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Jerry was in fine form as he stood at center stage, his hand resting on the microphone stand, waiting for the laughter to subside. He had invited me to watch him perform stand-up at this West Los Angeles comedy club, and he didn’t disappoint. But his wife, Sandy, wasn’t laughing. She leaned across the small cabaret table we were sharing and said, “I need to talk to you about Jerry.” They had both been patients of mine for many years. Both were late middle-aged, and neither had ever had a serious medical problem. I looked at her quizzically and she said, “His breath.”

I leaned closer and asked, “What about his breath?”

“It’s different. Not bad, but it’s changed. Something’s not right.”

“How long?”

“Maybe three months.”

I asked if anyone else had mentioned anything, and she shook her head.

“How does he feel?”

“He says he feels fine. But something is wrong. I’m his wife and I can tell. Something has changed.”

I looked up at Jerry. He was pulling faces now, mimicking his elderly father as part of his routine. The audience was loving it.

“Have him come see me in the office,” I told Sandy.

“Honest to God, doc, I’m fine,” Jerry insisted a week later. “If you ask me, I think it’s my wife’s sniffer that needs a checkup.” Jerry did indeed look well, and when I put my face close to his and asked him to exhale through an open mouth, I could detect no unusual or unpleasant odor. Likewise, when I had him breathe out through his nose, nothing struck me as especially noxious.

He told me there had been no recent dental problems, sores in his mouth, or other symptoms. He didn’t wear dentures and hadn’t begun using any new medications or supplements. The examination of his nose, mouth, tongue, throat, and gums was unremarkable to my internist’s eye. I took one more sniff. Nothing. Frankly, I wasn’t sure that anything was wrong, but I told him to go see his dentist.

“I was just there three months ago,” he protested. “Everything was OK”…

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