HALITOSIS (BAD BREATH)

AKUA BOAKYEWAA KONADU BDS,Bsc(Med Sci)

OUTLINE DEFINITION

EFFECT ON INDIVIDUAL

EPIDERMIOLOGY

ETIOPATHOGENESIS

CLASSIFICATION AND CAUSES

DIAGNOSIS

MANAGEMENT

DEFINITION

HALITOSIS means disease of the breath

It is a term used to describe noticeably unpleasant odours exhaled in breathing

INTRODUCTION Halitosis,is a condition that has multifactorial aetiology

has adverse social implications –

Halitosis.html

EPIDERMIOLOGY

In United States and other industrialized countries incidence is high and over $1billion is spent on deodorant type mouth(oral) rinse

A research done in Nigeria by

UguruC et al in 2011 showed delusional halitosis to be very high

EFFECTS OF HALITOSIS ON THE INDIVIDUAL

SOCIAL

PERSONAL DEVELOPMENT. ECONOMIC.

HEALTH

ETIOPATHOGENESIS

BACTERIA

Gram-negative,proteolytic Porphyromonas gingivalis, Prevotella intermedia /nigrescens, Actinobacillus actinomycetemcomitans

SULPHUR-CONTAINING AMINO ACIDS methionine,cystine and cysteine.

ETIOPATHOGENESIS cont

volatile sulfide compounds(vscs) • esp Methlymercaptan(CH3SH),H2S

DIAMINES • Eg Putrescine,cadaverine, indole, skatole

(Tangerman,2002,Awano et al 2004,Tangerman &Winkel2007)

CLASSIFICATION

in the morning Temporary when hungry Psuedo –Halitosis.Its non existent but

patients are convinced they have it Halitophobia

CLASSIFICATION cont

Physiological

Genuine Pathological Intraoral(80-90%) Pathological Extraoral

TRANSIENT/PHYSIOLOGICAL

IN THE MORNING(MORNING BREATH)

FOOD (FISH, GARLIC,ETC)

EXCESSIVE SMOKING

INCREASES WITH AGE.

HORMONAL

PSEUDO-HALITOSIS

If oral malodour does not exist but the patient believes that he or she has oral malodour.

PSEUDO-HALITOSIS HALITOPHOBIA

This classification allows the clinician to diagnose a psychological condition.

HALITHOPHOBIA

Halitophobia could be a serious problem, as it is sometimes associated with underlying mental conditions ( Eli

I, Baht R, Kozlovsky A, Rosenberg M 1996)

REPORTS OF SUICIDE (Yaegaki K1998)

psychosomatic factors, such as Socialphobia,

HALITHOPHOBIA

GENIUNE HALITOSIS

SOURCE…intra-oral accounts for 90%

extra-oral…….10%

EXTRA-ORAL

RESPIRATORY

PULMONARY

KIDNEY

LIVER

OTHERS.

Summary of causes

UPPER RESPIRATORY TRACT

INFECTIONS Chronic Sinusitis Tonsillitis Colds ( Common cold , Flu) Posterior nasal drip

. ALLERGIC REACTIONS : smoke, dusts, perfumes etc.

LESIONS Benign and malignant lesions

PULMONARY

LUNGS

Chronic infections + Fluid accummulation Bronchiestasis

SYSTEMIC DISEASES

Regurgitation of gastric gases (GERD)

Liver failure

Kidney failure

Diabetes mellitus

Trimethylaminuria

Autoimmune diseases with oral manifestations and ulcerations

INTRA-ORAL

TONGUE SURFACES

DENTAL CAVITIES / CARIES

POOR ORAL HYGIENE HABITS

GINGIVITIS AND PERIODONTAL (GUM)INFECTIONS

DENTAL ABSCESSES

OTHERS

TONGUE

Anatomy

Papillae

fissure

Deep fissures on tongue Fungal infection on tongue

DENTAL PLAQUE

Disclosed Plaque and swollen gums Clean teeth and healthy gums

CALCULUS

INTRAORAL CAUSES OF HALITOSIS

Poor oral hygiene Periodontal disease (gum disease)

OTHERS

NECROTIZING ULCERATIVE GINGIVITIS

DEHYDRATION STATES

CARIES

DENTAL PROTHESIS. (ARTIFICIAL AND FIXED)

ORAL CANCERS

SMOKERS BREATH.

NECROTIZING ULCERATIVE GINGIVITIS

Tooth decay and cavity formation trapping food

INTRAORAL CAUSES ( POOR DENTURE

MAINTENANCE)

Denture stomatitis

INTRAORAL CAUSES

CROWNS AND BRIDGES

SURGICAL WOUNDS

INFECTED TOOTH EXTRACTION SOCKET

DENTAL ABSCESS & TUMOURS

CARCINOMA OF PALATE MALIGNANT INFILTRATION FROM DISTANT LESION

Dry mouth

Menopause, Sjogren’s syndrome, Ectodermal dysplasia

ACUTE LEUKAEMIA

ERYTHEMA MULTIFORME OR PEMPHIGOID ERRUPTIONS

DRUG INDUCED GUM ENLARGEMENT

Gum enlargement in a patient on Nifedipine (An anti-hypertensive drug)

Gingival enlargement in an Epileptic patient on dilantin medication

DIAGNOSIS

DIAGNOSIS OF HALITOSIS SELF TESTING

Following sleep Covering mouth and blowing air towards nostrils

COLLABORATION CONFIDANT (Spouse,Colleagues)

PROFESSIONAL DIAGNOSIS There are no accepted clinical protocols for the

diagnosis of patients with halitosis History-taking Physical examination investigations

DIAGNOSIS OF HALITOSIS cont Scientific Testing /equipments

Chromatography Organoleptic devices Breath analyser NB:since breath odour changes in

intensity throughout the day depending on many factors, multiple testing sessions may be necessary.

TREATMENT

DENTIST Dental examination and restorations Scaling and polishing and OHI maintenance Dental check-up

PHYSICIAN Systemic disease treatment

PSYCHOTHERAPY

Restoration of self confidence Reassurance

SELF TREATMENT: OFF-THE-COUNTER PRODUCTS

Tooth brushing Chewing sticks Oral hygiene products and mouthwashes, chewing

gums

SELF TREATMENT

FOODS DEVELOP HEALTHY EATING HABITS KEEP GOOD ORAL HYGIENE BRUSH FREQUENTLY FLOSS REGULARLY

MOUTHWASHES

STOP SMOKING

Dental flossing

TOOTH BRUSH FLOSS

PROFESSIONAL SCALING OF THE CALCULUS ON TEETH WITH ULTRASONIC SCALERS

BEFORE SCALING AND POLISHING OF THE TEETH

NOTE HEAVY DEPOSITS (SUPRAGINGIVAL CALCULUS)

AFTER THOROUGH PROFESSIONAL CLEANING OF THE TEETH

PERIODONTAL SURGERY Elimination of gum swellings and pockets

SYSTEMIC DISEASES Medical consultation to treat other underlying illnesses

Regular medical check

Set regular review appointments with your dentist to put halitosis in check

Conclusion Social relationships

are one of the pillars of life (Elias &Ferriani

2006)

Halitosis has important socioeconomic consequence and can be a crippling social problem

Enjoy your social life

THANK YOU