My child has bad breath: What do I do?

July 9, 2019
Checking breath | Texas Children's Hospital
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You’re probably quick to detect a whiff of bad breath, especially when it’s coming from your own mouth. The smell might also be difficult to ignore if it’s coming from someone you’re in close contact with, such as a partner or child.

It’s undoubtedly a common occurrence; bad breath is estimated to affect 1 in 4 people across the globe. It can also be a source of worry and embarrassment. However, if your child is persistently experiencing bad breath – or halitosis – it’s important to investigate what’s causing it.

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First, consider this clarification before you start worrying. The familiar “morning breath” many of us experience isn’t considered true halitosis, alongside any lingering odors left from consuming a particular food, such as garlic or onions.

Pseudo-halitosis or subjective halitosis is when the malodor is felt by the individual but not observed by others around them. True halitosis is persistent bad breath or malodor that does not go away despite brushing and flossing.

True halitosis has a number of varied causes and may persist despite medical and surgical treatment.

  • Dental/oral: In most cases, poor oral hygiene is the primary culprit. Does your child thoroughly clean their teeth, gums and tongue each day? If not, plaque can easily build up and produce odor. Worse – the plaque can irritate the gums and cause inflammation between the teeth and gums called periodontitis and gingivitis. Dental caries (cavities) and chipped fillings can also be a cause.
  • Dehydration: Did you know saliva is critical in cleansing the mouth? If your child is dehydrated or has dry mouth, this could be causing the halitosis. Hydration is key!
  • Illness: Febrile illnesses in children, upper respiratory infection and or a sinus infection may lead to bad breath due to nasal congestion and mouth breathing. This usually resolves once the infection clears up.
  • Ears, nose and throat: While tonsil stones have typically been implicated as a cause of bad breath, the exact rate of occurrence is not known. Tonsil stones usually form in the tonsil crypts and their presence at the tonsil surface can give rise to recurrent bad breath. Children and teenagers can also experience this after they have tried to express out the tonsil stone from the tonsil crypts. Post nasal drainage, constant mucus in the back of the nose and mouth due to allergies and/or reflux may also cause malodor. Chronic sinusitis with adenoid inflammation can also result in persistent bad breath. Even once dental and ENT issues are ruled out, many children may still have persistent bad breath.
[learn more:] Texas Children’s Ears, Nose and Throat (otolaryngology)

What can be done for halitosis?

It’s important to note, halitosis is a symptom – not a disease in itself. For treatment, identifying the underlying cause is typically the first step.

You should start by taking your child to see a dentist. It is important to remember that brushing and flossing has to be supplemented by regular tongue cleansing since many bacteria that cause halitosis live on the tongue surface. Rinsing their mouth also helps.

Typically children are referred to an otolaryngologist (ENT doctor) after a dentist’s evaluation. A thorough history and physical exam will usually prompt us toward a diagnosis: recurrent sinusitis, recurrent tonsil stones or chronic mouth breathing, and/or recent dehydration.

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Tonsillectomy and or adenoidectomy should not be considered as a first line of treatment for tonsil stones/chronic adenoid inflammation, as medical management helps many of these children.

We usually suggest rinsing and gargling after each meal to prevent collection of food debris in the tonsil crypts; decreasing the likelihood of tonsil stones. Nasal rinsing and washing helps with post nasal drainage as well. When appropriate, reflux medications can be tried to help your child.

It is important for parents to know that many times we may not be able to find a definite diagnosis. However, maintaining excellent oral hygiene, including tongue cleaning, is shown to be effective in the treatment of halitosis.

Post by:

Shraddha S. Mukerji, MD, FACS

I believe in providing comprehensive care to all children with compassion and kindness. Getting parents involved in their child's treatment goes a long way in making families happy and engaging their trust in the long run. My clinical areas of interest include treatment and diagnosis of chronic...

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