or a condition known as "cryptic tonsillitis," where food particles and bacteria accumulate in the crevices of the tonsils, can lead to persistent bad breath. A family medicine physician can perform a thorough examination of your throat and may refer you to an ENT (ear, nose, and throat) specialist if necessary for further evaluation.

2. Systemic Conditions: Your lab results indicate elevated white blood cells, cholesterol, and CRP levels, which may suggest underlying inflammation or infection. Conditions such as diabetes, liver disease, or gastrointestinal disorders can also contribute to halitosis. A family physician can help interpret these results in the context of your overall health and may recommend additional tests to rule out systemic causes.

3. Gastrointestinal Issues: Since you have undergone gastrointestinal endoscopy, it’s essential to consider conditions like gastroesophageal reflux disease (GERD), which can cause bad breath due to stomach acids reaching the mouth. A family doctor can assess your symptoms and may suggest dietary modifications or medications to manage reflux.

4. Salivary Gland Function: Reduced saliva production (xerostomia) can lead to bad breath as saliva helps cleanse the mouth and neutralize acids produced by bacteria. A family physician can evaluate your hydration status and discuss potential treatments, including saliva substitutes or medications to stimulate saliva production.

5. Potential Genetic Factors: While it’s less common, some individuals may have a genetic predisposition to certain conditions that can lead to chronic bad breath. A family physician can take a detailed family history and may refer you to a genetic counselor if hereditary conditions are suspected.

6. Referral to Specialists: If your family physician identifies specific areas of concern, such as a suspected infection or a gastrointestinal issue, they may refer you to specialists such as an ENT, gastroenterologist, or even a dentist specializing in periodontics. This collaborative approach ensures that all potential causes are explored.

In conclusion, visiting a family medicine physician is a wise step in your journey to address chronic bad breath. They can provide a holistic assessment of your health, coordinate necessary tests, and refer you to specialists as needed. It’s essential to communicate all your symptoms and concerns clearly, as this will help guide the diagnostic process. With persistence and a comprehensive approach, you can work towards finding a solution to your chronic halitosis.

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