Oral

Malour
Presented by
Sharon Gladsie. R
IV year BDS.
 Breath odour
Breath odor can be defined as the subjective perception after
smelling someone’s breath
It can be pleasant, unpleasant or even disturbing
Malodor
•If Breath odor is unpleasant, It can be teemed as
Breath malodor , bad breath, or fetor oris.
•Not termed as oral malodor.
Oral Malodor
•This term restricts halitosis with origin in the oral
cavity
Categories

Genuine halitosis Pseudo- halitosis Halitophobia

Can be verified subjectively Malodor that is caused by No malodor can be elicited from
physiologic factor- Drinking or eating the patient objectively but the
patient belives that halitosis persist
even after treatment
Classification of Halitosis
Halitos is

Genuine Halitosis Pseudo Halitosis Temporary Halitosis

Physiological Pathological

Tongue Periodonti
um related Others
coating

Periodontiti
NUG NUP s
Xe
s to
a
r
o
mi
Car i
es
Etiology Of Halitosis

Halitosis

Physiological Pathological
1. Intraoral
2. Extraoral
Etiology

80% 20%
Intraoral Extra oral
Extra Oral Halitosis
● Sinusitis
● Tonsillitis
● Malignancy in RT
● Bronchiectasis
● Acute febrile illness
● Leukemia
● GI disorder
● Hepatic Failure
● Renal Failure
● Menstruation
● Diabetic ketoacidosis
Extra Oral Halitosis
Metabolites in
Lungs Breath
blood
Blood breath exchance
Intra Oral Halitosis

Poor Oral Periodontal Other oral

Dental Caries
Hygiene problems infections
 Role of tongue coating

Desquamated Food Bacteria Salivary Innumerable

epithelial cells debris protein depressions in the
tongue surface
 Role of volatile sulphur

Poly Acetone Acetaldehyde

Mercaptan,H2S, Short chain
amides
dimethyl sulphur fatty acids
Role of Drugs

Cytotoxic Chloral Alcohol

Tobacco Nitrates,
agents hydrate
nitrites
 Diagnosis

Self assessment test

Objective test
Self Assessment tests
Whole mouth Spoon test
malodor Wrist lick Test

Dental floss
test
Objective tests
Organoleptic Gas Sulphide
measurement Chromatography monitoring

Dark field Tongue coating

BANA test
microscopy index
Instructions before visit

Do not take antibiotics Not use scented

for 8 weeks before cosmetics or lotions on
testing the morning of
examination

Not to perform oral Do not take foods with

hygine practices on the onions or hot spices
morning of examination
Treatment

Mercury Mars Saturn Neptune Jupiter

Mercury is a small Mars is a very Saturn has several Neptune is an ice Jupiter is the
planet cold planet rings giant biggest planet
 Organoleptic measurement
● A method that can measure the strength of target
odors and expresses the value in terms of a point or
number with reference to a pre-defined Organoleptic
scale.
The odor judge
• Tr a i n e d n o s e s p a r t l y a g r e e w i t h s u l f i d e m e t e r s
• May be more relevant clinically
• Requires extensive training, periodic calibration
• Mainly for research, specialized clinics
The jury of one's peers
• Yo u r s p o u s e o r y o u r b e s t f r i e n d s
• Yo u r d e n t i s t ( o r y o u r p a t i e n t )
Self-incrimination - least reliable
• Many cannot detect odors apparent to other
• Some perceive odors no one else can detect
 Organoleptic measurement

Methodology:
• Place a translucent tube into the patients mouth
• Ask the patient to exhale slowly
• Tube is inserted through privacy screen
 Organoleptic measurement
Rosenberg Moloch et al. (1991)

Score Category Description

0 Absence of halitosis Not detected

1 Questionable halitosis Odor detectable

2 Slight Halitosis Exceed the threshold

of halitosis
3 Moderate halitosis Definite detection

4 Strong halitosis Toleratable

5 Severe halitosis Overwhelming

 Gas Chromatography
• This machine is designed to digitally measure molecular levels of the three
major VSCs in a sample of mouth air which are:
o Hydrogen sulfide
o Methymercaptan
o Dimethyl sulfide
• It is accurate
• Produces visual results in graph via computer interface
 Halimeter
• Can be used in a dental office
• Detects only VSC (misrepresents mercaptan sulfide in test results which
affects its accuracy)
• Must be calibrated regularly to maintain accuracy
• Sensitive to alcohol so one should stop drinking alcohol or using mouth
wash containing alcohol for at least 12 hrs prior to test
 BANA test
• BANA test (Benzoyl-d, L-arginine-naphthyl amide)
• -Bacteria like P.gingivalis, T. denticola, B. forsthyus produce waste
products contributing in causing bad breath.
• These bacteria can produce an enzyme that degrades (Benzoyl-d, L-
arginine-naphthyl amide) compound.
• So when sample of saliva that contains these bacteria is placed within the
BANA testing compound they cause its breakdown
• Test compound changes its color indicating a positive reaction
 Electronic nose
• Electronic device
• Clinically asses oral malodor
• Assess the association between oral malodor and oral health
 Dark field microscopy
• Used to determine the type of bacteria present in the plaque causing
halitosis
• Assess the association between oral malodor and oral pathogens
 Tongue coating index
Myasaki et al

Score Interpretation

0 Not visible

1 Less than 1/3rd of dorsum of tongue

2 Between 1/3rd and 2/3rd

3 More than 2/3rd of dorsum of tongue

 Prevention
• Visit a dental clinic regularly
• Periodical dental cleaning by dental professional
• Brushing of teeth twice daily with appropriate brushing techniques for at least 2- 3 minutes
• 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
• Limit intake of strong odor spices - Limit intake of sugar and coffee intake - Drink a lot of fluids
( juices and water) - Chew sugar free gums when mouth feels dry - Eat fruits and vegetables
Classification of halitosis based on treatment needs
Management of Halitosis

● Mechanical reduction of intra oral nutrients, bacteria and other

sources
● Chemical reduction of oral microbial load
● Rendering malodorous gases non volatile
● Masking the malodor
Mechanical reduction

● Tongue cleaning
● Tooth brushing
● Inter dental cleaning
● Periodical periodontal therapy
● Chewing gums
● Visit your dentist ( for dental treatments )
Chemical Reduction
● Chlorhexidine
● Chlorine dioxide
● Triclosan
● Hydrogen peroxides
● Oxidizing lozenges
Conversion of volatile sulphur
compounds

● Tooth paste
● Chewing gums
● Metal salt solutions – HgCl2, CuCl2
Masking Malodor

● Rinses
● Mouth wash
● Lozenges
● Chewing gums
Thank
You