HALITOSIS

DR ALEX ELIUS
DDS {MUHAS}

ORAL HEALTH DEPT

BMC
CONTENTS

- INTRODUCTION - DIAGNOSIS
- EPIDERMIOLOGY - PREVENTION
- CLASSIFICATION - TREATMENT
- ETIOLOGY - CONCLUSION
- REFFERENCES
 INTRODUCTION
- Halitosis is a general term used to describe
unpleasant or offensive odor from the breath
regardless wheather the odor originate from oral
or non oral sources
- Originates from latin words
- Halitus…. Breath
- Osis……… diseases
- It was described as a clinical entity by HOWE
(1874)
 SYNONYMS
- Bad or foul smell
- Breath malodor
- Oral malodor
- Foetal ex ore
- Foetal oris
- Stomato dysodia
 DEFINITION
- Halitosis is a general term used to describe a foul odor in which proteolysis,
metabolic products of the desquamiting cells and bacteria putrefication are involved
( Marita et al, 2001)
- Is a general term used to describe any disagreeable odor in expired air
regardless wheather the odorous substance originates from oral or non oral sources
(Tangerman 2001)
- Unpleasant odor of the expired air whatever the origion may be. Oral malodor
specifically refer to such odor originating from the oral cavity itself ( Jan lindhe
2003)
 EPIDEMIOLOGY
- Bad breath has been common problem for
thousands of years
- It is considerable social problem
- Its incidence remains poorly documented in
most countries
- In vast majority the cause originates from
the oral cavity
- Japan study 2672 individuals 6-23% of
subjects had oral malodor at some periods
during the day ( Miyazaki 1996)
- Another study in USA involving individuals
older than 60 year found that 24% had oral
malodor
- The prevalence of persistent oral
malodor in Brazilian study was
reported to be 15% , was nearly three
times higher in men than in women
(regardless of age) and the risk was
slightly more than three times in
people under 20 years of age compared
to those with 20 or more years of age
- In Tanzania a study at MNH among
young mothers (15 – 44 years) found
prevalence of self reported breath
malodor to be 14% ( Mumghamba et al
, 2006)
 CLASSIFICATION
1.Genuine halitosis
- Refers to bad breath that can be readly
detected by the organoleptic measures (Just
smelling the patients breath with your nose )
- or by using some testing apparatus that
may detect the compounds typically
associated with bad breath
- Obvious malodor beyond socially
acceptable intensity
.Two types of genuine halitosis
-Pathological
-physiological
Pathological halitosis
A person malodor is a symptom of a
disease or other pathological
condition, or aggreviated by it
Physiological halitosis
The malodor is attributable to
putrefaction process taking place in
their oral cavity, frequently in the
white colored coat found on the
posterior aspect of the tongue.
CONT….
2. Pseudo halitosis
Refer to a condition where an odor
condition is not present ( can not be
detected by smell or scientific
testing) but patients still feel that
they have bad breath.
Since no real problem exist,
treatment consist of councelling the
patients about their misconception
3 Halitophobia
-A situation where patient perception
about halitosis continues despite
successful treatment of their genuine
halitosis condition.
-Exagrated fear of having halitosis
-Also refered to delusional halitosis
-Considered variant of monosymptomatic
hypochondrical psychosis
 ETIOLOGY
- Halitosis arise as a result of bacterial decomposition of food particles,
cells , blood and some of chemical compounds of the saliva
- Release Sulphur containing compounds
- hydrogen sulphide… rotten egg smell
- dimethyl sulphide…. Rotten cabbage smell
- methyl mercaptan…. Feccal smell
AND
- Non Sulphur containing compounds ( Polyamines) like
-Cadaverines…. Cadaver smell
-Putrescines…… rotting meat smell
-Acetones
-Acetaldehyde
CONT…
CONT…
COMMON CAUSES - Oral ulceration
1. Local causes
- Oral malignancies 2. Systemicauses
- Food impaction
- Oral infections - Renal failure (end stage)
- Periodontis
- ANUG - Tonsilitis
- Gastro esophageal reflux
- ANUP - Sinusitis disease
- Pericoronitis
Volatile food stuffs - Hepatic failure ( fetor
- Dry socket
hepaticus)
- Xerostomia - Garlic
- Ect
- caries - Onions
- Spiced foods
CONT…
 DIAGNOSIS
Self assessment
Whole mouth malodor ( cupped breath)
-cupping the hand over the mouth and breath
through the nose
-The presence or absence of malodor is
evaluated by the patient him/herself

Wrist lick test

Subjects are asked to extendtheir tongue and lick
their wrist . The presence of odor is judged by
smelling the wrist after 5 seconds at a distance
of about 3cm
CONT..
Spoon test
Plastic spoon is
used to scrape and
scoop materials
from the back
region of the
tongue. The odor
is judged by
smelling the wrist
CONT…
Dental floss test
Unwaxed floss is passed
through the interproximal
contacts
CONT…
Saliva odor test
Involve having the subject
expectorate 1-2mls of
saliva into a petri dish,
the dish is covered
emediately incubated at
37c for 5minutes and
then presented for odor
evaluation.
 PREVENTIVE MEASURES
Preventive rather than curative measures are
highly recommended - Limit intake of strong odor spices
-Visit a dental clinic regularly - Limit intake of sugar and coffee intake
-Periodical dental cleaning by dental - Drink a lot of fluids ( juices and water)
professional
- Chew sugar free gums when mouth feels
-Brushing of teeth twice daily with appropriate dry
brushing techniques for at least 2- 3 minutes
- Eat fruits and vegetables
-Using of tongue scrapers to get rid of lurking
odour causing bacteria in the tongue surface
-Flossing after brushing to remove food
particles stuck in between tooth surfaces
 MANAGEMENT
1. Mechanical reduction of intra oral nutrients, bacteria and other sources
2. Chemical reduction of oral microbial load
3. Rendering malodorous gases non volatile
4. Masking the malodor
 CONT..
1. Mechanical reduction of intra oral
nutrients and micro organisms
- Tongue cleaning
- Tooth brushing
- Inter dental cleaning
- Periodical periodontal therapy
- Chewing gums
- Visit your dentist ( for dental treatments )
CONT…
2. Chemical reduction of oral
microbial load
- Chlorhexidine
- Chlorine dioxide
- Triclosan
- Hydrogen peroxides
- Oxidizing lozenges
CONT…
3. Convesion of volatile sulphide
compound
- Metal salt solution
- Tooth pastes
- Chewing gums
CONT…
4. Masking the malodor
- Rinses
- Mouth spays
- ect
CONLUSION

Halitosis is a common complaint that may affect most of the adult population.
Oral malodor which is commonly noticed by patients is an important clinical sign
and symptom that has many etiologies which include local and systemic factors
Although consultation and treatment may result in dramatic reduction in bad breath ,
patients may find it difficult to sense the improvement themselves
REFERENCES
CONT…

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