Oral Manifestations of Asthma and Inhaled Medications

Asthma is a chronic respiratory disease that affects millions of people worldwide. While its main symptoms involve the lungs, asthma and inhaled medications can also affect oral health.

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✅ What Is Asthma?
Asthma is a long-term inflammatory condition that narrows the airways, making breathing difficult. Many people manage asthma with inhaled medications, which deliver medicine directly into the lungs while reducing systemic side effects.

The two most common types are:
▪️ Inhaled corticosteroids (ICS): Reduce airway inflammation and help prevent asthma attacks.
▪️ Bronchodilators: Relax airway muscles and improve breathing.
Although these medications are highly effective, they may produce oral side effects, especially when proper inhaler technique or oral hygiene is lacking.

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✅ Why Can Asthma Affect Oral Health?
Several factors contribute to oral changes:

▪️ Reduced saliva production (dry mouth).
▪️ Medication deposits remaining inside the mouth.
▪️ Changes in the oral microbiome.
▪️ Mouth breathing, common in many asthma patients.
▪️ Frequent use of inhalers, particularly inhaled corticosteroids.
These factors increase the risk of several oral conditions.

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✅ Common Oral Manifestations of Asthma and Inhaled Medications

1. Oral Candidiasis
Oral candidiasis is one of the most common side effects of inhaled corticosteroids.

Signs include:
▪️ White patches on the tongue or cheeks.
▪️ Burning sensation.
▪️ Redness beneath removable dentures.
▪️ Mild discomfort while eating.
The medication can reduce the mouth's natural defense against Candida fungi.

2. Dry Mouth (Xerostomia)
Some asthma medications reduce saliva flow.
Symptoms include:
▪️ Dry or sticky feeling.
▪️ Difficulty swallowing.
▪️ Bad breath.
▪️ Increased thirst.
Since saliva protects teeth, dry mouth increases the risk of tooth decay and gum disease.

3. Increased Dental Caries
People with asthma may have a higher risk of cavities because of:
▪️ Dry mouth.
▪️ Mouth breathing.
▪️ Reduced saliva buffering.
▪️ Frequent consumption of sugary drinks after inhaler use.
▪️ Inhalers containing fermentable carbohydrates (certain formulations).

4. Dental Erosion
Repeated exposure to acidic medications or acidic beverages consumed after inhaler use may contribute to enamel erosion.
Common signs include:
▪️ Tooth sensitivity.
▪️ Smooth or shiny enamel.
▪️ Thinning of tooth edges.

5. Gingivitis and Periodontal Disease
Studies suggest that poorly controlled asthma and chronic inflammation may increase the likelihood of gum inflammation.
Additional contributing factors include:
▪️ Dry mouth.
▪️ Plaque accumulation.
▪️ Reduced oral hygiene.

6. Halitosis (Bad Breath)
Dry mouth, mouth breathing, and oral infections can lead to persistent bad breath.

7. Taste Alterations
Some patients report:
▪️ Metallic taste.
▪️ Bitter taste.
▪️ Temporary changes in taste perception.
These symptoms usually improve after rinsing the mouth.

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✅ How to Prevent Oral Problems
Simple habits can greatly reduce complications.

Recommended preventive measures:
▪️ Rinse your mouth with water immediately after using an inhaler.
▪️ Use a spacer device with metered-dose inhalers when recommended.
▪️ Brush twice daily with fluoride toothpaste.
▪️ Clean between teeth every day.
▪️ Stay well hydrated.
▪️ Limit sugary snacks and acidic drinks.
▪️ Visit the dentist regularly.
▪️ Inform your dentist about all asthma medications.

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✅ When Should You See a Dentist?
Seek dental evaluation if you notice:

▪️ White patches.
▪️ Persistent dry mouth.
▪️ Tooth sensitivity.
▪️ Frequent cavities.
▪️ Bleeding gums.
▪️ Persistent bad breath.
▪️ Oral discomfort lasting more than two weeks.
Early treatment helps prevent more serious complications.

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💬 Discussion
Current evidence indicates that most oral complications are related to inhaled corticosteroids, reduced salivary flow, and mouth breathing rather than asthma itself. Fortunately, these effects are usually preventable through correct inhaler technique, rinsing the mouth after each dose, maintaining good oral hygiene, and attending regular dental check-ups. Collaboration between physicians, dentists, and patients plays an important role in minimizing oral complications while maintaining effective asthma control.

🎯 Recommendations
▪️ Always rinse your mouth after using an inhaled corticosteroid.
▪️ Ask your healthcare provider whether a spacer device is appropriate.
▪️ Maintain excellent daily oral hygiene with fluoride toothpaste.
▪️ Drink water regularly to reduce dry mouth.
▪️ Schedule routine dental examinations every 6–12 months or more frequently if recommended.
▪️ Report persistent oral lesions, pain, or white patches to both your dentist and physician.
▪️ Never stop asthma medication without medical advice, even if oral side effects occur.

✍️ Conclusion
Asthma and inhaled medications can influence oral health, but most complications are preventable with simple daily habits. Oral candidiasis, dry mouth, dental caries, gingivitis, and bad breath are among the most common findings. Proper inhaler use, mouth rinsing after medication, good oral hygiene, and regular dental visits help maintain both respiratory and oral health.

📚 References

✔ Global Initiative for Asthma. (2025). Global strategy for asthma management and prevention. https://ginasthma.org
✔ Plemons, J. M., Al-Hashimi, I., & Marek, C. L. (2014). Managing xerostomia and salivary gland hypofunction: Executive summary of a report from the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association, 145(8), 867–873. https://doi.org/10.14219/jada.2014.44
✔ Samaranayake, L. P., & Janssen, J. P. (1991). Oral candidosis and carbohydrate-rich diets in patients receiving inhaled corticosteroid therapy. Journal of Oral Pathology & Medicine, 20(2), 97–101.
✔ Singh, A., Gupta, T., Sharma, A., & Schou, L. (2011). Asthma and oral health: A review. Oral Health & Preventive Dentistry, 9(2), 165–171.
✔ Global Initiative for Asthma guidelines and contemporary dental evidence continue to recommend preventive oral care and correct inhaler technique as key measures to reduce medication-related oral complications.

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Persistent Bad Breath: Causes Beyond Poor Oral Hygiene

Persistent bad breath, or halitosis, is a frequent complaint in dental practice and often attributed solely to inadequate brushing.

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However, chronic halitosis may originate from multiple oral and systemic sources, many of which require targeted diagnosis and interdisciplinary management. Recognizing causes beyond poor hygiene is essential for accurate treatment and improved patient outcomes.

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✅ Understanding Persistent Halitosis
Most cases of halitosis are oral in origin and associated with volatile sulfur compounds (VSCs) produced by anaerobic bacteria. Yet when halitosis persists despite proper hygiene, clinicians must consider non-hygiene-related etiologies, including tongue coating, infections, airway conditions, gastrointestinal disorders, and dietary factors.

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✅ Key Causes Beyond Poor Oral Hygiene

1. Tongue Coating and Microbial Imbalance
The dorsum of the tongue harbors anaerobic bacteria capable of producing VSCs. Excess coating may result from mouth breathing, dehydration, high-protein diets, or reduced saliva flow. Tongue cleaning remains one of the most effective evidence-based strategies.

2. Upper Airway and ENT Conditions
Chronic sinusitis, tonsilloliths, allergic rhinitis, and post-nasal drip contribute to extra-oral halitosis. Tonsilloliths, in particular, trap food debris and bacteria, causing a strong odor even in children.

3. Salivary Dysfunction
Xerostomia (dry mouth) from medications, mouth breathing, or systemic diseases reduces natural cleansing mechanisms, allowing VSC accumulation.

4. Dental Caries and Periodontal Disease
Although not strictly “poor hygiene,” active infections such as deep caries, necrotic pulps, or gingivitis can cause significant odor. Persistent halitosis may indicate an untreated odontogenic infection.

5. Gastrointestinal and Metabolic Conditions
Conditions such as gastroesophageal reflux disease (GERD), Helicobacter pylori infection, diabetes (ketone breath), and liver or kidney disorders can manifest as chronic halitosis. These are uncommon but clinically relevant when oral causes have been ruled out.

📊 Comparative Table: Oral vs. Extra-Oral Halitosis Sources

Aspect	Advantages	Limitations
Oral Halitosis Evaluation	Easy to diagnose; responds well to dental treatment	May overlook systemic or ENT-related causes
Extra-Oral Halitosis Evaluation	Identifies underlying medical or airway disorders	Requires multidisciplinary care and extended diagnostics

💬 Discussion
Evaluating persistent bad breath requires a multidisciplinary perspective. Identification of the primary source is more important than masking odor, and dentists must distinguish between oral halitosis, extra-oral halitosis, and pseudo-halitosis. Advanced diagnostic tools, such as gas chromatography and sulfide monitoring, have improved the accuracy of identifying VSCs and their bacterial origins. Parents and caregivers should be educated that chronic malodor is not always a reflection of poor care but may be a sign of underlying pathology requiring medical assessment.

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🔎 Recommendations
▪️ Perform complete intraoral and extraoral assessments when halitosis persists.
▪️ Encourage daily tongue cleaning, hydration, and assessment of salivary flow.
▪️ Treat all infectious sources, including caries, pulp infections, and gingival disease.
▪️ Refer to ENT, gastroenterology, or pediatrics when systemic or airway causes are suspected.
▪️ Avoid unnecessary antibiotic prescriptions; focus on etiology-based management.

✍️ Conclusion
Persistent halitosis is a multifactorial condition that extends beyond inadequate brushing or flossing. A comprehensive diagnostic approach allows clinicians to differentiate between oral and systemic origins and deliver targeted treatment. Early identification of non-hygienic causes is crucial to prevent chronic discomfort, social distress, and delayed medical diagnosis.

📚 References

✔ Aydin, M., & Harvey-Woodworth, C. N. (2014). Halitosis: A new definition and classification. British Dental Journal, 217(1), E1. https://doi.org/10.1038/sj.bdj.2014.551
✔ Porter, S. R., & Scully, C. (2006). Oral malodour (halitosis). BMJ, 333(7569), 632–635. https://doi.org/10.1136/bmj.38954.631968.AE
✔ Seerangaiyan, K., van Winkelhoff, A. J., & Harmsen, H. J. (2017). The tongue microbiome in healthy subjects and patients with halitosis. Journal of Breath Research, 11(3), 036010. https://doi.org/10.1088/1752-7163/aa7b51
✔ Scully, C., & Greenman, J. (2008). Halitosis (breath odor). Periodontology 2000, 48(1), 66–75. https://doi.org/10.1111/j.1600-0757.2008.00266.x

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Modern Diagnostic and Therapeutic Approaches for Halitosis in Children and Adults

✅ Abstract
Halitosis, or oral malodor, remains a prevalent condition affecting both children and adults. Advances in diagnostic tools and modern therapeutic approaches now allow for more accurate identification and management of its multifactorial causes.

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✅ Introduction
Halitosis, commonly referred to as bad breath, is an unpleasant odor emanating from the oral cavity that can arise from intraoral or extraoral sources. It affects approximately 30–50% of the global population and has significant psychosocial implications (Murata et al., 2023). Recent studies have focused on refining diagnostic methods and developing less invasive, more effective treatments tailored to both pediatric and adult patients.

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✅ Modern Diagnostic Methods
Accurate diagnosis of halitosis requires a combination of sensory, chemical, and digital evaluations. Traditional methods such as organoleptic tests remain common, yet newer innovations—including gas chromatography, Halimeter®, and AI-based devices—are improving precision and accessibility.
Endoscopic and complementary tests have also gained clinical importance, especially in identifying extraoral origins such as Helicobacter pylori infection or gastroesophageal reflux disease (Lee et al., 2022).

📊 Comparative Table: Modern Diagnostic Methods for Halitosis

Aspect	Advantages	Limitations
Organoleptic Test	Simple, low-cost method providing direct sensory evaluation of odor intensity	Subjective results; depends on examiner’s perception and consistency
Gas Chromatography	Accurate identification and quantification of volatile sulfur compounds (VSCs)	High operational cost and requires specialized equipment and expertise
Halimeter® Device	Portable, quick results, ideal for clinical screening of sulfur compounds	Limited sensitivity; cannot detect non-sulfur gases contributing to halitosis
Microbiological Culture	Identifies specific anaerobic bacteria related to halitosis etiology	Time-consuming and requires laboratory infrastructure
Digital Sensory Evaluation (AI-based Apps)	Provides at-home monitoring using artificial intelligence and volatile gas sensors	Still under validation; results depend on sensor accuracy and calibration
Endoscopy and Complementary Tests	Detects gastrointestinal causes such as H. pylori infection or reflux-related halitosis	Invasive, costly, and requires referral to medical specialists

✅ Contemporary Therapeutic Strategies
The modern management of halitosis emphasizes both etiological control and microbiome balance. Conventional approaches include chlorhexidine or zinc-based mouthrinses, while current evidence supports additional therapies such as probiotics, laser-assisted biofilm control, and multidisciplinary management when systemic or gastrointestinal factors are present (Kozlovsky et al., 2023; Murata et al., 2023).

📊 Comparative Table: Benefits of Modern Halitosis Treatments

Aspect	Advantages	Limitations
Chlorhexidine Mouthrinses	Effective antimicrobial action reducing oral bacterial load and VSCs	Prolonged use may cause staining and taste alteration
Zinc-Based Formulations	Neutralize volatile sulfur compounds and enhance oral freshness	Requires continuous application to maintain results
Probiotic Therapy	Restores balance in oral microbiota and reduces pathogenic species	Long-term clinical efficacy still under evaluation
Laser and Photodynamic Therapy	Non-invasive bacterial reduction and biofilm elimination	Expensive and requires professional training and devices
Multidisciplinary Management (Probiotics or H. pylori Eradication)	Addresses extraoral causes of halitosis and promotes systemic-microbial balance	Requires collaboration with gastroenterologists and longer treatment periods

💬 Discussion
The integration of technology and biology has revolutionized halitosis management. AI-driven diagnostic tools and portable halimeters allow for personalized tracking, while endoscopic assessments identify systemic causes more effectively. Therapeutically, shifting toward microbiota-centered interventions like probiotics reflects a paradigm change from masking odor to restoring microbial harmony. Multidisciplinary approaches—particularly in patients with gastrointestinal involvement—ensure comprehensive and long-lasting control.

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✍️ Conclusion
Modern halitosis diagnosis and treatment now emphasize precision, accessibility, and patient-centered care. Combining digital diagnostics, microbiological insight, and multidisciplinary management provides the best outcomes in both pediatric and adult populations. Ongoing research in artificial intelligence and probiotic modulation continues to redefine the future of halitosis therapy.

🔎 Recommendations

1. Integrate AI-based halitosis monitoring in clinical and home settings for early detection.
2. Evaluate gastrointestinal conditions when halitosis persists despite oral care.
3. Promote probiotic use as a preventive and adjunctive measure.
4. Encourage collaboration between dentists, gastroenterologists, and pediatricians for systemic cases.
5. Implement photodynamic or laser therapies as safe alternatives for biofilm control in resistant cases.

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📚 References

✔ Kim, J., Lee, S., & Park, Y. (2023). Development of a portable halitosis monitoring device using artificial intelligence-based volatile gas sensors. Sensors, 23(9), 4221. https://doi.org/10.3390/s23094221
✔ Lee, J. H., Han, D. H., & Kim, Y. S. (2022). Correlation between Helicobacter pylori infection and extraoral halitosis: A cross-sectional clinical study. Journal of Breath Research, 16(2), 026001. https://doi.org/10.1088/1752-7163/ac4b90
✔ Kozlovsky, A., Houri-Haddad, Y., & Feuerstein, O. (2023). Probiotic approaches for oral malodor: Evidence-based perspectives and clinical applications. Clinical Oral Investigations, 27(3), 1167–1176. https://doi.org/10.1007/s00784-022-04685-5
✔ Murata, T., Miyazaki, H., & Sakamoto, M. (2023). Current concepts in the diagnosis and management of oral malodor: A multidisciplinary approach. International Journal of Dental Hygiene, 21(4), 565–573. https://doi.org/10.1111/idh.12693
✔ Seerangaiyan, K., Jørgensen, M. G., & Belstrøm, D. (2022). Advances in diagnostic technologies for oral malodor: From organoleptic to AI-based systems. Frontiers in Oral Health, 3, 872198. https://doi.org/10.3389/froh.2022.872198

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Halitosis in Children: Definition, Etiology, Causes, and Treatments

Halitosis, commonly known as bad breath, is a frequent condition observed in children. Although often underestimated, it can negatively impact social interactions, self-esteem, and parental concern.

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✅ Etiology and Causes of Halitosis in Children
Halitosis originates primarily from oral sources but may also be linked to systemic conditions. Studies highlight that volatile sulfur compounds (VSCs), mainly hydrogen sulfide and methyl mercaptan, produced by anaerobic bacteria in the oral cavity, are the major contributors to unpleasant odors (Scully & Greenman, 2012).

1. Oral Causes

° Poor Oral Hygiene: Plaque accumulation, tongue coating, and food debris lead to bacterial putrefaction.
° Dental Caries and Gingivitis: Cavitated lesions and inflamed gingival tissue favor bacterial overgrowth.
° Xerostomia (Dry Mouth): Reduced salivary flow limits natural oral cleansing.

2. Non-Oral Causes

° Respiratory Infections: Tonsillitis, sinusitis, and pharyngitis are common sources of halitosis in children (Silva et al., 2020).
° Gastrointestinal Disorders: Though less frequent, gastroesophageal reflux disease (GERD) may contribute.
° Dietary Habits: Consumption of strong-smelling foods (onion, garlic) or inadequate hydration can intensify oral malodor.

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✅ Treatment and Preventive Strategies

1. Oral Hygiene Measures
° Twice-daily tooth brushing with fluoride toothpaste.
° Daily flossing or interdental cleaning.
° Tongue cleaning to reduce bacterial load.

2. Professional Dental Care
° Regular dental check-ups every 6 months.
° Treatment of caries, gingivitis, and periodontitis when diagnosed.
° Professional cleaning and application of antimicrobial agents when indicated.

3. Management of Systemic Factors
° Referral to pediatricians or otolaryngologists for upper airway infections.
° Gastroenterology consultation in cases of persistent reflux-related halitosis.

4. Preventive Education
° Educating children and parents on balanced diet, hydration, and consistent oral hygiene.
° Implementation of school-based oral health programs to reduce prevalence.

📊 Common Causes of Halitosis in Children and Preventive Measures

Cause	Description	Preventive Measures
Poor Oral Hygiene	Accumulation of plaque, food debris, and tongue coating that promote bacterial growth	Regular brushing, flossing, and tongue cleaning
Dental Caries and Gingivitis	Bacterial colonization in carious lesions and inflamed gingival tissues	Routine dental check-ups, restorations, and professional cleanings
Respiratory Infections	Tonsillitis, sinusitis, and pharyngitis causing bacterial secretion accumulation	Medical evaluation, adequate hydration, and antibiotic therapy if required
Dietary Factors	Consumption of strong-smelling foods such as garlic and onions or low water intake	Balanced diet, increased water intake, and limiting odor-causing foods
Xerostomia (Dry Mouth)	Reduced salivary flow leading to bacterial accumulation and odor	Stay hydrated, sugar-free gum, and medical evaluation for underlying causes

💬 Discussion
Recent studies indicate that 15–30% of children experience halitosis, with oral causes being the most prevalent (Silva et al., 2020). However, systemic conditions should not be overlooked, as failure to identify them may delay adequate treatment. The interdisciplinary collaboration between pediatric dentists, physicians, and parents is essential to address both local and systemic contributors effectively.

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🔎 Recommendations

1. Pediatric dentists should implement routine halitosis screening in dental check-ups.
2. Parents must be educated on proper oral hygiene practices and dietary control.
3. Clinicians should investigate systemic origins if halitosis persists despite proper dental care.
4. Public health initiatives should include halitosis education in preventive dental programs.

✍️ Conclusion
Halitosis in children is a multifactorial condition with oral hygiene being the leading cause. While most cases are manageable with preventive and therapeutic dental strategies, persistent halitosis may indicate systemic conditions requiring multidisciplinary care. Early diagnosis, comprehensive management, and parental involvement are key to reducing prevalence and ensuring overall child well-being.

📚 References

✔ Silva, M. F., Leite, F. R. M., Ferreira, L. B., Pola, N. M., Scannapieco, F. A., & Demarco, F. F. (2020). Estimated prevalence of halitosis: A systematic review and meta-regression analysis. Clinical Oral Investigations, 24(1), 67–81. https://doi.org/10.1007/s00784-019-03070-8
✔ Scully, C., & Greenman, J. (2012). Halitosis (breath odor). Periodontology 2000, 48(1), 66–75. https://doi.org/10.1111/j.1600-0757.2008.00266.x
✔ Seemann, R., Conceição, M. D., Filippi, A., Greenman, J., Lenton, P., Nachnani, S., Quirynen, M., & Sterer, N. (2014). Halitosis management by the general dental practitioner—results of an international consensus workshop. Journal of Breath Research, 8(1), 017101. https://doi.org/10.1088/1752-7155/8/1/017101

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Halitosis en niños - Etiología, diagnóstico, clasificación y tratamiento

La halitosis también conocido como mal aliento, es el olor desagradable de la cavidad bucal relacionada con falta de higiene pero también esta relacionada con enfermedades sistémicas.

El diagnóstico es importante para determinar el agente causante, y para ello nos podemos valer de la anamnesis, exploración bucal y del uso de instrumentos (medición compuesto sulfito y cromatografía gaseosa)

Enlaces Patrocinados

Compartimos un completo artículo sobre el diagnóstico, clasificación y opciones terapéuticas de la halitosis en niños y adolescentes.

ARTÍCULO RECOMENDADO
¿Qué son esas bolitas blancas de mi garganta?

👇 LEA Y DESCARGUE EL ARTÍCULO "Halitosis en niños - Etiología, diagnóstico, clasificación y tratamiento" AQUÍ 👇


Halitosis en el niño y el adolescente. A. Sangorrin Iranzo, et al. Acta Pediatr Esp. 2009; 67(8): 361-365

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How to Treat Tonsil Stones

Tonsil stones are calcifications of various sizes that are deposited on the tonsils. They are yellowish-white, with a bad smell and are made up of food debris and dead cells.

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The presence of the tonsil stone causes bad breath, and when they are large it causes discomfort when swallowing food.

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Souce: Youtube/ Mayo Clinic

The types of bad breath that we CAN'T treat in the dental office

Halitosis can have an oral origin, that means that the cause of bad breath is in the oral cavity, such as lack of hygiene, the presence of cavities, inflammation and bleeding gums.

We invite you to our English-only dental publishing groups

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There are other cases of bad breath that cannot be treated by dentistry, such as: keto breath, onion breath, garlic breath and acid reflux.

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We share the video of dr. Joseph Nemeth from the YouTube channel Joseph R Nemeth DDS & Associates, who explains in detail what are those causes of bad breath that cannot be treated in the dental office.

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What Causes Bad Breath? - How to get rid of it?

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Source: Youtube/ Joseph R Nemeth DDS & Associates