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Bad Breath (Halitosis)

Protocol Summary

90% of cases are intraoral. Professional cleaning, tongue scraping, antimicrobial rinses. Treat underlying conditions: periodontal disease, candidiasis, xerostomia.

Step-by-Step Management

Step 1: Identify the Cause

90% of cases are intraoral. Rule out poor hygiene, periodontal disease, tongue coating, xerostomia, and oral infections.

Step 2: Professional Cleaning

Perform thorough dental prophylaxis to remove plaque and calculus. Scale and polish teeth.

Step 3: Home Care Instructions

Instruct on proper brushing (2-3 minutes, twice daily), daily flossing, and tongue scraping (more effective than brushing).

Step 4: Antimicrobial Rinses

Consider short-term Chlorhexidine 0.12% (2 weeks maximum) or recommend zinc-containing rinses.

Step 5: Treat Underlying Conditions

Address periodontal disease with therapy, treat candidiasis with antifungals, manage xerostomia with saliva substitutes.

Step 6: Dietary Counseling

Reduce sulfur-containing foods (garlic, onions), increase water intake, avoid smoking and alcohol.

Common Causes

Cause Management
Poor Oral Hygiene Professional cleaning, patient education
Periodontal Disease Scaling and root planing, antimicrobial therapy
Tongue Coating Tongue scraping, antimicrobial rinses
Candidiasis Antifungal therapy (topical or systemic)
Xerostomia Saliva substitutes, stimulants, treat underlying cause
Extraoral (10%) Refer to physician for systemic evaluation