Basic Diagnosis And Treatment Protocol For Halitosis by Dr. John Halmaghi

Dr. John Halmaghi is in private practice in Southfield, MI, and has been a pioneer in cosmetic dentistry and complex dental care. A graduate of The University of Michigan, Medical College of Ohio, and University of Buffalo, he has maintained over ten times the national continuing education credits, and has written and published numerous articles and textbooks sold internationally. He loves to take on challenging cases. Visit his website.

At our office, we do not look at Halitosis treatment as a huge profit center. Rather, we approach it as a service to our patients that helps them improve a part of their lives with our help. It improves referrals and confidence immensely.

Now, here is the basic routine for our breath treatment:

1. Patient fills out simple consultation form.

2. Patient introduction and health history is performed. We take the time to see what medications or health issues the patient may have that could contribute to the breath problem. G.I. problems, hernias, ulcers, “heartburn”, digestive problems, xerostomia inducing meds, etc. can exacerbate halitosis.

3. Take two bitewing x-rays, unless patient denies. If patient does not consent, I inform them of the possibility of periodontal issues that we cannot address.

4. Take Halimeter® reading. Any levels between 150-180 are addressed as minor halitosis problems and treated normally with improved hygiene as discussed below. Any levels between 190-250 are addressed as moderate-severe halitosis problems and treated as discussed below. Any patients who present with levels higher than 250 are considered chronic, and may need antibiotic intervention (Doxycycline 100mg bid x 28 days, with or without periodontal treatment, if necessary) along with the following steps.

5. Periodontal screening. I feel that every dentist and hygienist can diagnose periodontal problems, however I see patients from other offices every day with undiagnosed periodontal problems. There is a large segment of the population with poorly or completely undiagnosed periodontal problems. These are the same patients that visit the dentist on a regular basis. These are the patients that bring in the profit margin at my office, and they are one of the reasons that we continue to perform Halitosis treatment.

What I am talking about is that I take the time to properly check for periodontal problems. Many patients have what I call the result of “supervised neglect,” from years of improper professional care. These patients have burnished interproximal calculus, pocketing, bleeding, and bone loss. A lot of these problems are usually a result of not only improper home care, but also poor professional treatment. I take the time to do what the office down the street has not done properly, maybe for many years. You can diagnose a patient’s periodontal condition with two bitewings and a probe. After careful diagnosis, I take the time to inform these patients of their problem and how it is contributing to their breath problem. They watch a video about periodontal disease and then they are informed about the need to perform a complete set of x-rays.

Once they are committed to complete diagnosis, I treat them as a new patient at our office and we perform our normal New Patient routine, including a periodontal chart and restorative findings. At this point I have gone from a $95 visit to a $2000 periodontal case, plus other possible restorative work.

6. The visit ends with proper instructions on how to use Oxyfresh products to cure the bad breath. The most important part of this education is to get the patient gargling briskly with mouthwash, brushing appropriately, flossing vigorously, and scrubbing the tongue with heavy duty force. The critical part is the scrubbing of the tongue. If the patient can keep their tongue clean and free of sulfur producing bacteria, their problem is solved.

Some patients have a huge gag reflex, so I reassure them that the problem will subside slowly as the brain learns to control the gagging. It helps to have the patient squeeze the tip of their tongue between thumb and forefinger. This breaks the gag reflex somewhat. As a treating dentist you have to emphasize to your patients that the tongue is responsible for 95% of all breath problems. Of course you cannot cure onion or garlic breath, but all halitosis issues can be successfully treated by making sure that the tongue is squeaky clean. Again, the patient must be educated about their problem. Take the time to explain to them how the tongue harbors sulfur producing bacteria. These bacteria hide in the ridges of the tongue and when patients try to use regular toothpaste to brush their tongue they are “sealing” the bacteria deep in the tongue, making the problem worse.

Only Oxyfresh and other chlorine dioxide products can kill the sulfur producing bacteria and get rid of the smell. Also, explain to patients that using mouthwashes such as Listerine, Scope, Listermint, etc. end up killing the good bacteria and allowing the sulfur bacteria to live. Furthermore, alcohol containing mouthwashes can make teeth sensitive by “drying” them, not to mention increasing the chance for oral cancer by 65%. Get your patients to stop using store products and switch them to Oxyfresh.

7. For patients with periodontal problems, we continue to address the breath issue during their periodontal care. We place these patients on fluoride as well as Oxyfresh. If the patient has xerostomia we also recommend Biotene products or Xero-Lube.

Although you will have to learn more about the specifics of Halitosis treatment, the above format will help you get started. This routine works for most of our patients. The patients that refuse bitewing x-rays are not denied treatment. You can still help these patients by showing them the basics of oral hygiene and tongue scrubbing. Just let them know about gum issues and the future need for evaluation. You’ll be surprised how many will return as new patients later. Oxyfresh has available all the products that you need, including patient home care videos. Don’t wait any longer to perform this treatment.