Halitosis PDF - Causes, Diagnosis & Treatment

Halitosis  What is halitosis and it prevalence? Halitosis is A word used to Nearly more than describe disagreeable bad or 50% of the general unpleasant odour coming from population have the mouth air and breath....

Halitosis  What is halitosis and it prevalence? Halitosis is A word used to Nearly more than describe disagreeable bad or 50% of the general unpleasant odour coming from population have the mouth air and breath. halitosis Halitosis is formed by volatile molecules which are caused because of pathological or non-pathological reasons. It originates from an oral or non-oral source. The origin of halitosis in 90% of patience is from the oral cavity. 9% of patient source of halitosis is non-oral reasons such as respiratory system gastrointestinal system or urinary system. 1% of patience and the cause of halitosis is diet or drugs. Volatile sulphur compounds are mainly responsible for intra oral halitosis. These compounds are mainly hydrogen sulphide and methyl mercaptan. Other compounds linked to halitosis are aromatic compounds nitrogen containing compounds , amines, short chain fatty acids alcohols, aliphatic compounds and ketones  What are the causes of? Halitosis has multifactorial origins , the source of 90% of Oral cavity such as poor hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas and throat infections, xerostomia , gingivitis, dry socket. Non-oral causes of halitosis include respiratory disease foreign body ,sinusitis, tonsillitis, Gastrointestinal diseases, renal disease, renal failure, diabetic ketoacidosis. Other causes of halitosis include garlic, onions, spiced foods, drugs, alcohol, tobacco, solvent abuse.  How is it classified ? Halitosis is classified as genuine halitosis, transient halitosis and persuasive halitosis/ halitophobia. Genuine halitosis can be further subclassified into physiological and pathological halitosis. Physiological halitosis is caused by factors like tongue coating while pathologic halitosis can be oral or extra oral.. Transient halitosis is a common and normal type of bad breath that usually goes away on its own. It often caused by morning breath, fasting, Eating or drinking certain foods and drinks, smoking. Persuasive halitosis/ halitophobia is a physiological phenomenon where patients believe they have bad breath but others don’t. Dental practitioners can treat persuaded halitosis. Patients with halitophobia should be referred to a psychological specialist. More recently a revived ecological classification system has been proposed for halitosis which divides pathologic halitosis into type zero physiological, type one oral, type two airway, type three gastrophageal, type four blood-borne and type five subjective.  How can it be measured? There are many ways halitosis can be measured. This includes organoleptic measurement, gas chromatography, sulphide monitoring, BANA test and chemical sensors have most commonly used than other methods. Organoleptic measurement is the oldest way for detection and is by smelling with the nose. This is done by the patient takes a breath deeply by inspiring the air by nostrils and holding a while then expiring this air by mouth by puppet while the examiner sniffs the odour at a distance of 20 cm. This measurement is considered the gold standard for measuring and assessing bad breath. Gas chromatography is considered highly objective reproduce and reliable, using gas chromatography we can measure VSCS. Samples are collected from saliva tongue coating or expired breath. Sulphide monitoring is an alternative to gas chromatography which avoids the disadvantages of this being difficult chair side and expensive. Patient should close the mouth and refrain from talking for five minutes prior to measurement then a disposable tube of sulphide monitor is inserted into the patient’s mouth to collect air, the disposable tube is connected to the monitor. Sulphur containing compounds in the breath generate an electro chemical reaction. Chemical sensors- because of difficulties of gas chromatography and less sensitivity of sulphide monitors we use chemical sensors instead which have an integrated probe to measure sulphur compounds from periodontal pockets and on the tongue surface. Working in principle the chemical sensors is similar to sulphide monitoring a sulphur sensing probe sulphide compound generated and electro chemical voltage and this voltage is measured by electronic unit.. BANA test - is a practical test for chair side usage. It is a microbial enzymatic test that measures the presence of certain bacteria in plastic samples that contribute to bad breath and periodontal disease.  How can it be managed ? Self-care products such as chewing gum mints, toothpaste, mouth rinses and sprays decrease the odour and attempt to mask halitosis with pleasant fragrances. Chewing gum may decrease halitosis especially through increasing the salivary secretion. Mouth rinses containing chlorine dioxide and zinc salts have a substantial effect on masking halitosis especially dietary caused halitosis such as onions, garlic, or cigarettes. professional treatment such as Good oral hygiene appropriate periodontal management instructions, including this is because by keeping proper brushing dental periodontal pockets clean and floss and inter dental bacteria load low can control the brushes , Cleaning of the amount of halitosis caused by tongue Can help keep bacteria, bacteria low down.  When should the Dh refer ? Patients with halitophobia should be referred to a psychological specialist. Patient with a suspicious lesion should be referred to a specialist. If halitosis persists after addressing all intra oral causes, then a referral should be done.  Halitosis Quiz 1.What percentage of halitosis cases originate from the oral cavity? A) 10% B) 90% - C) 60% 2.Genuine halitosis can be sub-divided into A) Pseudohalitosis and Physiologic B) Pathologic and Pseudohalitosis - C) Physiologic and Pathologic 3.Halitophobia can be described as A) A transient oral malodour - B) A fear of others no=cing an individual has oral malodour C) Oral malodour origina=ng from a non-oral cause 4.A more recent revised aeCological classiDcaCon has been proposed which further divides pathological halitosis into how many types? A) 5 B) 6 - C) 7 5.The gold standard measure of halitosis is A) BANA test B) Sulphide monitoring - C) Organolep=c measurements 6.Which of the following are potenCal oral causes of halitosis? A) Xerostomia - B) Tonsilli=s X C) CleH Palate D) ANUG ~ E) Dry Socket - F) Orthodon=c Appliance - 7.Which of the following are potenCal non-oral/other causes of halitosis? A) Diabe=c Ketoacidosis - B) Alcohol - C) Poor Oral Hygiene D) Peri-Implan==s - E) Gastric ReTux F) Sinusi=s - 8.How can halitosis be managed by the dental hygienist/dental therapist? A) Oral hygiene instruc=on ~ B) Treatment of periodontal condi=on - C) Fluoride varnish applica=on - - D) Chlorhexidine mouthwash E) Xerostomia advice - F) Smoking and alcohol cessa=on - G) Diet Advice - 9.What are the main compounds responsible for intra-oral halitosis? A) Vola=le Sulphur Compounds - B) Very Smelly Compounds C) Violent Sulphide Compounds 10.When should the dental hygienist/dental therapist consider an onward referral? A) Run out of op=ons B) Halitophobia - C) Suspicious lesion - - D) Halitosis persists aHer addressing intra-oral cause E) When halitosis is no=ced as not within scope of prac=ce Answers: Q1. B Q2. C Q3. B Q4. B Q5. C Q6. A, D, E, F Q7. A, B, E, F Q8. A, B, C, D, E, F, G Q9. A Q10. B, C, D