Introduction
Halitosis also termed fetor ex ore, fetor oris, bad breath and oral malodor is foul or offensive odor emanating from the oral cavity.Oral malodor may rank only behind dental caries and periodontal disease as the cause of a patient's visit to the dentist. The prevalence of malodor in US is not well documented, but, judging by the $1 Billion a year spent on the deodorant-type mouth rinses, it is considerable.
Bad breath has been with us for thousands of years. The problem is discussed at length in the Jewish Talmud, as well as by Greek and Roman writers.
Prevalence of oral malodor.
The overall prevalence of oral malodor in adult population is uncertain. According to Tonzetich (1976), it is a common condition found in approximately 50 % of the adult population. Bosy et al 1997 stated that at least 50 % of the sampled population suffered from persistent oral malodor, and that for approx. Half of these people (i.e. 25 %) bad breath was a severe chronic problem.
Halitosis can be caused due to a number of factors as under :-
Halitosis due to local factors of pathological origin
In general, up to 90% of the halitosis cases have an intraoral origin. In adults, chronic periodontal disease is a major cause of halitosis. Other causes include local conditions such as poor oral hygiene, extensive caries, gingivitis, open contacts allowing for food impaction, periodontitis, Vincent's disease, Hairy or coated tongue, fissured tongue, excessive smoking, healing extraction wounds and necrotic tissues from ulcerations.
Periodontal pockets produce hydrogen sulfide, which give off an offensive odor; these pockets encourage trapping of food. Halitosis may also be related to an increase of gram-negative filamentous organisms in periodontal pockets.
Other conditions implicated as a cause of halitosis are chronic sinusitis with postnasal drip, rhinitis, pharyngitis, tonsillitis, syphilitic ulcers, cancrum oris, tumors of trachea and bronchi and infected malignant neoplasm of the oral and pharyngeal cavities.
Halitosis due to local factors of non-pathologic origin.
Stagnation of saliva associated with food debris which causes the halitosis most often experienced in the morning is due, in part to lack of movement of the cheek and tongue and also to a decrease in the BMR during sleep which inhibits self-cleansing of the oral cavity.
Excessive smoking, especially cigar, not only causes fetid odor but also encourages the hairy tongue condition, which traps food debris and tobacco odor. It also decreases the salivary flow and further increases the severity of the condition.
Dentures can cause a type of halitosis known as "denture breath". Certain age groups present a characteristic specific mouth odor. Young children of 2-5 yrs have a sweet fetid mouth odor due to their tonsil crypts lodging food and bacteria.
Halitosis due to Systemic factors of pathologic origin
M Diabetes is well known example which has an acetone, sweet, fruity.
M The odor of ammonia and urine on the breath may well suggest uremia or kidney failure.
M In severe hepatic failure the breath, known as fetor hepaticus, produces a sweet, feculent, amine odor resembling a fresh cadaver.
M An acid sweet odor suggests acute rheumatic fever, and a foul putrefactive breath is indicative of lung abscess or bronchiectiasis.
Halitosis due to systemic administration of drugs.
Halitosis due to xerostomia (dry mouth).
Clinical Examination of Halitosis
Both diagnosing and managing oral malodor is a challenging task in the clinical practice. Detection of the presence of halitosis can be by either self assessment by the patient himself or by subjective or objective measurements carried out by the dental surgeon. Further these measurements can be by either direct or indirect methods. For any of the methods used, the following initial steps are to be carried out.
Before their first visit to the office, patients are instructed to abstain from
The first step in diagnosing the cause of a patient's complaint of bad breath is to determine if the complaint is objectively verifiable. A history of recent and repeated verbal confirmations of breath malodor from friends or family members is usually a reliable indicator. Separate organoleptic assessments of oral, nasal and pulmonary air can be performed and recorded independently by two operators.
MANAGEMENT OF ORAL MALODOR
The various treatment modalities are aimed at:-
The patient is given a complete dental examination. Localized dental infections are often the source of patients' complaints of self-perceived bad tastes or odors, which are not necessarily perceived by others.
Because orally generated breath malodor is caused by the emission of thiols and sulfides by anaerobic bacteria, treatment is directed toward permanently reducing oral anaerobes both mechanically and chemically.
Mouthwashes have been used as chemical approach to combat oral malodor. Mouth rinsing is a common oral hygiene dating back to ancient times. Antibacterial components such as cetylpyridinium chloride, Chlorhexidine, Triclosan, essential oils, quaternary ammonium compounds, benzalkonium chloride hydrogen peroxide, sodium bicarbonate, zinc salts and combinations have been considered along with mechanical approaches to reduce oral malodor.
Other Products: Breathnol is a proprietary mixture of edible flavors, which was evaluated in a clinical study, and this formulation reduced oral malodor for at least 3 hours. Certain lozenges, chewing gums, and mints have been reported to reduce tongue dorsum malodor.
Bad breath is a common condition, which usually comes from the mouth itself, and rarely from the gastrointestinal tract. The dentist has the primary responsibility for diagnosing and treating bad breath. Patients complaining of bad breath should be assigned a separate appointment. Although correlative quantitative measurement techniques are available and helpful, the clinician should also make a differential judgment based on actual smelling of the odor emanating from the patient's mouth and nose. In most cases, bad breath can be ameliorated by proper dental care, oral hygiene, deep tongue cleaning and, if necessary, rinsing with an effective mouthwash. If the problem persists (or the perception of suffering from the problem persists), the patient should be promptly referred for appropriate medical care.
Halitosis also termed fetor ex ore, fetor oris, bad breath and oral malodor is foul or offensive odor emanating from the oral cavity.Oral malodor may rank only behind dental caries and periodontal disease as the cause of a patient's visit to the dentist. The prevalence of malodor in US is not well documented, but, judging by the $1 Billion a year spent on the deodorant-type mouth rinses, it is considerable.
Bad breath has been with us for thousands of years. The problem is discussed at length in the Jewish Talmud, as well as by Greek and Roman writers.
Prevalence of oral malodor.
The overall prevalence of oral malodor in adult population is uncertain. According to Tonzetich (1976), it is a common condition found in approximately 50 % of the adult population. Bosy et al 1997 stated that at least 50 % of the sampled population suffered from persistent oral malodor, and that for approx. Half of these people (i.e. 25 %) bad breath was a severe chronic problem.
Halitosis can be caused due to a number of factors as under :-
Halitosis due to local factors of pathological origin
In general, up to 90% of the halitosis cases have an intraoral origin. In adults, chronic periodontal disease is a major cause of halitosis. Other causes include local conditions such as poor oral hygiene, extensive caries, gingivitis, open contacts allowing for food impaction, periodontitis, Vincent's disease, Hairy or coated tongue, fissured tongue, excessive smoking, healing extraction wounds and necrotic tissues from ulcerations.
Periodontal pockets produce hydrogen sulfide, which give off an offensive odor; these pockets encourage trapping of food. Halitosis may also be related to an increase of gram-negative filamentous organisms in periodontal pockets.
Other conditions implicated as a cause of halitosis are chronic sinusitis with postnasal drip, rhinitis, pharyngitis, tonsillitis, syphilitic ulcers, cancrum oris, tumors of trachea and bronchi and infected malignant neoplasm of the oral and pharyngeal cavities.
Halitosis due to local factors of non-pathologic origin.
Stagnation of saliva associated with food debris which causes the halitosis most often experienced in the morning is due, in part to lack of movement of the cheek and tongue and also to a decrease in the BMR during sleep which inhibits self-cleansing of the oral cavity.
Excessive smoking, especially cigar, not only causes fetid odor but also encourages the hairy tongue condition, which traps food debris and tobacco odor. It also decreases the salivary flow and further increases the severity of the condition.
Dentures can cause a type of halitosis known as "denture breath". Certain age groups present a characteristic specific mouth odor. Young children of 2-5 yrs have a sweet fetid mouth odor due to their tonsil crypts lodging food and bacteria.
Halitosis due to Systemic factors of pathologic origin
M Diabetes is well known example which has an acetone, sweet, fruity.
M The odor of ammonia and urine on the breath may well suggest uremia or kidney failure.
M In severe hepatic failure the breath, known as fetor hepaticus, produces a sweet, feculent, amine odor resembling a fresh cadaver.
M An acid sweet odor suggests acute rheumatic fever, and a foul putrefactive breath is indicative of lung abscess or bronchiectiasis.
Halitosis due to systemic administration of drugs.
Halitosis due to xerostomia (dry mouth).
Clinical Examination of Halitosis
Both diagnosing and managing oral malodor is a challenging task in the clinical practice. Detection of the presence of halitosis can be by either self assessment by the patient himself or by subjective or objective measurements carried out by the dental surgeon. Further these measurements can be by either direct or indirect methods. For any of the methods used, the following initial steps are to be carried out.
Before their first visit to the office, patients are instructed to abstain from
- Food, breath fresheners, and oral hygiene for 6 hours;
- Smoking for 12 hours;
- Scented cosmetics for 24 hours;
- Onions, garlic, and spicy foods for 48 hours and
- Antibiotics for 3 weeks.
The first step in diagnosing the cause of a patient's complaint of bad breath is to determine if the complaint is objectively verifiable. A history of recent and repeated verbal confirmations of breath malodor from friends or family members is usually a reliable indicator. Separate organoleptic assessments of oral, nasal and pulmonary air can be performed and recorded independently by two operators.
MANAGEMENT OF ORAL MALODOR
The various treatment modalities are aimed at:-
- Mechanical reduction of intraoral debris and microbes
- Chemical reduction of oral microbial load.
- Making the malodorous gases non-volatile.
- Masking the malodor.
The patient is given a complete dental examination. Localized dental infections are often the source of patients' complaints of self-perceived bad tastes or odors, which are not necessarily perceived by others.
Because orally generated breath malodor is caused by the emission of thiols and sulfides by anaerobic bacteria, treatment is directed toward permanently reducing oral anaerobes both mechanically and chemically.
Mouthwashes have been used as chemical approach to combat oral malodor. Mouth rinsing is a common oral hygiene dating back to ancient times. Antibacterial components such as cetylpyridinium chloride, Chlorhexidine, Triclosan, essential oils, quaternary ammonium compounds, benzalkonium chloride hydrogen peroxide, sodium bicarbonate, zinc salts and combinations have been considered along with mechanical approaches to reduce oral malodor.
Other Products: Breathnol is a proprietary mixture of edible flavors, which was evaluated in a clinical study, and this formulation reduced oral malodor for at least 3 hours. Certain lozenges, chewing gums, and mints have been reported to reduce tongue dorsum malodor.
Bad breath is a common condition, which usually comes from the mouth itself, and rarely from the gastrointestinal tract. The dentist has the primary responsibility for diagnosing and treating bad breath. Patients complaining of bad breath should be assigned a separate appointment. Although correlative quantitative measurement techniques are available and helpful, the clinician should also make a differential judgment based on actual smelling of the odor emanating from the patient's mouth and nose. In most cases, bad breath can be ameliorated by proper dental care, oral hygiene, deep tongue cleaning and, if necessary, rinsing with an effective mouthwash. If the problem persists (or the perception of suffering from the problem persists), the patient should be promptly referred for appropriate medical care.
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