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Bad breath caused by gastrointestinal problems?
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Bad breath caused by gastrointestinal problems?

I'm a 19 year old male and for at least the past 10 years now I've been suffering from chronic bad breath with no apparent cause. I've tried all the usual stuff like mouthwashes, I have perfect oral hygeine, brush my teeth twice a day and floss, also use a tongue brush, never smoke or drink alcohol either and don't eat garlic or spicy foods.

My dentist can't find anything wrong with my mouth even after x-rays and says my oral hygiene is perfect and that I am one of his best patients health wise (I have no fillings and my teeth are perfectly after seeing an orthodontist). I've been to a consultant oral & maxillofacial surgeon who also could not find anything wrong after taking x-rays, I've also been to a consultant ENT who could find nothing wrong after performing multiple rhinoscopies and a CT scan of my sinuses.

I've tried a 2 week course of amoxicillin, which had no effect and a 2 month course of omeprazole which also had no efffect, I wasn't able to tolerate the metoclopramide I was given (made me very drowsy). I was also given some nasal steroid drops and saline spray which had no effect. The only time that my bad breath ever disappeared for a few days was when I was in hospital for abdominal pain and I was given IV metronidazole and co-amoxiclav. Liver function and standard blood tests were normal.

The strange thing is that my saliva smells really bad as well as my breath (this also went away after the antibiotics) and a scraping from the back of my tongue smells horrific as well. Strangely though my nasal breath doesn't seem to smell bad, (haven't had that confirmed by someone else though). Could this happen in a case of acid reflux?

Is it possible that a gastrointestinal problem such as GERD or an infection is causing my bad breath? The consultants all say that's the only remaining thing they can think of as causing my problem. The fact that metronidazole temporarily cured my halitosis would suggest that it's anerobic bacteria causing the smell right?
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Halitosis, bad breath, can come from foul smelling gas from the mouth, to the throat, to the stomach, even the intestines, since gas can rise back up, past the sphincters that keep solids from coming back up.  Dental hygiene is important to clear food from being stuck in between the teeth that can degrade with bacteria and cause foul odors. A water pick and flossing is very helpful to clear those.  Gingivitis can give off foul smells.  Acid reflux can bring up awful smelling odors from the stomach.  Further down, gas can even come back from the intestines that is from digesting food.  Antibiotics that kill anerobic bacteria can decrease the presence of bacteria that give off foul odors.  Unfortunately, ongoing use of antibiotics can lead to complications of side effects, resistant bacteria, and digestion problems since there are a lot of bacteria that are necessary in normal digestion.  Different foods are digested differently by different people, consider if a dietary change can help change the odor of breath.  A second opinion is always a good idea, both with physicians and dentists/endodontists/periodontists.

Enoch Choi, MD
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