Bad breath, also known as halitosis, is breath that has an unpleasant odor. This odor can strike periodically or be persistent, depending on the cause. In many people, the millions of bacteria that live in the mouth (particularly on the back of the tongue) are the primary causes of bad breath. The mouth's warm, moist conditions make an ideal environment for these bacteria to grow. Most bad breath is caused by something in the mouth.
Some types of bad breath, such as "morning mouth," are considered to be fairly normal, and they usually are not health concerns. The "morning mouth" type of bad breath occurs because the saliva that regularly washes away decaying food and odors during the daytime diminishes at night while you sleep. Your mouth becomes dry, and dead cells adhere to your tongue and to the inside of your cheeks. Bacteria use these cells for food and expel compounds that have a foul odor.
A person may not always know that he or she has bad breath. This phenomenon is because odor-detecting cells in the nose eventually become accustomed to the constant flow of bad smells from the mouth. Others may notice and react by recoiling as you speak.
Dr. Misha Susoeff or physician may notice the patient's bad breath while the patient is discussing his or her medical history and symptoms. In some cases, depending on the smell of the patient's breath, Dr. Misha Susoeff or physician may suspect a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. A urine-like smell, especially in a person who is at high risk of kidney disease, can sometimes indicate kidney failure.
Dr. Misha Susoeff will review your medical history for medical conditions that can cause bad breath and for medications that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms, including when the bad breath was noticed and by whom.
Dr. Misha Susoeff will examine your teeth, gums, oral tissues and salivary glands. He or she also will feel your head and neck and will evaluate your breath when you exhale from your nose and from your mouth. Once the physical examination is finished, Dr. Misha Susoeff may refer you to your family physician if systemic problems are the most likely cause. In severe cases of gum disease, Dr. Misha Susoeff may recommend that you be seen by a periodontist (dentist who specializes in gum problems).
You will need diagnostic tests if the doctor suspects a lung infection, diabetes, kidney disease, liver disease or Sj?gren's syndrome. Depending on the suspected illness, these tests may include blood tests, urine tests, X-rays of the chest or sinuses, or other specialized testing.