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Suggest Treatment For Severe Bad Breath

Posted on Thu, 2 Jul 2015

Question: Hi Doctor,

I have a severe issue related to my bad breath. I have contacted many doctors earlier and has taken all the tests. I have taken sinus scan, visited gastroenterologists, ENT, Dentist and used many fresh breath mints, products, tablets. But none gave any respite. All the reports were fine and said to continue using mint products. But that never helped in the first place.

I am not sure what next steps I can take, and its been more than 4 years since this problem started and I am loosing my confidence because of this.

Please guide me on this.

Thanks, XXXXXXX

Answered by Dr. Mahesh Kumar T S (7 hours later)

Brief Answer:
xerostomia, pneumonia, bronchitis, diabetes, investigations

Detailed Answer:
Thanks for your query. I have gone through your query.
I feel really sad for your condition, i went through your previous discussion also.
As far as the bad breath is concerned, i have the following possibilities.
Since you have already ruled out the dental related issues, gastroenterological, ENT related problems, the other possible cause can be, xerostomia(reduced salivary secretion), diabetes, pneumonia or bronchitis.
Consult a good oral physician and get yourself evaluated, i feel some body is missing some clinical finding in you without diagnosing. Get your stimulated and unstimulated salivary flow rate. If there is reduced salivary flow, then it can cause halitosis because of the impaired cleansing activity.
The other advise what i would like to give you is, get a random blood sugar level checked since diabetes can also cause halitosis. The last thing what i wanted to rule out was pneumonia or bronchitis, even in these conditions you may have halitosis. So i would suggest you to consult a pulmonologist and take an opinion and let me know his comments.
If you can upload the images of the teeth and the tongue, i will have a look and let you know if there is any problem with the teeth and tongue.
So kindly upload the images, get the above said investigations and consult a pulmonologist and get back to me.
Mean while you can use mouth wash containing chlorhexidine and mint. Do morning and night brushing, do rinse your mouth soon after eating anything.
I hope i have answered your query. I will be waiting for your reply.
Take care.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Mahesh Kumar T S (19 minutes later)

Thanks for the detailed information Doctor.

If I summarize, I need to take the below tests

1. Sugar level
2. salivary flow rate
3. pulmonologist (for pneumonia or bronchitis)

can you suggest me some good doctor in XXXXXXX where I can get the check-ups done? All the doctors I visited never came to my rescue.

Please help me out here as I believe this as my last chance to figure out what's exactly wrong.

Answered by Dr. Mahesh Kumar T S (5 minutes later)

Brief Answer:
Diagnostic laboratory, be positive

Detailed Answer:
Thanks for your feedback.
I am sorry, i do not know any doctors in XXXXXXX The investigations what i told you can be done in any diagnostic laboratories. But ask for any pulmonologist in any hospital and take an opinion. Upload the images of the teeth, gums and tongue. I strongly feel that it is more of teeth and gums related. Any way get the investigations and upload the reports and images. I will tell you the solution. Do not loose hopes, be positive. Halitosis is not a major issue, it can be cured.
I hope i have answered your query. Waiting for your reports and images.
Take care.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Mahesh Kumar T S (2 days later)

Thanks Doctor.

I have uploaded the images of my teeth and tongue. I will upload the other reports soon.

Answered by Dr. Mahesh Kumar T S (9 hours later)

Brief Answer:
not related to teeth and gums, upload other reports

Detailed Answer:
Thanks for the reply.
I have gone through the images. As per the images the teeth looks fine. I am not able to see the gums of back teeth. I feel it is not from teeth or gums. If you have radiograph you can upload the images. Waiting for you to upload the other reports. Take care

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Mahesh Kumar T S (36 hours later)

Could you please let me know the exact name of the test to take? I see many test related to sugar and the test for salivary flow rate.

Please mention the test names.

Thanks, XXXXXXX

Answered by Dr. Mahesh Kumar T S (3 hours later)

Brief Answer:
spitting method, wafers method, Other investigations.

Detailed Answer:
Thanks for your reply and concern.
I would like to know the stimulated or unstimulated salivary flow rate by wafers method or spitting method. Regarding the blood sugar level, i wanted you to get random, fasting blood sugar level.
I would like to get some more information, if possible give the following details.
1. I want your diet chart for a minimum of 5 days, means - what food you consume for break fast, lunch dinner and any other habits you have?
Because food stuff containing hydrogen sulfide may result in halitosis. Food stuff containing or releasing hydrogen sulfide are egg and fish.
2. I want you to consult a good ENT surgeon and get yourself evaluated for any vallecula present near the tonsil or near epiglottis may result in accumulation of food debris and fluid may result in halitosis. So i want you to get this also evaluated by a good ENT surgeon.
3. You can get a gaschromatography test, this finds out whether you have halitosis or not and also finds out which cheical is causing the halitosis.
4. Opinion from an endocrinologist reagarding halitosis related to endocrine disorders.
Get these tests done and let me know the results. I hope i have answered your query.
Waiting for your reply. Take care.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Mahesh Kumar T S (3 days later)

Hi Doctor,

As suggested, I have visited NT doctor and also took my FBS test.

ENT doctor, ruled out the possibilities of salivary issue, vallecula is also fine. No issues with gaschromatography as well.

I will upload the reports tomorrow.

only thing left out is endocrinologist , which is very rare cause for halitosis as suggested by ENT specialist where I visited.

Answered by Dr. Mahesh Kumar T S (10 hours later)

Brief Answer:
Pseudo-halitosis and Olfactory reference syndrome, Psychiatrist

Detailed Answer:
Thanks for your feed back.
You can upload the reports.
The endocrine problems can also result in halitosis like in case of thyroid problems, renal problems,
If the reports gives no significant findings then we have to think of condition called Pseudo-halitosis and Olfactory reference syndrome (ORS) where the patients who consider to have bad breath, but who does not have it, and finally get convinced during diagnosis and therapy. So these conditions are managed by Selective Serotonin Reuptake Inhibitor, which increases the concentration of serotonin in the brain, can help to treat this phenomenon.
So you need to consult a psychitrist or psycologist because they are the one who has to treat these conditions and administer these drugs.

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E