mouth and dental disorders
Bad Breath
Evaluation of Bad Breath
Bad breath rarely requires an immediate evaluation by a doctor or dentist. The following information can help people decide whether an evaluation is needed and help them know what to expect during the evaluation. Certain symptoms and characteristics are cause for concern. They include Fever Pus-filled (purulent) sputum or discharge from the nose Visible or touchable abnormal spots in the mouth People who have fever or purulent sputum or nasal discharge or who may have inhaled a foreign object should see a doctor right away. People who discover an abnormal spot in their mouth should see a dentist within several days. People with bad breath but no warning signs and who otherwise feel well should see a dentist when they are able. Dentists and doctors first ask questions about the person's symptoms and medical history. They then do a physical examination. What they find during the history and physical examination often suggests a cause of the bad breath and the tests that may need to be done (see table). Thesniff testis a helpful part of the examination that can help tell whether the bad odor is coming from a nose or sinus disorder versus a mouth or lung disorder. The person exhales about 4 inches (about 10 centimeters) away from the doctor’s nose, first through the mouth with the nose pinched shut and then through the nose with the mouth closed. If the odor is worse through the mouth, the cause most likely originates in the mouth. If the odor is worse through the nose, the cause most likely originates in the nose or sinuses. If the odor is similar from both the nose and the mouth, the cause most likely originates from another part of the body or the lungs. If the examiner is unable to tell where the cause originates, the back of the tongue is scraped with a plastic spoon. After 5 seconds, the spoon is sniffed. A bad odor on the spoon shows that the likely problem is bacteria on the tongue. The need for testing depends on what the doctor finds during the history and physical examination, particularly whether Warning signs are present. Some specialists who focus on bad breath have unusual testing equipment, such as portable sulfur monitors, gas chromatography, and chemical tests for tongue scrapings. Such testing is rarely needed except for medical research. The doctor may suggest that people whose symptoms seem to be related to ingested or inhaled substances avoid the suspected substances for a period of time to see whether the symptoms go away (trial of avoidance). 