If you notice that you or a loved one is experiencing bad breath that doesn't go away, schedule a trip to the dentist or family doctor. Sometimes, the smell of a person's breath may suggest a likely cause for the problem. For example, "fruity" breath may be a sign of uncontrolled diabetes. This is why it's important to follow up and schedule an exam with a doctor or dentist if you are experiencing chronic bad breath over a longer period of time.
As you prepare to visit the doctor's office to diagnose bad breath, don't eat, drink, chew gum, smoke or brush your teeth for three hours before your appointment. Also, don't wear perfume, scented lotions, or scented lipstick or lip gloss to your appointment, as these products could mask any odors. If you've taken antibiotics within the last month, check to see if your appointment needs to be rescheduled. Antibiotics can sometimes temporarily reduce the number of odor-causing bacteria.
First, a dentist will review your medical history for conditions that can cause bad breath and for medicines that can cause dry mouth. Your dentist also will ask you about your diet, personal habits (smoking, chewing tobacco) and any symptoms. S/He will ask who noticed the bad breath and when. Your doctor or dentist is likely to ask you a number of questions, such as:
A dentist will examine the teeth, gums, mouth and salivary glands during an appointment. S/He also will palpate the head and neck and evaluate your breath when you exhale from your nose and from your mouth. Your dentist may refer you to your family physician if a body wide illness is the most likely cause. In severe cases of gum disease, your dentist may suggest that you see 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 Sjögren's syndrome. The type of tests you get depends on the suspected illness. You may get blood tests, urine tests, X-rays of the chest or sinuses, or other tests used for the laboratorial diagnosis of bad breath:
β-galactosidase test - salivary levels of this enzyme were found to be correlated with oral malodor.
BANA test - this test is directed to find the salivary levels of an enzyme indicating the presence of certain halitosis-related bacteria.
Gas chromatography - This technology is specifically designed to digitally measure molecular levels of the three major gases in a sample of mouth air (hydrogen sulfide, methyl mercaptan, and dimethyl sulfide).
Halimeter - a portable sulfide monitor used to test for levels of sulfur emissions (specifically, hydrogen sulfide) in the mouth air.
Odor rating - Your doctor or dentist will likely smell both the breath from your mouth and the breath from your nose, and he or she will rate the odor on a scale of 0 to 5, with 0 being no odor. He or she may also scrape the back of your tongue with a plastic spoon, and rate its odor. Researchers are currently trying to develop a machine that could more objectively assess odors, but none are currently sufficiently reliable. Although such instrumentation and examinations are widely used in breath clinics, the most important measurement of bad breath (the gold standard) is the actual sniffing and scoring of the level and type of the odor carried out by trained experts ("organoleptic measurements"). The level of odor is usually assessed on a six point intensity scale.
Bad breath that results from a systemic illness may be a long-term problem. It often can be controlled with proper medical care. To learn more about how to treat bad breath, continue reading the next section on treating bad breath here.