halitosis

• 50-65% of population
• 60 millions people suffered from the ch.
Halitosis in USA
• Nearly 10 billions dollar are spent to treat
the halitosis.
Types of oral odour
A: Exogenous malodour:
• Food (onion, smoke, garlic, spices,
alcohol, dairy products contain protein)
B: True oral malodour
(Endogenous)
Oral cause
Drug induced
Systemic diseases
Psychogenic
Sources of halitosis
Oral cause
Drug induced > 90%
Systemic diseases
Psychogenic
Intraoral causes of halitosis
• Insufficient mechanical cleaning
– Upon arising from sleep
– After fasting
– Stubborn food particles
– Poor maintained prosthesis
• Periodontal disease and carries
Intraoral causes of halitosis
• Other types of inflammation
– Gingivitis
– Tonsillitis
– Vincent angina
– Diphtheria
– Atrophic rhinitis
– Vits deficiencies
• intraoral bleeding especially
from periodontitis
Intraoral causes of halitosis

• Redused salivary flow

– Sleeping with mouth open
– Damage to salivary gland
– Medications
– Sympathetic stimulation
 Anorexiant Preludin, Tenuate

Sources of halitosis Aventyl, Elavil

Marplan, Nardil
Sinequan,Tofranil
Antihistamine Actifed,Phenergan

Oral cause Benadryl, Vistaril

Dimetane, Atarax
Chlor-trimeton

Drug induced
Anticholinergic Agent Atropisol, Banthine
Bentyl,Combid
Daricon, Lomotil
Pro-Banthine

Systemic diseases
Antihypertensive Aldomet, Catapres
Eutonyl, Hytrin
Ismelin, Minipress
Serpasil

Psychogenic
Antiparkinson Akineton, Artane
Cogentin, Lardopa
Parsidol, Tolserol
Antipsychotic Compazine, Haldol
Mellaril, Sparine
Stelazine, Thorazine
Triavil
Anxiolytic Agent Equanil, Librium
Miltown, Serax
Marijuana, Valium
Decongestant Dimetapp, Sudactone
Diuretic Agent Aldactone, Diuril
Dyrenium, Lasix
HydroDiuril,
90
80
70
60
50
East
40
West
30
North
20
10
0
1st 2nd 3rd 4th
Qtr Qtr Qtr Qtr
Sources of halitosis
Oral cause •Respiratory infections, sinusitis.
•Disease of GIT
Drug induced •Diabetic ketosis (acetone)
Systemic diseases •Ch. Liver disease
•Renal failure
Psychogenic •Sjogren syndrome
•Post irradiation therapy
•Retained F.B in nose ,lung or
esophagus
Sources of halitosis
Oral cause Imaginary halitosis
Drug induced monosymptomatic neuroses
assoc. with schizophrenia
Systemic diseases ,, ,, temporal bone epilepsy
Psychogenic
Where does the odour come from?
the back of the
tongue (80% ) .
Sulphur-containing amino acids (inside
mouth)
• Cysteine Gram-negative proteolytic anaerobes
• Methionine (usually on tongue surface)
Fusobacterium nucleatum
Veillonella
T. denticola
Bacteroides forsythus

Volatile sulphur compounds (VSCs)

• Hydrogen sulphide
• Dimethyl sulphide
• Methyl mercaptan
Compounds commonly
produced by mouth bacteria
and their odours:
• Hydrogen sulfide- rotten eggs
• Methl mercaptan- faeces
• Skatole- faeces
• Cadaverine- corpses
• Putrescine- decaying meat
• Isovaleric acid- sweaty feet
Management

Diagnosis
Dietary advice
Tongue scraping
Mouthrinses
Pt home care instructionS
 Diagnosis
• Full medical history
• Examination .
• Radiographs
• Oral odor assessment
– Organoleptic measurment
– Halimeter
– Gas chromatograph
– Electronic nose
 Diagnosis
• Organoleptic measurement
Objective assessment still best performed by
human sense of smell
- Odor grading
0 = no odor present
1 = barely noticeable odor
2 = slight but clearly noticeable odor
3 = moderate odor
4 = strong offensive odor
5 = extremely foul odor
 Diagnosis
• halimeter
 Diagnosis
halimeter
• No food, smoking, drinking, OH for at
least 4 hours
• Keep mouth closed for 3 mins
• <100 “normal”
• 100-180 minor halitosis
• >250 chronic
Self diagnosis ?

it is inaccurate test
• By un-waxed,unflavored white dental floss
• By clean white washcloth
• By licking ur tongue on ur own clean wrist
• Halitox test
Management • Avoid odiferous foods:
Onion, Garlic, Spices
• Avoid habits:
Smoking, Alcohol, Coffee
Dietary advice • Take regular meals, incl
Tongue scraping fresh fruit: Pineapples
• Drink tea regularly:
Mouthrinses Polyphenols in tea inhibit
Dental floss bacterial growth

Pt home care
instructions
Management

Dietary advice
Tongue scraping
Mouthrinses
Dental floss
Management
•“The most effective products
contained chlorine dioxide
which
Dietary advice •a) directly oxidizes volatile
sulphur compounds to non-
Tongue scraping malodorous products
•b) can kill odourigenic
Mouthrinses microorganisms.”

dental floss
Management •“Mouthrinses
containing zinc ions
are able to reduce the
levels of volatile sulfur
compounds by
Dietary advice converting these
volatile compounds to
Tongue scraping non-malodourous zinc
sulphides.”
Mouthrinses
Management
•...It was demonstrated
that the Essential Oil
mouthwash effectively
kills bacteria in the hard-
to-reach interproximal
Dietary advice space. The crevicular
odourgenic micro-
Tongue scraping organism count was
significantly reduced by
Mouthrinses Listerine at all post-
treatment sampling times
Dental floss (Pitts et al. 1983).
Management Chlorhexidine rinses
- most effective anti- plaque
& antigingivitis agent known
today
Dietary advice Side effect
1-discoloration of teeth and
Tongue scraping tongue
2-long term use disrupt the
Mouthrinses oral flora
Dental floss
instructions
Management

• Avoid toothpastes or mouthrinses contain

– Baking soda
– Peroxide
– alcohol
Management

• Dental floss
In one study,
subjective who
flossed were found
to have significantly
less mouth odor
 patient home care instructions
• Visit your dentist regularly
• Have your teeth cleaned periodically by a dental
professional
• Floss or otherwise clean between your teeth, as
recommended by your dentist.
• Brush your teeth and gums properly
• Ask your doctor to recommend a toothbrush or
scraper for your tongue.
Pt home care instructions
 pt home care instructions
• Drink plenty of liquids
• Chew sugar-free gum for a minute or two at a time,
especially if your mouth feels dry, chewing parsley,
mint, cloves or fennel seeds may also help.
• Clean your mouth after eating or drinking milk
products, fish, meat, garlic, onion, coffee and smoke.
• Unless your dentist advises otherwise, soak
dentures overnight in antiseptic solution.
• Get control over the problem. Ask a family member
to tell you whenever you have bad breath.
• If someone in your family or a close friend has
bad breath, find a kind way to let them know.
• Ask your dentist to recommend a mouthwash
which has been shown to be clinically effective
in fighting bad breath.
• Use it most effectively right before sleeping.
• Eat fresh, fibrous vegetables such as carrots.
Pt home care instructions

• Don’t let your concern about having bad breath

run your life. Don’t be passive.
• Don’t be depressed. Get help. Don’t ignore your
gums- you can lose your teeth as well as smell
bad.
• Don’t drink too much coffee- it may make the
situation worse.
• Don’t forget to clean behind the back teeth in
each row.
 pt home care instructions

• Don’t give mouthwash to very young children as

they can swallow it.
• Don’t clean your tongue so hard that it hurts.
• Don’t rely on mouthwash alone- practice complete
oral hygiene.
 conclusion
• Bad breath is a common condition which usually
comes from mouth itself and rarely from GIT
• The post. Tongue dorsum is most frequent site
of halitosis
• In most cases bad breath can be ameliorated by
proper dental care, oral hygiene, deep tongue
cleaning and mouthrinses
• If problem persist, the pt should be promptly
referred to appropriate medical care
Thank
you !