Halitosis Revision PDF

Halitosis Halitosis = Unpleasant odour from the oral cavity, (‘bad breath’). Very common, nearly more than Causes 50% of the general population have Physiological...

Halitosis Halitosis = Unpleasant odour from the oral cavity, (‘bad breath’). Very common, nearly more than Causes 50% of the general population have Physiological - halitosis. Hypo-salivation and bacterial activity during sleep. 85-90% of halitosis cases Reduction in oxygen levels within saliva. originate from the oral cavity. (Smoking, alcohol and some foods). Pathogenic originated from oral cavity - Poor oral hygiene, tongue biofilm, food impactions and candidiasis are main oral causes of halitosis. Mainly gram negative anaerobes responsible for halitosis. Pathogenic originated extra-oral - Respiratory system - Diseases of respiratory system can cause expiration of bad odour from oral cavity and nose. (Bronchitis, lung disease, cleft lip and palate, tonsillitis). Gastrointestinal system - High correlation between presence and severity of gastroesophageal reflex and halitosis. Metabolic diseases - Diabetes, kidney failure, liver failure can all contribute to halitosis. Increased concentration of salivary urea and uric acid that be causative factor. Drug/medications - Chemotherapy drugs may cause xerostomia - cause of halitosis. Many medications may causes halitosis due to a decrease in saliva flow; blood pressure, antidepressants, diuretics, diabetes, vitamin supplements. Classification Halitosis Delusional Genuine halitosis (pseudohalitosis, halitophobia) Physiologic Pathogenic Oral Extra-oral Treatment by DH/DT Reduction of bacterial load - Tailored and good oral hygiene instructions, periodontal therapy, antiseptic/zinc based mouthwash, tongue hygiene. Review of existing restorations and prothesis - Secondary local factors should be reviewed to minimise the plaque retentive factors present. Diagnose and treat oral conditions - Xerostomia, pericoronitis, orall ulcerations; all can contribute to halitosis so need to be diagnosed and treated appropriately. Referral to specialist - If halitosis is caused by other medical condition beyond scope of practice, or if halitosis persists or the patient is experiencing halitophobia. Measurement of halitosis Direct - Organoleptic measurement - Patient takes a deep breath inspired by nostrils, then expires by the mouth (a plastic tube may be used) and the clinician grades the odour on a scale of 0-5 (0 no odour, and 5 very strong malodour). Very quick, easy and cost effective to perform, however can cause embarrassment to patient and clinician. Gold standard measure of halitosis. Gas chromatography - Quantitate analysis of VSC’s causing odour, samples collected from saliva, tongue coating or breath using a syringe. Measurement performed by flame photometric detector or producing mass spectra. Highly objective, reproducible and reliable, however expensive, non-transportable size. Sulfide monitoring - Tube is inserted into patients mouth and air is collected, sulfur-containing compounds generate electro-chemical reactions. More portable than gas chromatography but less sensitive and specific. Indirect - Not been validated! BANA test (Benzoyl-DL-arginine-a-Naphthylamide test) - Tongue is wiped with cotton swab chair-side, samples placed on BANA test strip which is put in incubator. Sample is heated for 5min at 55 degrees. If T.denticola, P.gingivalis or B.forsythus are present the strip will turn blue. Salivary incubation test - Saliva collected and incubated at 37 degrees for many hours in anaerobic medium. Less affected external factors. Ammonia monitoring - Pump draws expiratory air into ammonia gas detector from patient mouth through a tube. Patients rinse mouth with urea and blow into tube and ammonia amount is detected. Ninhydrin method - Detection of low molecule weight amines and polyamines that can’t be detected using sulfer monitor. Isopropanol is mixed with sample from patient and centrifuged. VSC’s = Volatile sulphur compounds