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Referral and warning signs
When to refer
Refer to Dentist (HC4) for assessment and treatment of underlying dental causes (gum disease, caries). Refer to Physician if systemic cause suspected.
Signs and symptoms
- Noticeable unpleasant odour from the mouth reported by patient or others.
Risk factors
- Poor brushing techniques
- Gum disease / Oral infections
- Tobacco smoking and chewing
- Systemic conditions (e.g., liver disease, kidney disease, lung disease)
- Decayed teeth (caries)
- Certain diets
- Dry mouth (xerostomia)
Diagnosis
Clinical assessment
Based on patient or third-party report of bad breath. Examination focuses on identifying underlying oral or systemic causes (oral hygiene status, gum disease, caries, signs of systemic illness).
Investigations
- Dental examination
- Periodontal assessment
- Consider investigations for systemic causes if suspected.
Diagnostic criteria
Subjective or objective assessment of malodour originating from the oral cavity.
Management
Non-pharmacological management
- Treat underlying condition (e.g., gum disease, caries, systemic illness).
- Improve oral hygiene: Brush teeth thoroughly at least twice daily, tongue cleaning.
- Drink plenty of water to encourage saliva production.
- Use of sugar-free gum to stimulate saliva.
- Dietary changes (e.g., increase raw vegetables like carrots, reduce odour-producing foods).
Monitoring
Monitor persistence of halitosis and effectiveness of hygiene measures/treatment of underlying cause.
Complications
- Social embarrassment
- May indicate underlying untreated dental or systemic disease.
Prevention
- Good oral hygiene practices (brushing, flossing).
- Regular dental check-ups.
- Adequate hydration.
- Avoidance of tobacco products.
- Management of underlying medical conditions.
Patient education
- Importance of thorough teeth brushing (at least twice daily) and tongue cleaning.
- Role of hydration and diet.
- Need to treat underlying dental/medical conditions.
- Avoidance of tobacco.
Uganda-specific notes
Focus on improving oral hygiene and identifying treatable dental causes.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 23, Section 23.1.1