halitosis or oral malodor

8/3/2019 Halitosis or Oral Malodor

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Halitosis or oral malodor


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Definition

Offensive odor originating from the

oral cavity or air-filled cavities such

as the nose, sinuses, and pharynx.


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Epidemiology

Breath malodor considered as social

problem.

Poorly documented in most countries.

Japanese study reported that VSCs

increase with age , tongue coating &

periodontal inflammation.


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Volatile Sulfur Compounds

Protein metabolismby the bacteria; production of

sulfur-containing gases known as volatile sulfur

compounds (VSCs).

Exhaling these gases causes "bad breath"

The primary VSCs produced in the oral cavity aremethyl mercaptan (CH3SH) and hydrogen sulfide

(H2S) and dimethyl sulfide[(CH3)2S].

Other compounds in mouth air may also beoffensive such as indole , skatole andbutyric or

propionic acid.


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Intra oral causes

Dentition.

Periodontal infections.

Tongue and tongue coating.

Dry mouth (Xerostomia).


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Dentition

Deep carious lesions.

Extraction wounds filled with a

blood clot.

Crowding of teeth.

Acrylic dentures.


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Periodontal infections

In deep pockets, there is increased production

of VSCs


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Tongue and tonguecoating

The dorsal tongue shows a very irregular

surface topography.

Contain high number of papillae (filiform0.5mm in length , fungiform 0.5 to 0.8mm ,

vallate 1mm in length).

A fissured tongue and a hairy tongue have and

even rougher surface.


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Xerostomia

Causes:Medications:

antihistamines, antidepressants, antipsychotics,

benzodiazepines, anti-Parkinson agents, diuretics, systemic

bronchodilators, beta-blockers, and anticholinergic.

alcohol-containing mouth-rinses,

cancer,

high fever,

severe dehydration

mouth breathing


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Xerostomia; leads to Halitosis:

less mechanical washing.

pH raise above 7.0.

Reduced salivary antibacterial components.


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Extra Oral Causes

Postnasal drip.

Tonsils.

Gastrointestinal Tract.

Diabetes.

Liver Diseases.

Upper Respiratory Tract.

Trimethylaminuria: It is a genetic disorder in which the

body is unable to break down trimethylamine, a

compound derived from the diet. it is characterized by

an offensive body odor that smells like rotting fish.


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Postnasal drip

Accumulation of mucus in the postnasal space caused by:hypersecretion from the paranasal sinuses or adisturbance of normal drainage

The result of;

allergic rhinitis, acute or chronic sinusitis

anatomic obstructions;

nasal polyps,

enlarged adenoids in children, septal deflections,

congenital abnormalities,

foreign bodies


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Tonsils

Causes transient odors especially with the

production of small, soft, whitish-

yellowish secretions called tonsilloliths. Tonsilloliths migrate from the tonsil area

into the oral cavity onto the dorsum of

tongue. A foul odor is emanated as theybreak up.


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Gastrointestinal Tract

Rarely Responsible for bad breath.

The following pathologies might be responsiblefor less than 1% of malodor :-

Zenkers diverticulum.

Gastric hernia.

Regurgitation esophagitis

*ZD. is a pouch that forms at the back of thethroat at the junction of the pharynx and the

esophagus


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Diabetes & Liver Diseases

Diabetic ketoacidosis and hyperglycemia

produce a sweet, fruity breath malodor.

Liver failure is associated with acharacteristic sweet amine odor that is related

to the amount of expired dimethyl sulfide

produced by bacterial action on sulfur-containing amino acids.


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Upper Respiratory Tract

Halitosis may be a manifestation of

infection, inflammation, or malignancy of

any part of the upper respiratory tractincluding bronchitis, pneumonia,

bronchiectasis, and tuberculosis.


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Trimethylaminuria

Hereditary metabolic disorder.

Typical fishy odor of breath, urine, sweat,

expired air, and other body secretions.


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Psychosomatic halitosis

Imaginary halitosis.

Needs reassurance; psychological

management.


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Examination for Halitosis

Organoleptic measurement.

Portable Gas chromatography.

Portable Sulfide monitor.

Electronic Nose.


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Organoleptic measurement

Sensory test; scored on the basis of the examinersperception of a subjects malodor.

Sniffing the patients breath and scoring the level of oral

malodor. 0= no odor.

1=barely noticeable odor.

2=slight but clearly noticeable odor.

3=moderate odor. 4=strong offensive odor.

5=extremely foul odor.


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Organoleptic measurement

Patients must abstain from:

Antibiotics; 3 weeks before test

Eating garlic, onion and spicy foods; 48hrs

Scented cosmetics; 24hrs Ingesting any food, oral hygiene practices, oral rinse,

smoking; 12hrs

Examinerrefrain from:

Drinking coffee, tea or juice

Smoking

Using scented cosmetics before assessment


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PortableGas chromatography

Small amount of breathsample.

Aspirated with a plasticsyringe.

Injected into the inputport of the GC.

The Computer displaysthe detection and

amount of the threeimportant VSCs (inppb) within 8min.


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One part per billion is like

one sheet in a role of toiletpaper stretching from New

York to London.


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Portable Sulfide monitor

Electronic deviceanalysis theconcentration ofH2S&CH3SH.

Should be done after atleast 4hrs of fasting andafter keeping the mouthclosed for 3min.

Absence of breathmalodor leads toreadings of 100ppb orlower.


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Electronic Nose

An artificial Nose that has the same

capacities as the human Nose.

Currently significant improvement

still need to be made.


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Treatments ofHalitosis

Treat the underling cause.

Mechanical Reduction of intraoral

nutrients and micro organisms. Chemical Reduction of oral microbial

load.

Masking the malodor.


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halitosis or oral malodor

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