Oral odors - is it more than just bad breath?

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As dentists, we all know just how prevalent halitosis is across the United States, and it’s something we see in our patients each and every day. Reports suggest that as much as 65% of the population have bad breath, but fortunately halitosis is rarely more than a sign that patients have been brushing properly. 

But what if it is bad brushing?

Oral Causes of Halitosis

Most cases of halitosis are simply caused by a failure to maintain good oral hygiene, and can be effectively treated at home through interdental cleaning, tongue cleaning, and the use of mouth rinses both morning and evening. Sometimes, there can be a little more to it, with bad breath being caused by conditions such as gingivitis or periodontal disease, but again these are all oral causes that we’re trained to both identify and treat at the practice. In total, it’s estimated that between 65 and 85% of halitosis cases are the result of problems arising on the tongue or in the parodontium area of the mouth. 

Non-Oral Halitosis

The remaining 15 - 35% of halitosis cases can be a little more tricky to manage. While it is statistically most likely that non-oral causes are minor, it can’t be overlooked that bad breath can indicate very serious localized or systemic conditions. Diabetes, liver failure, and lung diseases such as respiratory infections and cystic fibrosis can all present with bad breath as one of the most prominent symptoms. 

Perhaps even more incredibly, MIT reports that bad breath can also signal lung cancer. It has been found that, in some cases of lung cancer and some forms of lung infection, bad breath can present as the first noticeable symptom. This occurs long before fever, cough, or chest pain are experienced by the patient. 

Knowing What to Look For

While we are not trained to diagnose or treat these types of conditions, as dentists it is essential that we understand that oral symptoms are not always indicative of oral health or oral conditions. Knowing what’s normal — and what’s not normal — in the presentation of halitosis really could save a life. 

Here are two of the most common indicators that halitosis has a non-oral cause:

  • Acetone / Nail Polish Remover

If a patient’s breath smells like nail polish remover, it should be recommended that the patient makes an appointment with their physician to have their blood sugar levels checked. In cases of diabetes, diabetic ketoacidosis occurs when there are very high levels of ketones in the blood, resulting in a greater odor. Ketones have a strong smell which is most commonly associated with nail polish remover. That’s because many nail polish removers contain acetone, a form of ketone that’s often used for cleaning purposes. 

  • Sweet / Musty / Perfume

If a patient’s breath smells somewhat perfumey, with a definite sweet and musty aroma, it may be that the cause isn’t due to ketones, but to limonene. Studies have found that those suffering from liver disease have more of the chemical compound limonene in the body than healthy individuals. The link is so strong that limonene is on track to be used as an official biomarker for early stage liver disease. With symptoms rarely presenting in early stages, bad breath could be key to more timely diagnostics. 

Share, Don’t Scare

The most important aspect to keep in mind is that different odors smell different to different people, so even if you do identify an unusual smell on your patient’s breath it does not always mean there is cause for alarm. If there is uncertainty as to the cause of bad breath, or halitosis is not responding as expected to common forms of treatment, advise your patients to visit their physician for further examination.

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