Halitosis treatment in the dental office was developed in 1991 by Dr. Jon Richter, of Philadelphia. At present, thousands of other dentists are now providing this service, in their offices. I would like to report that the majority of practitioners are indeed performing the rigorous diagnostic workup as recommended by Richter. Sadly, though, that is not the case.

As manufacturers of the Halimeter, an instrument used in the diagnosis of chronic halitosis, we would estimate that perhaps half of the breath malodor dentists are not doing any kind of reasonable diagnostic procedure, at all. For them, the patient presents with a claim of halitosis, and the dentist merely dispenses a chlorinated mouthwash with tongue scraper.

My friends, this is not professional health care. It is really nothing more than being a snake oil merchant. Clearly, if it were not for the marketing arrangement that, at least for now, provides that only dentists can sell the mouthwash, the patient could just as well self-diagnose, and buy the mouthwash at his local pharmacy.

Even though most chronic halitosis does originate in the mouth and can be treated with tongue scraping and chlorinated mouthwash, what about those cases caused by nasal polyps, lung abscesses, or other maladies? Such conditions will not at all be helped with the conventional treatment. And, these are precisely the types of conditions that are ruled out by a proper diagnostic workup.

The only time that treatment without diagnosis can be justified ethically is under the notion of "empirical treatment." Empirical treatment occurs when a patient presents with symptoms that can reasonably be attributed to a particular condition. To make a definitive diagnosis might require a CT Scan, or other expensive procedure, which would seem to be overkill at the time. In such a case, a drug may be prescribed, but only after the patient understands that if his condition does not improve quickly, he must submit to further tests.

An example of this treatment would be a complaint of acid indigestion, provisionally treated with Zantac. The patient would be instructed to call the physician if he did not feel better after a few days, being further told that Zantac may not be the ultimate answer.

Unfortunately, it stretches credibility to think that the mouthwash peddlers are operating under the auspices of empirical treatment.

Why should we care? Simple. The only way that bad breath treatment is going to be accepted by the dental mainstream is for all practitioners to follow strict ethical guidelines. If a large number of dentists prefer to pursue a "fast buck" approach, I'm afraid that halitosis treatment will fall by the wayside. That would be sad for the ethical dentists, and sadder still for the patients.