What Is the Point of Having a Periodontal Examination for Recurrent Bad Breath?｜證據鏈

Recurrent bad breath does not necessarily mean that you have periodontitis, but a periodontal examination is valuable because it can locate intraoral sources such as dental plaque, tongue coating, gingivitis and periodontal pockets one by one. It can also show when simply changing toothpaste or mouthwash again is no longer appropriate. A systematic review estimated that 80% to 90% of halitosis is associated with intraoral factors, with tongue coating, periodontal disease and poor oral hygiene as the main factors; the remaining 10% to 20% may be associated with extraoral or systemic factors. Periodontitis and halitosis do have a positive association in pooled analyses, but the available pooled data come from 9 observational studies and have high statistical heterogeneity, so they cannot prove that periodontitis causes bad breath in every patient. The purpose of ‘having a periodontal examination first’ is therefore not to assume the answer, but to establish a pathway that allows exclusion, measurement and reassessment: determine whether an objective odour is present, examine the tongue coating and full-mouth periodontal condition, treat visible inflammation and biofilm, and then see whether the odour changes accordingly.