Halitosis revision notes quiz

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Questions and Answers

What is primarily responsible for the majority of halitosis cases?

Gastrointestinal disorders

Metabolic diseases

Bacterial activity in the oral cavity (correct)

Pathogens from the respiratory system

Which of the following is NOT a physiological cause of halitosis?

Smoking

Xerostomia from medications

Bacterial activity during sleep

Poor oral hygiene (correct)

Which condition is correlated with the presence and severity of halitosis?

Bronchitis

Cleft lip and palate

Liver failure

Gastroesophageal reflux (correct)

Which type of halitosis describes a patient who believes they have bad breath but does not?

Delusional halitosis Signup and view all the answers

What could be an expected outcome of chemotherapy regarding halitosis?

Xerostomia leading to bad breath Signup and view all the answers

Which bacteria are mainly responsible for causing halitosis?

Gram-negative anaerobes Signup and view all the answers

What is the best initial treatment approach for halitosis by dental professionals?

Reduction of bacterial load and oral hygiene instructions Signup and view all the answers

Which of the following is a potential extra-oral cause of halitosis?

Tonsillitis Signup and view all the answers

What should be reviewed in patients with halitosis to minimize plaque retention?

Existing restorations and prostheses Signup and view all the answers

Which metabolic disease can contribute to halitosis due to increased levels of salivary urea?

Diabetes Signup and view all the answers

What is the primary advantage of using organoleptic measurement for assessing halitosis?

It is quick, easy, and cost-effective. Signup and view all the answers

Which method is considered the gold standard for measuring halitosis?

Organoleptic measurement Signup and view all the answers

What is a significant limitation of gas chromatography in measuring halitosis?

It is expensive and non-transportable. Signup and view all the answers

Which of the following tests involves the incubation of saliva at 37 degrees in an anaerobic medium?

Salivary incubation test Signup and view all the answers

What does the BANA test primarily indicate?

Presence of specific bacteria associated with periodontal disease. Signup and view all the answers

What is a characteristic of sulfide monitoring compared to gas chromatography?

It generates electro-chemical reactions. Signup and view all the answers

Which method is used to detect low molecular weight amines and polyamines in halitosis assessment?

Ninhydrin method Signup and view all the answers

What is the major drawback of indirect methods for measuring halitosis?

They have not been validated. Signup and view all the answers

Which testing method requires the use of a pump to draw air from the patient's mouth?

Ammonia monitoring Signup and view all the answers

Why might organoleptic measurement be considered less favorable in clinical settings?

It can cause embarrassment to both clinician and patient. Signup and view all the answers

Study Notes

Halitosis

Refers to unpleasant breath odor.
Affects nearly over half of the general population.
85-90% of halitosis cases originate from the oral cavity.
Hypo-salivation and bacterial activity are common during sleep.
Smoking, alcohol, and certain foods can contribute to halitosis.

Causes of Halitosis

Oral Causes:
- Poor oral hygiene
- Tongue biofilm
- Food impactions
- Candidiasis
- Gram-negative anaerobic bacteria are primarily responsible for halitosis.
Extra-Oral Causes:
- Respiratory System: Diseases like bronchitis, lung disease, cleft lip and palate, and tonsillitis can exhale bad odor from the mouth and nose.
- Gastrointestinal System: High correlation between gastroesophageal reflux and halitosis.
- Metabolic Diseases: Diabetes, kidney failure, and liver failure can contribute to halitosis due to increased salivary urea and uric acid.
- Medications: Chemotherapy drugs can cause xerostomia, leading to halitosis. Many medications can reduce saliva flow, including blood pressure medications, antidepressants, diuretics, diabetes medications, and vitamin supplements.

Classification of Halitosis

Genuine Halitosis:
- Physiological: Caused by natural bodily processes.
- Pathogenic
  - Oral: Originates in the mouth due to poor hygiene or other oral conditions.
  - Extra-Oral: Originates outside the mouth due to conditions like respiratory disease or metabolic disorders.
Delusional Halitosis: Also known as pseudohalitosis or halitophobia. This refers to the belief that one has bad breath despite no objective evidence.

Treatment of Halitosis

Dental Hygienist/Dental Therapist Treatment:
- Reduce bacterial load: Tailored oral hygiene instructions, periodontal therapy, antiseptic/zinc-based mouthwashes, and tongue hygiene.
- Review existing restorations and prosthesis to minimize plaque retention.
- Diagnose and treat oral conditions: Conditions like xerostomia, pericoronitis, and oral ulcerations can contribute to halitosis and need appropriate treatment.
- Refer to specialists: Referral may be necessary if halitosis is due to other medical issues or if halitosis persists or the patient is experiencing halitophobia.

Measurement of Halitosis

Direct Methods:
- Organoleptic Measurement: Clinician grades breath odor on a scale of 0-5 (0 being no odor and 5 being very strong malodour). This method is quick, easy, and cost-effective but can be embarrassing for both the patient and clinician. Considered the "gold standard" for assessing halitosis.
- Gas Chromatography: Analyzes volatile sulfur compounds (VSCs) in breath samples from saliva, tongue coating, or breath using a syringe. This method is highly objective, reproducible, and reliable, but it is expensive and utilizes non-portable equipment.
- Sulfide Monitoring: Air containing sulfur-containing compounds is collected from the patient's mouth. The compounds generate electrochemical reactions allowing for measurement. This method is more portable than gas chromatography but less sensitive and specific.
Indirect Methods (not validated):
- BANA Test (Benzoyl-DL-arginine-a-Naphthylamide test): The tongue is wiped with a cotton swab, and the sample is placed on a BANA test strip in an incubator. The strip turns blue if certain bacteria are present.
- Salivary Incubation Test: Saliva is collected and incubated in anaerobic medium for many hours. Less affected by external factors.
- Ammonia Monitoring: Expiratory air containing ammonia is drawn into a detector through a tube after rinsing the mouth with urea.
- Ninhydrin Method: detects low-molecular-weight amines and polyamines not detectable by sulfur monitors.

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Description

This quiz covers the various causes of halitosis, including oral and extra-oral factors. Learn about how poor oral hygiene, medications, and certain diseases contribute to unpleasant breath odor. Test your understanding of halitosis and its impacts on the general population.