Halitosis (bad breath) Flashcards
Probability diagnosis
The commonest causes are:
- Oro-dental disease due to poor oral hygiene (esp. gingivitis, discharging abscess)
- and inappropriate diet.
One survey indicated that:
- 87% had an oral cause
- 8% ENT
- 5% an unidentified cause
Serious disorders not to be missed
Malignancy
- lung, oropharynx, larynx, stomach, nose, leukaemia
Pulmonary tuberculosis
Quinsy
Lung abscess
Blood dyscrasias/leukaemia
Uraemia
Hepatic failure
Pitfalls (often missed)
- Nasal and sinus infection
- Tonsillitis
- Mouth breathing
- Systemic infection
- Appendicitis
- Bronchiectasis
- GORD/Hiatus hernia
Rarities:
- hairy tongue
- pharyngeal and oesophageal diverticula
- Sjögren syndrome
- scurvy
Masquerades checklist
Depression
Diabetes (acetone)
Drugs (e.g. antidepressants, isosorbide)
Is the patient trying to tell me something?
Possible manifestation of psychogenic disorder (e.g. depression).
Key history
General health
Respiratory history
Gastrointestinal history including dry mouth and reflux
Dental history
Drug history including;
- OTC preparations
- alcohol
- smoking
Dietary history: ask about onions, garlic, peppers, curries, spicy salami and similar meats, strong cheeses and water intake
Psychosocial history
Key examination
Orodental inspection, also oropharynx, nose and sinuses
Respiratory system
Abdominal examination
Key investigations
FBE
ESR/CRP
Urine analysis
Blood sugar
Kidney function tests
Liver function tests
- X-ray of sinuses
- Consider CT scan sinuses
Diagnostic tips
If cause is unknown refer to a dental surgeon; consider an ENT opinion.
Bacterial putrefaction of dental and food debris plus inflammation of the gums are largely responsible for oral malodour.
Smoking, alcohol and a dry mouth all aggravate the problem.
Consider drugs, e.g.
- isosorbide dinitrate
- antidepressants
Management
Avoid or limit onions, garlic, peppers, spicy salami and similar meats
Avoid or limit strong cheeses
Avoid smoking and excessive nips of alcohol
Brush teeth regularly during day—immediately after a meal
Rinse mouth out with water after meals
Avoid fasting for long periods during the day
Gargle with mouthwash regularly (e.g. Listerine, Cepacol Mint mouthwash, 0.2% aqueous chlorhexidine)
Use dental floss regularly to clean the teeth
Chew sugarless gum to moisten mouth
Use an oil/water wash:
- e.g. equal volumes of aqu. Cepacol and olive oil
- gargle a well-shaken mixture and spit out, qid.
