Halitosis and The Role of The Hygienist

Apparently, 1 in 4 of us has bad breath.  In our social and workplace spheres, it’s a very delicate issue to tackle. 

A family member or a very best friend might be kind (and courageous) enough to tell us, and a line manager at work will probably have to raise it if it’s a chronic issue which is causing discomfort amongst colleagues.  Unfortunately, the sufferer is often the last person to know. 

Hygienists can identify halitosis and can refer the patient for treatment if necessary.  However, it is better to ask the patient the question about bad breath than to tell the patient they have it!  This question might be one of those on a pre-assessment form to be completed before any treatment, or the hygienist may feel comfortable to ask it in person.  

Initially, it is important to ask the patient about their hygiene regime in case they need guidance on correct brushing as well as how to floss effectively.  Tongue-cleaning should not be omitted.  If there are signs that treatment by a dentist is required, the dentist may undertake scaling and root-planing under anaesthesia.  

It is important to communicate to the patient that scaling and root-planing is a method for removing tartar (hardened plaque) from the teeth and from where it has spread under the gums.

Patients should be aware that whilst bad breath may be the presenting problem, tartar build up can cause periodontal disease, and with gum disease come the risks of loose or lost teeth.

What if the treatment and improved hygiene don’t resolve the problem?

The patient has much improved oral hygiene and is attending checkup appointments and seeing the hygienist, so clearly, there is more to investigate.  

Here’s the science:  

Volatile sulphur compounds are produced by anaerobic bacteria, which are the primary source of most cases of halitosis.  These bacteria cannot survive in oxygen, so they lurk within the fissures of the tongue (particularly the back and sides where the filaments are deep and long)  and in gingival pockets.  They then combine with debris which is proteinaceous, and that’s what produces the unpleasant smell.  These compounds include methyl mercapten and hydrogen sulphide.  

Some patients can actually identify the exact location in their mouth where they believe the smell originates.  

So – further treatment may be necessary if gum disease is diagnosed, which must be discussed with the patient, to be sure they fully understand their options and the process.

Explain the efficacy of the most common remedies patients might have tried:

Mouthwashes

These contain alcohol, which is a drying agent.  Whilst in the very short term, the mouthwash seems to have been the solution, after a little longer, the odour comes back with a vengeance.  Anaerobic bacteria become more active in dryer conditions.  Mouthwashes are therefore considered to be just a short term fix.

Tongue Scrapers or Brushes

Whilst toothbrushes are too large for this task, tongue scrapers should be used with caution, because if they damage the tongue, this is offputting and may lead to neglect in future.  Tongue brushes are more gentle and can be used with toothpaste.

Whilst determining the best treatment for halitosis might require some investigative work on the part of any dental professional, there’s no doubt that once the halitosis is resolved, the relief the patient experiences will be well worth the effort.