HALITOSIS DR ALEX ELIUS DDS {MUHAS} ORAL HEALTH DEPT BMC

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CONTENTS - INTRODUCTION - EPIDERMIOLOGY - CLASSIFICATION - ETIOLOGY

CONT.. - DIAGNOSIS - PREVENTION - TREATMENT - CONCLUSION - REFFERENCES

INTRODUCTION - Halitosis is a general term used to describe unpleasant or offensive odor from the breath regardless wheather the odor originate from oral or non oral sources - Originates from latin words - Halitus…. Breath - Osis……… diseases - It was described as a clinical entity by HOWE (1874)

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SYNONYMS - Bad or foul smell - Breath malodor - Oral malodor - Foetal ex ore - Foetal oris - Stomato dysodia

DEFINITION - Halitosis is a general term used to describe a foul odor in which proteolysis, metabolic products of the desquamiting cells and bacteria putrefication are involved ( Marita et al, 2001) - Is a general term used to describe any disagreeable odor in expired air regardless wheather the odorous substance originates from oral or non oral sources (Tangerman 2001) - Unpleasant odor of the expired air whatever the origion may be. Oral malodor specifically refer to such odor originating from the oral cavity itself ( Jan lindhe 2003)

EPIDEMIOLOGY - Bad breath has been common problem for thousands of years - It is considerable social problem - Its incidence remains poorly documented in most countries - In vast majority the cause originates from the oral cavity - Japan study 2672 individuals 6-23% of subjects had oral malodor at some periods during the day ( Miyazaki 1996) - Another study in USA involving individuals older than 60 year found that 24% had oral malodor

CONT… - The prevalence of persistent oral malodor in Brazilian study was reported to be 15%, was nearly three times higher in men than in women (regardless of age) and the risk was slightly more than three times in people under 20 years of age compared to those with 20 or more years of age - In Tanzania a study at MNH among young mothers (15 – 44 years) found prevalence of self reported breath malodor to be 14% ( Mumghamba et al, 2006)

CLASSIFICATION 1. Genuine halitosis - Refers to bad breath that can be readly detected by the organoleptic measures (Just smelling the patients breath with your nose ) - or by using some testing apparatus that may detect the compounds typically associated with bad breath - Obvious malodor beyond socially acceptable intensity.Two types of genuine halitosis -Pathological -physiological

CONT.. Pathological halitosis A person malodor is a symptom of a disease or other pathological condition, or aggreviated by it Physiological halitosis The malodor is attributable to putrefaction process taking place in their oral cavity, frequently in the white colored coat found on the posterior aspect of the tongue.

CONT…. 2. Pseudo halitosis Refer to a condition where an odor condition is not present ( can not be detected by smell or scientific testing) but patients still feel that they have bad breath. Since no real problem exist, treatment consist of councelling the patients about their misconception

CONT… 3 Halitophobia -A situation where patient perception about halitosis continues despite successful treatment of their genuine halitosis condition. -Exagrated fear of having halitosis -Also refered to delusional halitosis -Considered variant of monosymptomatic hypochondrical psychosis

ETIOLOGY - Halitosis arise as a result of bacterial decomposition of food particles, cells, blood and some of chemical compounds of the saliva - Release Sulphur containing compounds - hydrogen sulphide… rotten egg smell - dimethyl sulphide…. Rotten cabbage smell - methyl mercaptan…. Feccal smell AND

CONT…. - Non Sulphur containing compounds ( Polyamines) like -Cadaverines…. Cadaver smell -Putrescines…… rotting meat smell -Acetones -Acetaldehyde

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COMMON CAUSES 1. Local causes - Food impaction - Periodontis - ANUG - ANUP - Pericoronitis - Dry socket - Xerostomia - caries

CONT.. - Oral ulceration - Oral malignancies - Oral infections - Tonsilitis - Sinusitis

CONT.. Volatile food stuffs - Garlic - Onions - Spiced foods

CONT.. 2. Systemicauses - Renal failure (end stage) - Gastro esophageal reflux disease - Hepatic failure ( fetor hepaticus) - Ect

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DIAGNOSIS Self assessment Whole mouth malodor ( cupped breath) -cupping the hand over the mouth and breath through the nose -The presence or absence of malodor is evaluated by the patient him/herself Wrist lick test Subjects are asked to extendtheir tongue and lick their wrist. The presence of odor is judged by smelling the wrist after 5 seconds at a distance of about 3cm

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Spoon test Plastic spoon is used to scrape and scoop materials from the back region of the tongue. The odor is judged by smelling the wrist

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Dental floss test Unwaxed floss is passed through the interproximal contacts

CONT… Saliva odor test Involve having the subject expectorate 1-2mls of saliva into a petri dish, the dish is covered emediately incubated at 37c for 5minutes and then presented for odor evaluation.

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VOLATILE SULPHUR MONITOR

GAS CHROMATOGRAPH

DIAMOND PROBE

ELECTRONIC NOSE

PREVENTIVE MEASURES Preventive rather than curative measures are highly recommended -Visit a dental clinic regularly -Periodical dental cleaning by dental professional -Brushing of teeth twice daily with appropriate brushing techniques for at least 2- 3 minutes -Using of tongue scrapers to get rid of lurking odour causing bacteria in the tongue surface -Flossing after brushing to remove food particles stuck in between tooth surfaces

CONT.. - Limit intake of strong odor spices - Limit intake of sugar and coffee intake - Drink a lot of fluids ( juices and water) - Chew sugar free gums when mouth feels dry - Eat fruits and vegetables

MANAGEMENT 1.Mechanical reduction of intra oral nutrients, bacteria and other sources 2.Chemical reduction of oral microbial load 3.Rendering malodorous gases non volatile 4.Masking the malodor

CONT.. 1.Mechanical reduction of intra oral nutrients and micro organisms - Tongue cleaning - Tooth brushing - Inter dental cleaning - Periodical periodontal therapy - Chewing gums - Visit your dentist ( for dental treatments )

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2. Chemical reduction of oral microbial load - Chlorhexidine - Chlorine dioxide - Triclosan - Hydrogen peroxides - Oxidizing lozenges

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CONT… 3. Convesion of volatile sulphide compound - Metal salt solution - Tooth pastes - Chewing gums

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4.Masking the malodor - Rinses - Mouth spays - ect

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CONLUSION Halitosis is a common complaint that may affect most of the adult population. Oral malodor which is commonly noticed by patients is an important clinical sign and symptom that has many etiologies which include local and systemic factors Although consultation and treatment may result in dramatic reduction in bad breath, patients may find it difficult to sense the improvement themselves

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