Can a coated tongue cause bad breath?
Dear Dr.
Tseng,
Recently, I saw a television advertisement stating that tongue coating can affect oral taste and cause bad breath.
I have been experiencing bad breath for over 20 years (since middle school, when others informed me about it).
I have visited countless dentists who have said that I only have mild periodontal disease and calculus, which should not cause bad breath.
I also went to National Taiwan University Hospital to see Dr.
Sun Andy, who examined me and said there were no issues in my oral cavity and that my bad breath should not be severe.
I consulted an ENT specialist who confirmed that I do not have sinusitis, and I also visited a gastroenterologist and underwent a Helicobacter pylori test, which came back normal.
My mother suggested traditional Chinese medicine, saying I have "excess heat," while my husband recommended herbal remedies, claiming I have "liver heat." Some have advised me to supplement with vitamins—oh my! I am going crazy! Why has this hidden ailment troubled me for so many years without a clear cause, making me hesitant to speak closely with others (sometimes I can faintly smell the bad odor when talking on the phone)? My interpersonal relationships are poor, my career is suffering, and my social interactions are challenging—all because of this "bad breath." I have often thought that if there were a surgical solution to this condition, I would not hesitate to pursue it!
Could you please tell me, Dr.
Tseng, what this issue might be? I have been diligently brushing my tongue, but the bad breath persists.
Drinking more water has not helped or improved the situation.
Can you advise me on what the underlying problem might be? How should I find a doctor? Could you recommend a reputable dentist or oral specialist in Taichung (as I have seen too many dentists already) to see if my fate can be changed? Thank you!
Sincerely,
Xiao You
Xiao You, 30~39 year old female. Ask Date: 2004/11/24
Dr. Zeng Guanghui reply Dentistry
The causes of halitosis can be divided into external and internal factors.
External factors refer to poor oral hygiene, which allows bacteria in the mouth to ferment food residues left in the oral cavity, producing volatile sulfur compounds that lead to a distinct odor.
This includes bacteria and food debris that remain on the tongue.
If the tongue is not properly cleaned, it may contribute to bad breath.
Internal factors refer to systemic diseases, including issues with the liver, kidneys, gastrointestinal system, immune system, and certain upper respiratory infections (including those in the nasal cavity).
Conditions such as diabetes and metabolic disorders (like hyperthyroidism) can also lead to halitosis.
It is advisable to consult an oral pathologist for further examination to identify the underlying cause, allowing for targeted treatment to resolve the issue of bad breath.
Reply Date: 2004/11/24
More Info
Bad breath, or halitosis, can be a complex issue with multiple underlying causes, and tongue coating is indeed one of the contributing factors. The surface of the tongue can harbor bacteria, food particles, and dead cells, which can lead to an unpleasant odor. This is particularly true if the tongue is not cleaned regularly, as the bacteria can produce volatile sulfur compounds (VSCs) that are primarily responsible for bad breath.
In your case, it sounds like you've been through a comprehensive evaluation with various specialists, including dentists and ENT doctors, and have not found a definitive cause for your chronic bad breath. This can be incredibly frustrating, especially when it affects your social interactions and self-esteem.
Here are some potential factors and recommendations to consider:
1. Tongue Coating: As you mentioned, a coated tongue can contribute to bad breath. Regularly brushing your tongue with a toothbrush or using a tongue scraper can help reduce the buildup of bacteria and debris. It's essential to incorporate this into your daily oral hygiene routine.
2. Oral Hygiene: While you've indicated that you've been diligent about brushing your teeth, it's also crucial to floss daily and use an antibacterial mouthwash. These practices can help eliminate food particles and bacteria that contribute to bad breath.
3. Dry Mouth: A dry mouth can exacerbate bad breath. Saliva plays a vital role in washing away food particles and bacteria. If you experience dry mouth, consider staying hydrated, chewing sugar-free gum, or using saliva substitutes. Certain medications and conditions can lead to dry mouth, so discussing this with your healthcare provider may be beneficial.
4. Diet: Certain foods, such as garlic and onions, can contribute to bad breath. Additionally, a diet high in sugar can promote bacterial growth in the mouth. Consider evaluating your diet and making adjustments if necessary.
5. Underlying Health Issues: While you've had tests for conditions like sinusitis and H. pylori, other health issues could still be at play. Gastroesophageal reflux disease (GERD) can cause bad breath due to stomach acids reaching the mouth. If you suspect this might be an issue, discussing it with a gastroenterologist could be worthwhile.
6. Consulting a Specialist: Given your ongoing concerns and the lack of resolution, it may be beneficial to consult with a specialist in oral medicine or a periodontist who focuses on gum health and oral diseases. They may provide a fresh perspective or additional diagnostic tests that could uncover underlying issues.
7. Psychological Factors: Sometimes, the perception of bad breath can be influenced by anxiety or stress. If you find that your concerns about bad breath are affecting your mental health or social interactions, speaking with a mental health professional may also be helpful.
8. Alternative Therapies: Some individuals find relief through alternative therapies, such as acupuncture or herbal remedies. While these should not replace conventional treatments, they may provide additional support.
In summary, while tongue coating can contribute to bad breath, it is essential to consider a holistic approach that includes thorough oral hygiene, dietary adjustments, and possibly further medical evaluations. If you're looking for a reputable dental or oral health specialist in Taichung, I recommend checking local dental associations or seeking referrals from trusted healthcare providers. They can help you navigate this challenging issue and work towards finding a solution that improves your quality of life.
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