Siti Chumaeroh

Halitosis from the Latin halitus for breath

= malodour = foetor ex ore

- unpleasent odors in breathing

- mainly in adult  30% over 60 year
- psichogenic basis
- to be the third most frequent reason for
seeking dental aid
- 85-90% orginates in the mouth itself
- morning breath  - a low salivary flow
- oral cleansing during
sleep
- during the day :
- foods : garlic, onion or spices
- habits (smoking, drinking alcohol)
- oral bacterial activity  anaerobes
 Oral bacterial activity arising from :
 * poor oral hygiene
 * gingivitis (especially necrotizing gingivitis)
 * periodontitis
 * pericoronitis
 * infected extraction sockets
 * residual blood postoperatively
 * debris under bridges or appliances
 * ulcers
 * dry mouth
 Porphyromonas gingivalis
 Prevotella intermedia
 Fusobacterium nucleatum
 Bacteriodes forsythus
 Treponema denticola

produce the chemicals that cause malodour

The tongue is the location of organisms above
 The chemicals include:

* volatile sulphur compounds (VSC’s) mainly:

- methyl mercaptan
- hydrogen sulphide
- dimethyl sulphide
* polyamines : - putrescine
- cadaverine
* short-chain fatty acids :
- butyric acids
- valeric acids
- propionic acids
 Odors are due to the breakdown of certain
proteinsindividual amino acids
 Certain aminoacids  foul gases
 Forexamples : breakdown cystein &
methionine  hidogen sulfide
 methyl mercaptan
 Volatile sulfur compounds stastically
associated with malodour
 Starvation
 Drugs : - amphetamines
- chloral hydrate
- cytotoxic agents
- dimethyl sulphoxide (DMSCO)
- disulfiram
- nitrates and nitrites
- phenothiazines
- solvent abuse
 * Diabetes  diabetic acidosis  aceton
 * Respiratory disease
Nasal sepsis
Infection of paranasal sinuses
Infection of respiratory tract : - tonsilitis
- bronchitis
- lung infect.
- tumors, etc
* Gastrointestinal disease : intestinal bleeding
* Hepatic failure: chronic  rare
* Renal failure : uremia in saliva amonia
* Psychosomatic factors (halitophobia ) 0,5-1%
 Volatile sulphur
Debris
compounds Psychogenic
Blood
Hydrogen
sulphide
Aminoacids H₂S
Cysteine
Methionine Methyl
Cysteine desulphydrase mercaptan
Methionine desulphydrase CH₃SH
Oral Dimethyl
bacteria disulphide
(CH₃)₂SH
SYSTEMIC
P. gingivalis
Lungs
F. nucleatum
Gastrointesti
Prev. intermedia
nal MALODOU
B. forsythus
R URu R
T. denticola
Hepatic
Renal
diabetes
 HALITOSIS

Psychogenic, psychosis or
Is there objective
cerebral tumour
halitosis? No

Recently ingested foods Foods

Ye
s such as
Yes
garlic, curry, onion, duria Drugs :
n, etc? alcohol, chloral, nitrites/nitrates
, DMSO, cytotoxics, phenothiazi
N Drugs/smoking
o nes, amphetamines or smoking
responsible? Yes
Abcess, dry
socket, pericoronitis, acute
N
Oral sinus or pharyngeal ulcerative
o
infections?
Yes gingivitis, tonsilitis, sinusitis or
nasal or foreign body
See “dry mouth”
N Xerostomia? Yes
o Respiratory disease, hepatic
disease, renal
No disease, gastrointestinal
disease, diabetes mellitus, or
other condition
Materia alba and marginal gingivitis
Plaque accumulation and gingivitis
 Dentures can produce accumulation of
microbial plaque ( bacteria and/or yeast)
on and in the fitting surfaces of the
denture and underlying mucosa
 The plaque undergoes sequential development
 is colonized by organisms
 The decreased salivary flow
 A low PH under the denture

inflammation  denture –related

stomatitis
 - full history
 - examination
 - assessment of halitosis
 - volatile sulphur compounds  halimeter
 - oral flora
Hand held halimeter
- Patient education
- Treating the cause
- Avoiding smoking, foods such as
onion, garlic etc
- Good oral hygiene : tooth
brushing, flossing, tongue cleaning (before
going to bed)
- Oral antiseptics
- Denture care
 Wearing a denture encourage food
accumulation , the denture plaque and
fitting surface  be infected with
microorganism usually C. albican
 - Keep as clean as natural teeth
 - Clean both surfaces inside and outside
after meal and at night using washing
up liquid , toothbrush and warm
water hold it over a basin
containing water
- should be left out overnight and keep
them in water  it may distort if
allowed to dry out
- An infection are increased if the
denture are worn 24 hours a day
 If the denture is infested with microorg
  should be removed
  Denture left out the mouth at night
  Clean , disinfected
  Stored in an antiseptic denture cleanser
 Denture soak solutions containing
benzoic acid eradicate C albicans from
denture surface internal surface of
prosthesis
 Chlorhexidine : reduction palatinal infection
 Mucosal infection  by brushing the palate
 using antifungal for 4 weeks
TERIMA KASIH