Chronic Halitosis Investigation and Struggles
Demographic Information: Nonbinary individual, 26 years old, 5 feet 5 inches tall, weighing 140 pounds, non-smoker, currently not on any medications. Hello everyone, I am reaching out in a final attempt to address my ongoing issue with chronic bad breath. I have undergone a multitude of tests and imaging procedures, including gastrointestinal (GI), ear, nose, and throat (ENT), as well as dental evaluations, all of which returned normal results. I have also explored various homeopathic treatments, including Traditional Chinese Medicine (TCM). The only abnormal finding was minor reflux, but anti-reflux medications did not alleviate my symptoms. An interesting detail from my breath analysis showed elevated levels of CH3SH (methyl mercaptan), yet tests for methane and sulfur produced no results, which baffled my healthcare providers. I want to emphasize that I have had an extensive range of tests, such as SIBO tests, MRI, MRCP, colonoscopy, endoscopic ultrasound (EUS), barium swallow study, and sinus CT, with all results showing no issues. Additionally, I have had bacterial cultures taken from my throat and nasal passages. I have attempted various lifestyle changes, such as eliminating sugar and altering my dietary choices, in addition to trying several non-conventional approaches and supplements. I’m currently not on any medication and have been tested for Sjögren’s syndrome and other autoimmune diseases with negative results, as well as negative tests for H. pylori and parasites. This condition is not something I have experienced since birth. I have also tried numerous mouth rinses, including chlorine rinse, CHX (Peridex), and Therabreath, as well as oral antibiotic and antifungal treatments, in both rinse and pill forms. I’ve even had a tonsillectomy, which has ruled out that potential source of the problem. This is definitely not a fabricated concern; it’s genuinely affecting my life. In addition to the persistent halitosis, I experience some gastrointestinal symptoms such as reflux (which has not improved with many different medications), feelings of fullness that seem artificial, early satiety, nausea, constipation, and alternating loose stools. However, functionally, I seem fine overall. I have also tried a range of antidepressants to see if the issue is linked to stress or anxiety; unfortunately, they have not made any difference. Once more, this is not an oral hygiene issue; I maintain excellent oral health, as confirmed by my dentist, hygienist, and periodontist. The ENT specialist has also cleared me. In summary: I am dealing with chronic bad breath, with testing from ENT, allergy, and dental sources ruling out possible causes. The breath test highlighted increased production of methyl mercaptan, which may suggest a systemic or gut-related origin. Both hydrogen sulfide and methane levels were found to be zero, while the breath has a methyl mercaptan-related odor.
Answers (1)
8/9/2025, 7:01:52 AM
OpenHealth AI
Chronic bad breath (halitosis) can indeed be challenging to address, especially when you've already undertaken extensive testing and tried numerous treatments with little relief. Given your ongoing symptoms and detailed history, we can focus on exploring some additional avenues to possibly tackle the underlying issues contributing to your chronic halitosis, particularly in relation to gastrointestinal factors.
Summary of Key Points
- Persistent Halitosis: Despite extensive testing, the elevated levels of methyl mercaptan indicate a possible metabolic or gastrointestinal source.
- Gastrointestinal Symptoms: Your symptoms like reflux, nausea, and altered bowel habits suggest a potential digestive issue that may relate to your halitosis.
- Oral Health is Not the Issue: You've confirmed excellent oral hygiene, which rules out common dental causes.
Explanation
Methyl mercaptan is a compound often associated with certain gastrointestinal disorders, including issues with digestion or absorption. Although your tests have returned largely normal, the symptoms you report, including reflux and erratic bowel movements, might hint at an underlying functional gastrointestinal disorder, such as a motility issue or an imbalance in gut bacteria that may not have been fully uncovered by common testing.
Next Steps
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Dietary and Symptom Diary: Start tracking your food intake and gastrointestinal symptoms in detail. This can help identify any specific triggers or patterns associated with your halitosis and digestive issues. Focus on noting when the odor seems worse, and the type of foods consumed around that time.
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Consider a Low FODMAP Diet: Although food intolerances can vary widely, trying a low FODMAP diet may help. This approach can reduce certain fermentable carbohydrates that give rise to excess gas and digestive distress, potentially alleviating both halitosis and GI symptoms. Consult resources or a nutritionist specializing in digestive health if needed.
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Probiotic Trial: If not already tried, consider incorporating a high-quality probiotic that includes strains specifically beneficial for gut health, which might help in restoring balance and relieve some gastrointestinal symptoms.
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Hydration and Saliva Production: Ensure you are drinking plenty of water throughout the day, as dehydration can affect breath odor. Consider using products that can stimulate saliva production, like sugar-free gum or mints.
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Functional Gastrointestinal Assessment: If not done recently, you might revisit the possibility of functional GI disorders. Symptoms like early satiety and fullness can relate to conditions such as gastroparesis or esophageal dysmotility. A gastroenterologist might suggest more specialized testing like a gastric emptying study or esophageal manometry.
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Ongoing Symptom Monitoring: Keep your healthcare providers informed of any changes in symptoms, especially response to dietary changes or the introduction of probiotics. This information can guide future evaluations or interventions.
Reassurance
I understand how deeply frustrating and impactful this issue has been on your life. It's important to be persistent and proactive in finding solutions. If these steps do not lead to improvement, it may be beneficial to seek a specialist in functional gastroenterology or a multidisciplinary team who can provide a comprehensive review of your situation.
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