Halitosis - Logical work-up approach?

RE: Halitosis - Logical work-up approach?

Stephen Courtney — Sun, 25 Feb 2018 18:27:50 GMT

If its really smelly then something is infected and / or rotting. So you need to rule out oral pathology, and that means a proper look under GA.

You also need to look down the back of the throat - larynx, airways and oesophagus, likely scope and rads will be needed.

And also make sure it isn't something like chronic anal sac infection /similar, though those tend to to exist more in the client's minds than in reality.

Unless you are feeding something rotten or there is regular access to carrion, I really couldn't put dietary causes high on the list of differentials

RE: Halitosis - Logical work-up approach?

rhmrcvs — Sat, 24 Feb 2018 11:12:16 GMT

I've seen similar. Lab been seen 3 x at previous vets for bad breath over approx 6 month period, including at booster / health chk. Seen by us 3 m after booster as now appetites decreased and some weight loss. Could smell it across room. Had to look hard with mouth v wide open, stick lodged across palate. Removed under sedation as soft tissue growing around. Pus at lat msrgins. Did v well , poor dog was ravenous.

RE: Halitosis - Logical work-up approach?

Gillian Mostyn — Sat, 24 Feb 2018 09:49:25 GMT

[quote user="Evelyn Barbour-Hill"]Yeah but it's a different smell[/quote]

Absolutely...but the owners always book them in for bad breath!

RE: Halitosis - Logical work-up approach?

Richard Carter — Sat, 24 Feb 2018 09:36:43 GMT

and also start with a check of anal glands and a good tape worm/ round worm treatment. I have scoped a staffy anticipating stomach ulceration to find bundle of worms which after treatment cured all the vomiting, reflux etc

RE: Halitosis - Logical work-up approach?

Evelyn Barbour-Hill — Fri, 23 Feb 2018 18:20:39 GMT

[quote user="Gillian Mostyn"] the dogs with manky folds around the mouth...you really can smell them across the room![/quote]

Yeah but it's a different smell (connoisseur, me )

RE: Halitosis - Logical work-up approach?

Gillian Mostyn — Fri, 23 Feb 2018 18:14:57 GMT

Have you checked the smell isn't from wet skin folds around the mouth due to drooling saliva? The worst oral smells I see tend to see (smell) are from the dogs with manky folds around the mouth...you really can smell them across the room!

RE: Halitosis - Logical work-up approach?

Rob Davis — Fri, 23 Feb 2018 17:52:21 GMT

[quote user="Anthony Todd"]

I should have said "after a thorough examination of the mouth" [which I thought would be a given].

[/quote]

Which is not possible in a conscious patient. In the patient above, this was not seen until the dog was under GA. Sometimes it is possible to perform a complete superficial examination conscious, but non-displaced slab fractures, localised periodontal pockets, foreign bodies etc will often be missed.

RE: Halitosis - Logical work-up approach?

Beats — Fri, 23 Feb 2018 17:25:29 GMT

I don't have a great sense of smell, but it did appear to stink when sniffing the air coming out of the mouth.

Hugely scientficially, I held the mouth closed and thought the air coming out of the nostrils stank too, but not quite as badly.l

EDIT - I don't think I've ever encountered a dog with stinky breath (that I could smell) and nothing obvious on conscious exam or history before, so I'm already in uncharted waters for me.

As I don't normally appreciate bad smells, given I could smell it, i think there genuinely is a bad smell.

Hopefully cause will be obvious, but it got me thinking what to do if cause was not obvious.

RE: Halitosis - Logical work-up approach?

Anthony Todd — Fri, 23 Feb 2018 17:25:11 GMT

Sorry, done it again!

RE: Halitosis - Logical work-up approach?

Anthony Todd — Fri, 23 Feb 2018 17:24:41 GMT

I should have said "after a thorough examination of the mouth" [which I thought would be a given].

RE: Halitosis - Logical work-up approach?

Rob Davis — Fri, 23 Feb 2018 17:19:09 GMT

[quote user="Anthony Todd"]ie prove that the diet is the cause before you start the "veterinary " investigations.....[/quote]

I thinks this depends how stinky the mouth is. If this is a "smell him from across the room" job, there is likely to be a pathological cause.

This is the last one I saw which presented like this:

Very smelly and necrotic beneath the trapped piece of bone.

RE: Halitosis - Logical work-up approach?

Anthony Todd — Fri, 23 Feb 2018 16:56:51 GMT

[quote user="Beats"]Owner has changed diet once so far with no change in bad breath noted.[/quote]

Yes but each diet may contain the component that the bacteria causing the bad breath thrive on.

You've got to do it single component by single component!

ie prove that the diet is the cause before you start the "veterinary " investigations.....

And But this sort of trial is free......

RE: Halitosis - Logical work-up approach?

Evelyn Barbour-Hill — Fri, 23 Feb 2018 14:29:41 GMT

Not being funny, but does it really have halitosis? What I mean is, does it smell abnormally bad to you, or is it just the owner's complaint?

Assuming it's real, I'd add tracheal and oesophageal endoscopy to your investigations.

RE: Halitosis - Logical work-up approach?

Beats — Fri, 23 Feb 2018 13:02:53 GMT

Owner has changed diet once so far with no change in bad breath noted.

RE: Halitosis - Logical work-up approach?

Rob Davis — Fri, 23 Feb 2018 12:45:59 GMT

[quote user="Anthony Todd"]As you've eliminated the pathology,[/quote]

You haven't....

RE: Halitosis - Logical work-up approach?

Rob Davis — Fri, 23 Feb 2018 12:45:06 GMT

[quote user="Beats"]6 year old Labrador with mandibular brachygnathism[/quote]

Is there a malocclusion? It is common with mandibular brachygnathism to find the lower canines traumatising the palate (occasionally causing oro-nasal fistulation), which could be a trap for necrotic debris, food material etc and can be really smelly.

If it's breath is really smelly, I would be surprised if you don't find a cause.

RE: Halitosis - Logical work-up approach?

Jill Butterworth — Fri, 23 Feb 2018 11:53:10 GMT

Assuming you aren't suspicious of renal disease, I would concur that a trial diet change is worthwhile.

RE: Halitosis - Logical work-up approach?

Anthony Todd — Fri, 23 Feb 2018 10:40:11 GMT

[quote user="Beats"]All thoughts welcome [/quote]

As you've eliminated the pathology, 99 times out of 98 diagnosed and cured by itemised diet change, but too basic, obvious, "unscientific" and easy these days.

Owner continued compliance, as always, is key.