Halitosis

Halitosis is derived from a Latin word which means unpleasant breath. If not treated, it could affect your social life. Majority of the cases of halitosis have oral origin. Therefore, appropriate dental treatment eliminates the cause.

1. HALITOSIS -Dr.Shraddha Kode

2. Halitosis – any disagreeable odour of expired air Synonyms: fetor oris, fetor ex ore, oral malodour, bad breath Prevalence of halitosis: 10-30% in the United States 87% o f the cases with halitosis had oral causes

3. Biochemistry of halitosis? 3 Primary cause – degradation of oral substances by bacteria Main micro-organisms – gram negative anaerobic bacteria Most important substrates – cysteine & methionine Degradation results in – formation of volatile sulfur compounds (VSC’s)

4. Different types of VSC’s 4 Hydrogen sulfide (H2S) Methyl mercaptan (CH3SH) Dimethyl sulfide (CH3)2S Other molecules: diamines ( indole & skatole )or polyamines ( cadverin and putrescin )

5. 5 Classification Genuine halitosis Pseudo halitosis Halitophobia 1. Physiological halitosis 2. Pathological halitosis Oral origin Systemic origin Originates from the oral cavity No halitosis present but patient believes so – brain dysfunctions: delusional cacosmia , o lfactory reference syndrome Persistent belief of patient that he/she has halitosis despite reassurance, treatment and counselling PHYSIOLOGICAL – Absence of disease; eating or drinking food – malodour PATHOLOGICAL – Presence of disease

6. 6 Etiology of halitosis Oral causes : Tongue coating – niche for oral bacteria – embedded desquamating epithelial cells, food remnants, components of saliva – putrefaction of these substrates – lead to halitosis Periodontal infections – positive correlation with gingivitis and periodontitis; NUG/NUP – extremely offensive malodour due to excessive periodontal destruction

7. 7 Xerostomia – reduced salivary flow – favours proliferation of Gram – ve bacteria – increased accumulation of plaque on the tooth surfaces and increased tongue coating Other oral causes – decayed teeth with exposed necrotic pulp, extraction wounds, dry socket, food impaction, pericoronitis, peri- implantitis , recurrent oral ulcerations, herpetic gingivitis

8. 8 Non-o ral causes : ENT & pulmonary causes: Tonsilitis , post nasal drip – excess mucus formation due to cold, allergies, bacterial infection, rhinitis, sinusitis, bronchiectasis , lung abscesses,etc Gastrointestinal causes: Gastric regurgitation, gastric cancer, malabsorption , intestinal obstruction

9. Diabetes mellitus: uncontrolled diabetes mellitus having diabetic ketoacidosis – ketonic breath/sweet fruity smell, rotten apple breath Liver pathologies: reduced liver function – accumulation of metabolites in the blood – eliminated thr lungs – sweet, excremental odour – fetor hepaticus

10. 10 Renal disorders: impaired renal function – high blood urea nitrogen levels – typical uremic odour Trimethylamineuria : genetic disorder of bowels – fish smelling compound trimethylamine – accumulates in the body - excreted – fishy odour Medications: bisphosphonates – necrosis of tissues – filthy odour

11. Intestinal obstruction Fecal odour Diabetes mellitus Fruity odour/ ketonic breath/rotten apple odour Hepatic cirrhosis Musty or mousey odour Renal insufficiency Trimethylaminuria Ammonia/fishy odour Wegner’s granulomatosis Necrotic or putrefactive odour Methionine adenosyltransferase (MAT) deficiency Cooked cabbage odour Maple syrup urine disease Burned sugar odour Lung abscess, tuberculosis Foul putrefactive odour

12. 12 Diagnosis of halitosis Identify the source of malodour (oral/non-oral) Organoleptic grading: Sniffing the patient’s breath (expired air) and grading the level of halitosis 0 = no odour 1= barely noticeable odour 2= slight but clearly noticeable odour 3= moderate odour 4= strong offensive odour 5= extremely foul odour

13. 13 Gas chromatography : OralChroma - measurement of VSC’s – to assess breath malodour – identifies various components in a minute quantity of air Sulfide Monitors: Halimeter – electrochemical voltammetric sensor generates a signal when exposed to sulfur gases

14. 14 Bacterial culture & smear : Samples taken from oral cavity are cultured and bacterial species identified BANA TEST: Benzoyl-DL-arginine-2-naphthylamide Detect T.denticola , B.forsythus , P.gingivalis which are capable of producing VSC’s Sample placed on BANA test strip – incubated at 55degrees for 5mins – strip turns blue in presence of above micro-organisms

15. 15 Treatment Oral origin : Periodontal therapy – along with mechanical and chemical plaque control Tongue cleaning – to reduce the bacterial load – tongue scraper Dietary counselling – drink plenty of fluids, eat fresh, fibrous vegetables, imp to rinse the mouth especially after meals

16. 16 Treatment of pathologies associated with teeth – decayed and endodontically involved teeth, unhealed extraction sockets, pus discharging sinus and fistula Non-oral origin : Identify the systemic cause – & refer to a specialist

17. CONCLUSION: Halitosis affects the social life Most commonly patients use masking agents to get temporary relief But, identify the exact cause Majority of cases – oral origin ; appropriate dental treatment eliminates the cause Systemic origin – refer to a specialist