Oral Malodor (Bad Breath) PDF

ORAL MALODOR Catherine McConnell https://youtu.be/ZrbRb50V8mE? si=8X27ycDPKPBW2oeg&t=82  An offensive odor that emanates from the oral cavity, Halitosis… mouth...

ORAL MALODOR Catherine McConnell https://youtu.be/ZrbRb50V8mE? si=8X27ycDPKPBW2oeg&t=82  An offensive odor that emanates from the oral cavity, Halitosis… mouth air & breath… …in which proteolysis, Bad Breath… Loading… metabolic products of the desquamating cells and bacterial putrefaction are Oral Malodor… involved. Origin: Halitus – Breath Fetor Oris… Osis - Disease Marita et al., (2001) Loading…  Very common condition affecting 50-60% of the population. A chief complaint reported to oral health professionals. Acute (short term) or chronic (long term) depending on the cause. It may indicate other health problems Marita et al., (2001)  CAUSES = MULTI- FACTORIAL Intra & Extra Oral Origin GINGIVITIS/ PERIODONTITIS NASAL PASSAGE INFLAMMATION CHRONIC SINUSITIS DIABETES MELLITUS LIVER INSUFFICIENCY ETC.. Quirynen, Zhao,et al., (2003)  Causes… Can be linked to more serious underlying medical problems including Primary biliary cirrhosis (liver bile ducts destroyed) Uremia ( Kidney related- raised blood Urea levels) Lung carcinoma Decompensated liver cirrhosis (Serious liver breakdown) Trimethylaminuria (fish odor syndrome)  ODORS ARE ESSENTIAL CLUES IN THE CREATION & CONSERVATION OF SOCIAL BONDS. PSYCHOLOGICAL DISTRESS EMBARRASSING SOCIAL HANDICAPPING SOCIAL SITUATION AVOIDANCE  Pseudo-halitosis Comprises about 21.2% of total cases Patients feel they are suffering from bad breath- not perceived by others. Loading… Halitophobia Comprises 1.9% of total cases The perception of malodor by the patient continues to persist in spite of the treatment of genuine halitosis. Psychological/delusional fear of bad breath  Genuine Halitosis Comprises about 76.9% of the total cases Refers to malodor readily detected by smelling or clinical testing. Genuine halitosis is further subdivided into two categories - pathologic and physiologic halitosis. Pathologic halitosis Physiologic halitosis Bad breath is a result of a diseased Malodor attributed to the putrefaction state or aggravated by disease. (decomposition) process occurring in the oral cavity. Oral Extra oral (tissues of the oral cavity) (body tissues other than the oral cavity).  Physiological halitosis Tobacco products Medications = Xerostomia LIFE STYLE Poor Oral Hygiene Certain foods  PATHOGENIC HALITOSIS POOR ORAL HYGIENE XEROSTOMIA Bacteria DENTAL CARIES related PERIODONTAL DISEASES IN PARTICULAR NG & NP PERICORONITIS DRY SOCKET Volatile Sulphur Compounds TONGUE COATING (VSC) TONSILLOLITHS ORAL CARCINOMA. Intra oral and extra oral origin affects 90% of patients. http://www.google.ca/url? sa=i&rct=j&q=&esrc=s&fr m=1&source=images&cd= &cad=rja&uact=8&ved=0 CAcQjRxqFQoTCIKy05zn ncgCFYpxPgodNswLgQ& url=http://www.human- PERIODONTAL anatomy99.info/moderate- periodontal- DISEASE disease/&psig=AFQjCNGd 1S1D5LPIHOIJS_Ew7GFo s9ZHKg&ust=1443669778 225345 POST NASAL DRIP http://www.google.ca/url? sa=i&rct=j&q=&esrc=s&fr m=1&source=images&cd= &cad=rja&uact=8&ved=0 CAcQjRxqFQoTCPiBrYT mncgCFUltPgodQG0E3Q &url=http://therabreath.co. za/fresh-breath/how-to- stop-halitosis-caused-by- post-nasal- drip/&psig=AFQjCNFDNI vI2N41UZJUXt2EgucmsR uv_Q&ust=144366917712 6477 TONSILLOLITH  THE TONGUE HALITOSIS GENERALLY ARISES AS A RESULT OF THE BACTERIAL DECOMPOSITION OF FOOD PARTICLES, CELLS, BLOOD AND SOME CHEMICAL COMPOUNDS OF THE SALIVA.– MOSS, 1998  Tongue coatings include … Desquamated epithelial cells Food debris Bacteria Salivary proteins …provides an ideal environment for the generation of VSCs and other compounds that contribute to malodor. https://th.bing.com/th/id/R.188b4268ff59d4ae4b26ddd0098c1b8b? rik=jalcSMvwd8cvqA&riu=http%3a%2f%2falhabibdentalclinic.weebly.com%2fuplo ads%2f1%2f5%2f4%2f9%2f15495716%2f5354849_orig.jpg%3f0&ehk=uj7a9gQVb 7M%2fBUUTFS1WinG%2bPROR3L67GwZ0qYG1Wto%3d&risl=&pid=ImgRaw &r=0 Thereis more bacteria because with salive it's being flushed out ↑  MORNING BREATH BIOFILM PH IS HIGHEST IN THE MORNING- RESULTING IN ORAL CAVITY ALKALINITY. Putrefaction occurs with high bacterial accumulations Neutral or alkaline oral pH favors an increase VSC’S Acidic pH inhibits their production Subgingival Asacchralytic Bacteria metabolize nitrous compounds in the gingival crevicular fluids (GFC), creating a neutral pH and an anaerobic environment.  VSC’S AND YOUR NOSE… Hydrogen and dimethyl sulfide account for about 90% of the volatile sulfur compounds found in breath.  EXTRA-ORAL ORIGIN As most cases of halitosis are caused by poor oral hygiene and chronic dry mouth that promotes anaerobic bacterial growth… Halitosis could be the result of a bad breath disease affecting other parts of the body. Certain systemic diseases may affect multiple organs and tissues - such - as: Diabetes, rheumatoid arthritis, metabolic disorders and hypertension, are also referred to as "blood-borne" halitosis diseases because they can induce non-oral bad breath.  Bloodborne Sources Loading… The absence of intra-oral causes may indicate systemic/metabolic disease, genetic/psychological disorders, medication pharmacokinetics, transient factors or particular physiological processes.  Non-bloodborne Sources Originates from the nose, upper and lower respiratory tracts, the gastrointestinal tract- is attributable to infection, disease or disorders of these areas. Olfactory System The human nose has roughly 400 types of scent receptors detect at least 1 trillion different odors. Dogs possess up to 300 million olfactory receptors in their noses, compared to about six million in humans U nf av or ab le O do ↑ rs C au sa ti ve O rg an The gram –ve anaerobes is cause the formation of Volatile Sulfur Compounds… m O do ↑ r C o m po un ds ORIGINS OF ODORS ASSESSMENT METHODS  ASSESSMENT 1- ORGANOLEPTIC MEASUREMENTS (OM) 2- SULFIDE MONITORING (SM) [HALIMETER®] 3- GAS CHROMATOGRAPHY (GC) [ORALCHROMA™] 4- MICROBIAL TESTING 5. CHEMICAL TEST STRIPS.  ORGANOLEPTIC MEASUREMENTS Pros Cons Requires Nose has +++ trained, calibrated smell capacity assessors No equipment required Subjective Correlates with other Lacks specificity methods Considered ORGANOLEPTIC “gold standard”??? Organoleptic Technique  HALIMETER Pros Cons Detects Only detects volume of VSCs VSCs Non-differential, so can’t Objective detect DMS Can’t detect blood-borne Portable halitosis  & Chromatograph Cons (traditional gas Pros (portable gas chromatograph) chromatograph) Highly specialized, precise Stationary model Detects VSCs differentially Test is time consuming Detects blood-borne halitosis Requires skilled operator Has diagnostic and prognostic value Results are visual (monitor and chromatogram) Objective New protocols suggest should be new “gold-standard”  NEEDS ASSESSMENT Gas chromatograph = Differential diagnosis  IDENTIFY & ELIMINATE the causal eliminating 16 managing denttigging or · and & Armstrong BL et al. (2010). CLASSIFICATION Armstrong BL et al. (2010). TREATMENT PLAN Armstrong BL et al. (2010).  http://www.google.ca/url? sa=i&rct=j&q=&esrc=s&frm=1&source=ima ges&cd=&cad=rja&uact=8&ved=0CAcQjRx qFQoTCLTxnZDpnsgCFQR0PgodsEoMXg &url=http://blog.juliegillisdds.com/tongue- scraping-really-is-that- necessary/&psig=AFQjCNFQ_syAin72D6dE U7HQzu0jXJ88gQ&ust=1443704513450641 http://www.google.ca/url? sa=i&rct=j&q=&esrc=s&frm=1&source=images &cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoT CLK7spjqnsgCFUU- PgodWkcB5A&url=http://www.stlawrencedentist ry.com/flossing-your-teeth-are-there- alternatives/&psig=AFQjCNF8MhMWt- uf7eUAC5xB6axK23ha8w&ust=1443704877818 020 http://www.google.ca/url? sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&c ad=rja&uact=8&ved=0CAcQjRxqFQoTCNvnx6TrnsgCF QQ9PgodtmAONw&url=http://www.freysmiles.com/blog /view/diy-antiseptic-mouthwash-for-better-gum- health&psig=AFQjCNE6omTQsm1XJSJGW5huOn0Qw O0CwA&ust=1443705029049283 With permission from P. McCarthy  REFEREN Armstrong B L, Sensat M L & Stoltenberg J L (2010). Halitosis: aCES review of current literature J. Dent. Hyg. 84(2) 65–74 Badanjak, S. (2012). Halitosis in the absence of oral causes: recent research on the etiology of non- oral origins of halitosis. Can J Dent Hygiene. 46(4). 231-237 FiS Inc.(2013). OralChroma™ internal document. Osaka, Japan; Lee,S.,(2014). ORAL MALODOR: A REVIEW OF KEY PRINCIPLES. Colgate Oral Health Network. Morita, M. and Wang, H.-L. (2001), Association between oral malodor and adult periodontitis: a review. Journal of Clinical Periodontology, 28: 813- 819. https://doi.org/10.1034/j.1600-051x.2001.028009813.x Nachnani S.(2011). Oral malodor: Causes, assessment, and treatment. Compend Contin Educ Dent. 2011;32(1):22-24. Scully C et al.(2011). Halitology (breath odour: aetiopathogenesis and management) Oral Disease;18(4):333-345. Tangerman A et al. (2010). Extra-oral halitosis: an overview. J Breath Res. 4(1):1-6. Yaegaki K et al. (2012).Hydrogen sulfide increases hepatic differentiation in tooth-pulp stemcells. J Breath Res. 6(1):110 Quirynen, M., et al. (2003). A salivary incubation test for evaluation of oral malodor: a pilot study. Jour periodontology, 74(7), 937– 944.https://doi.org/10.1902/jop.2003.74.7.937 http://www.slideshare.net/dandu1990/halitosisppt