Young teen with very bad breath - what could it be? What can we do?

[ElderflowerCordiality]

DS, 13, has pretty grim breath - not constantly, but much of the time. I can be aware of it when I'm a metre away and he's cleaned his teeth.

He's attracted some attention from girls ... and then they've distanced themselves from him, and I wonder if his breath may be a factor. (He's a nice boy, so I don't think it's him, IYSWIM.)

He's feeling dejected and rejected and I want to get this breath issue sorted, as it's really starting to get to him.

He has good oral hygiene, confirmed by his dentist and orthodontist - we've raised this issue with both of them. The orthodontist thought his breath was fine and seemed to think we were making a mountain out of a molehill (it wasn't that bad that day - it seems to go in phases and we're in one at the moment). But still, it is a thing and is getting DS down - a few friends have commented, so he's feeling increasingly self-conscious.

I remind him to drink plenty. He is a mouth-breather at night, which I realise doesn't always help, but there's not much we can do about that. He cleans his teeth/braces/tongue regularly and well - and he had this before his braces were fitted. He seems to have back-to-back colds and coughs in the winter - not sure if tonsils could be a factor?

What else could it be? Could a big surge in hormones cause this (he's got a lot spottier and hairier and more muscly lately)? Would the GP actually take him seriously?!

DS was so down about it before school this morning. I just want to get it sorted so he can feel rightly confident in himself and not need to worry about it anymore.

Grateful for any advice on what could be causing it, and how we can improve it ourselves.

Yes, take him to the GP, you've ruled out his teeth which is good, but there can be other medical causes for bad breath, such as kidney problems, sinus infections, even things stuck up the nose or in the ear, although that's normally younger children.

Does he have issues with his tonsils? Tonsil stones smell rank and can be present in teens. Get him to open his mouth and see if you can see crypts/indentations in his tonsils that could be trapping food. Ultradex mouthwash is excellent. I would get his GP to rule out other issues first as bad breath can be a sign of an underlying issue, commonly tummy/sinus problems.

Tonsil stones is another very common cause of bad breath, as is bacteria on tongues. Does he brush his tongue regularly? Drink plenty of water?

Sinusitis can cause bad breath, that would also be in line with periods where his breath is worse. Might be worth having a look into that too

Thank you all for your posts yesterday.

I went and picked up some Ultradex, DrE678. DS used it last night and this morning, and said he thinks it makes the problem worse! - like minty bad breath. But we're going to stick with it for a bit; I said it could take a while to take effect.

I had a good look at DS's tonsils last night with a torch and couldn't see anything untoward.

I called our GP surgery this morning and spoke to a GP who was really understanding, suggested an ENT referral may be in order, and booked DS in for a GP appointment late morning today.

We saw a different doctor at the surgery, who had a good look in DS's mouth. She confirmed his teeth are impeccably clean, his tonsils look absolutely normal (she said she checked them for tonsil stones), his throat isn't inflamed, and his glands aren't swollen. She was basically stumped - said there was nothing else it could be.

She said the only thing she noticed is that DS's tongue is heavily coated/furred, and she sent us away with instructions for DS to brush his tongue instead of use a tongue scraper (which he's been doing for ages, on instruction from his dentist).

She said she wouldn't refer DS to a specialist, as she couldn't see anything concerning that needed a closer look, and she didn't want to "raise our hopes".

DS was miserable about it again this morning - had breakfast, cleaned his teeth, gargled with Ultradex, and it was still there. He says he feels like it's coming from far back in his mouth.

I feel like we're getting nowhere. What else could it be? What could cause his tongue to be so white and furred (I'm thinking thrush, but would guess the GP would have recognised this)? Argh!

Thanks.

BTW, no sinusitis that I'm aware of - DS doesn't generally complain of other symptoms consistent with this (except in winter when he has colds/coughs that seem to last forever).

Is post nasal drip a possibility? Are there any tie-ins to what he is eating/drinking?

Helicobacter pylori can cause bad breath-easy to treat too.

I'd keep going back to the GP.

Could it be from food repeating on him, rather than from his mouth?

Is it worse with any types of food?

Gum disease is usually the reason Has he had a check up recently?

RTFT @bumblebee61 his dental hygiene is impeccable.

Thanks for further posts. I am quite catarrh-y, but DS doesn't seem to be - which I'm guessing would rule out post nasal drip?

We haven't noticed any pattern with regard to what he's eating. We cut out milk from his breakfast for months, in case it was dairy - no discernible difference. But we haven't cut dairy out completely - I'd be reluctant to experiment with cutting out a whole nutritious food group while he's growing so much, eating so much and is so active.

DoltTooJulia, how would we know if it's Helicobacter pylori, and how's it treated? Antibiotics?

No gum disease, bumblebee61. DS looks after his teeth really well. Dentist, orthodontist and now GP have all ruled out teeth and gums as causal.

ElderflowerCordiality I'm not sure if it's the same for kids, but a breath test and it a blood test usually. Sometimes an endoscopy.

Hope it's sorted soon for him.

I expect it's jot this - but just to check all bases covered, have you any suspicion of eating disorder? (I used to vomit as a teenager after eating, totally in secret, brushed my teeth a lot, but others koticed bad breath). Worth ruling out

'Not' not 'jot' and 'noticed' not 'koticed'!!