Examination, Classification, and Treatment of Halitosis; Clinical PerspectivesKen Yaegaki, DDS, PhD Jeffrey M. Coil, DMD, MSD, PhD, FRCD(C)

Examination for halitosis:1. Organoleptic measurement-A sensory test performed by the examinerHow is it performed? -simply by sniffing the patients breath through a translucent tube (measurements of 2.5 cm in diameter, 10 cm in length) -operator must be positioned behind a separating wall to prevent patient form seeing the operator thus creating a strong believe to the patient that he is undergoing a specific malodour examination-when pseudo-halitosis or halitophobia is expected, this assessment should be carried out on two or three different days for reliable diagnosis

Ideal Conditions of the Patient-abstention from antibiotics for 3 weeks before the test-abstention from garlic, onion and spicy foods for 48 hours before the test-avoid scented cosmetics for 24 hours before the test-abstention from food and drink-omit usual oral hygiene practices-abstention from mouth rinses and breath fresheners -abstention from smoking for 12 hours before the testIdeal Conditions of the Examiner-normal sense of smell-refrain from coffee, tea or juice and also smoking-refrain from using scented cosmetics

2. Gas chromatography, GC (considered as gold standard)-performed with apparatus equipped with flame photometric detector (detects volatile sulphur compounds (VSC); main cause of oral malodour) -drawbacks: needs a skillful operator and it is impractical for a general dental practitioner to equip their office with a GC

3. Sulphide monitoring

-analyze total sulphur content of subjects mouth air-drawbacks: most equipments are not specific for VSC

Classification of Patients (by Miyazaki and others)1. Genuine halitosisI. Physiologic halitosisII. Pathologic halitosis

2. Pseudo-halitosis-definition: patient believes that he/she has oral malodour but it does not exist

3. Halitophobia-definition: after treatment, patient still believes that he/she has halitosis-this allows a diagnosis of a psychological condition

Treatment of Halitosis1. Treatment 1 Physiological halitosisCleaning the tongue is a very effective measure for improving physiologic halitosis. Using a tongue scraper or adult toothbrush for cleaning the tongue is not recommended because of possible damage to the tongue surface. An infant toothbrush or a small tongue brush is preferred. It is important to demonstrate to patients the anatomical limits for cleaning because patients may overzealously scrape or brush the tongue till bleeding starts and sometimes they inappropriately brush or scrape the tongue tonsil. Routine oral hygiene procedures and mouth rinsing are included as part of the treatment. Research articles on North American mouthwashes containing zinc, chlorhexidine and hydrogen peroxide indicate the efficacy of these agents in reducing malodour.

2. Treatment 2Pathological halitosisOral pathologic halitosis is caused mainly by periodontal disease which a condition that could be managed by periodontal treatment. Sometimes, dental treatment may be necessary to correct faulty restorations that might contribute to poor oral health.

3. Treatment 3Extraoral pathological halitosisPatient with no oral cause of halitosis should be referred to medical specialists.

4. Treatment 4Pseudo-halitosisPatients with pseudo-halitosis need to be counselled, with literature support, education and explanation of examination results that the intensity of their malodour is not beyond a socially acceptable level. This step in patient management is most important in differentiating pseudo-halitosis from halitophobia.

5. Treatment 5HalitophobiaPatients who cannot accept their perception of malodour as a mistaken belief are classified as halitophobic and need assistance from a physician, psychiatrist or psychological specialist.

Source: http://www.cda-adc.ca/jcda/vol-66/issue-5/257.html4