Persistent Bad Breath: When Dental Treatments Fail, What’s Next?

Persistent bad breath that dental treatments cannot resolve?

Hello Doctor: My husband informed me that even after brushing my teeth, he can still smell a foul odor coming from my mouth from about 30 cm away.
The smell resembles that of something rotting, making it difficult to breathe without noticing it.
I have visited several dental clinics; some dentists said my cavities were manageable and could be filled, and when I asked if I had periodontal disease, they all said no.
However, despite long-term treatment, the odor persists.
I always use dental floss after meals, brush my teeth diligently, and drink plenty of water.
I don’t smoke, drink alcohol, or consume soft drinks, yet I don’t know how to eliminate this odor.
As a woman, this is really embarrassing, and I find it hard to communicate with others.
Why hasn’t it improved? Doctor, besides seeing a dentist, what else can I do? A distressed young lady.

Ms. Huang, 40~49 year old female. Ask Date: 2013/10/22

Dr. Zheng Jueyi reply Otolaryngology

Dear Ms.
Huang,
Hello.
There are many factors that can cause unpleasant oral odors.
If dental issues have been ruled out, you may want to consult an otolaryngologist to check for chronic sinusitis, or visit a gastroenterologist to investigate potential issues such as gastroesophageal reflux disease.
Additionally, it may be beneficial to see an endocrinologist to assess for any metabolic disorders.
Wishing you safety and health.
Sincerely,
Dr.
Cheng Jue-Yi
Director, Department of Otolaryngology
Taoyuan General Hospital, Ministry of Health and Welfare

Reply Date: 2013/10/22

More Info

Persistent bad breath, or halitosis, can be a distressing condition, especially when dental treatments have not resolved the issue. It’s important to understand that bad breath can stem from various causes, and addressing it may require a multifaceted approach.

Understanding the Causes of Bad Breath
1. Oral Hygiene: While you mentioned that you maintain good oral hygiene by brushing and flossing regularly, it’s essential to ensure that you are doing it effectively. Bacteria can accumulate on the tongue, in between teeth, and along the gum line, leading to bad breath. Using a tongue scraper and ensuring that you clean your tongue can significantly help in reducing odor.

2. Dental Issues: Even if dentists have stated that you do not have periodontal disease, other dental problems such as untreated cavities, cracked teeth, or issues with dental restorations (fillings, crowns) can harbor bacteria and contribute to bad breath. It might be worthwhile to seek a second opinion or consult a specialist, such as a periodontist or an oral surgeon, to rule out any underlying dental issues.

3. Dry Mouth (Xerostomia): Saliva plays a crucial role in washing away food particles and bacteria. If you suffer from dry mouth, it can lead to an increase in bad breath. This condition can be caused by medications, certain health conditions, or even breathing through your mouth. Staying hydrated and using saliva substitutes or mouthwashes designed for dry mouth can be beneficial.

4. Dietary Factors: Certain foods, such as garlic, onions, and spices, can contribute to bad breath. Additionally, a diet low in carbohydrates can lead to ketosis, which can also produce a foul odor. Keeping a food diary to identify any potential dietary triggers may help.

5. Systemic Conditions: Sometimes, persistent bad breath can be a sign of an underlying health issue, such as diabetes, liver disease, or gastrointestinal problems. If dental treatments have failed to resolve the issue, it may be prudent to consult a physician for a thorough evaluation.

Next Steps to Address Bad Breath
1. Consult a Specialist: If your current dental treatments have not resolved the issue, consider visiting a specialist. An oral and maxillofacial specialist or a periodontist can provide a more in-depth examination of your oral health.

2. Regular Dental Check-ups: Ensure that you have regular dental check-ups to monitor your oral health. This can help catch any potential issues early.

3. Improve Oral Hygiene Practices:
- Use an antibacterial mouthwash to help reduce bacteria in the mouth.

- Incorporate a tongue scraper into your daily routine.

- Consider using dental products containing xylitol, which can help reduce bacteria.

4. Stay Hydrated: Drink plenty of water throughout the day to help keep your mouth moist and wash away food particles.

5. Dietary Adjustments: Pay attention to your diet and consider reducing foods that may contribute to bad breath. Incorporating crunchy fruits and vegetables can help clean your teeth naturally.

6. Explore Medical Causes: If dental solutions do not work, seek a medical evaluation to rule out systemic causes of bad breath. A physician can conduct tests to check for conditions that may be contributing to your symptoms.

Conclusion
Persistent bad breath can be a complex issue that requires a comprehensive approach to diagnosis and treatment. By exploring various dental and medical avenues, you can work towards finding a solution. Remember, it’s essential to communicate openly with your healthcare providers about your concerns, as they can offer tailored advice and treatment options based on your specific situation. Don’t hesitate to seek help until you find a resolution that works for you.

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