What causes chronic bad breath in adults despite treatment?

Question

Hello doctor,

I am a 22-year-old boy. For more than a decade, I have had chronic bad breath. I improved my oral hygiene and followed all the advice. I take all the prescribed medicines but still find no relief. Finally, I suspected tonsil stones, so I went for surgery and had my tonsils removed. However, I am still suffering from the same problem. There is no history of any disorder with me except for malaria. What should I do?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I understand how troubling and frustrating chronic bad breath can be, especially after trying so many treatments, including tonsil removal. You have made great efforts so far, including maintaining oral hygiene and undergoing the tonsillectomy procedure. There could be several other causes in this case. Possible causes include a coated tongue, which should be cleaned daily, especially the back part near the throat; gum infection or dental cavities; acid reflux or stomach issues such as Helicobacter pylori infection; sinus infection or post-nasal drip; dry mouth due to salivary gland malfunction or dehydration; and mouth breathing. It is important to check for these conditions.

I recommend visiting a dentist for a full mouth and gum check, an ear, nose, and throat specialist to rule out nasal or sinus problems, and a gastroenterologist to evaluate for acid reflux or stomach-related issues. To manage this problem, focus on the following points:

Oral hygiene by brushing twice daily, using a tongue scraper to clean the back of the tongue, and flossing daily to remove food particles between the teeth.
Stay hydrated by drinking two to three liters of water each day.
Avoid habits such as smoking and alcohol consumption if applicable, and reduce excessive intake of coffee.
Follow a balanced diet by eating regularly without skipping meals, cutting down on onions, garlic, and spicy or protein-heavy foods, and limiting sugary foods that encourage bacterial growth.

Bad breath is often associated with multiple contributing factors, and finding the exact cause is essential for lasting relief. Do not lose hope; many people do experience improvement once the underlying issue is identified. Please plan a follow-up in two to three weeks to reassess your symptoms. If the discomfort worsens before that, consult earlier. I will be happy to guide you further.

The probable causes include gastroesophageal reflux disease (GERD), dry mouth possibly due to Sjögren’s syndrome, mouth breathing, dehydration, and smoking. Recommended investigations include intraoral examination to rule out dental issues, evaluation by an ear, nose, and throat specialist for sinus problems, tests by a gastroenterologist for gastroesophageal reflux disease, a complete blood count, and blood sugar testing. The most likely diagnosis is halitosis.

The treatment plan involves maintaining good oral hygiene, improving diet and hydration, consulting relevant specialists, and making lifestyle changes, such as quitting harmful habits. Follow-up is necessary in two to three weeks or sooner if symptoms increase. Preventive measures include good oral hygiene, adequate hydration, and healthy lifestyle choices.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.