Halitosis

Prepared by: Jamal Q Ahmed

Supervised by: Prof. Dr. Ali Al-
Zubaidi
 Extremely common.

 Majority of adult population have had it at some

point in time! Up to ¼ on a regular basis.

 Very subjective “it’s a perception rather than a real

thing, everybody’s breath smells to a certain extent”.

 Unpleasantcondition which creates huge

embarrassment with potentially grave
consequences.

 Most seek help from GP initially, not the dentist!

 Oral malodour is common on awakening
(morning breath) and is then usually a
consequence of low salivary flow and oral
cleansing during sleep. This rarely has any
special significance, and can be readily
rectified by eating, oral cleansing and
rinsing the mouth with fresh water. Halitosis
at other times is often the consequence of
eating various foods such as garlic, onion
or spices, or of habits such as smoking or
drinking alcohol. The avoidance of these
foods and habits is the best prevention.
 WHO SEEKS HELP ?

 Most have been oblivious to the problem !

 Studiesshow that people are poor judges of their own
breath odour ( adaptation/desensitisation due to chronic
exposure?).

 Some may have exaggerated concerns !

 poorjudgement, personal experiences, childhood

memories, perception of other people’s behaviours etc
leading to preoccupation with concealing perceived
malodour, social avoidance etc. Concept of
“HALITOPHOBIA”.
 WHERE DOES IT COME FROM ?

 85-90% comes from the mouth itself.

 Formed by bacterial putrefaction of food debris, cells,
saliva and blood.
 Proteolysis of proteins peptides  aminoacids  free
thiol groups & volatile sulphides.
 Results from any form of sepsis : increased anaerobic
activity of pathogens ( Treponema denticola, P.Gingivalis and
Bacteroides forsythus).
 Despite rigorous hygiene, good dentition, posterior
dorsum of tongue is often a source (Post nasal drip
related?).
The organisms implicated include:
Phyromonas gingivalis
Prevotella intermedia
Fusobacterium nucleatum
Bacteroides forsythus
Treponema denticola
 MOST WANTED LIST
 Compounds commonly produced by
mouth bacteria and their odours.

 Hydrogen Sulphide Rotten Eggs

 Methyl mercaptan Faeces
 Skatole Faeces
 Cadaverine Corpses
 Putrescine Decaying meat
 Isovaleric acid Sweaty Feet
 Causes
 Local and systemic causes
 Local
 Mouth
 Poor oral hygiene
 Food stagnation
 Chronic periodontal diseases and ANUG
 Dry socket / pericoronitis/ chronic dental sepsis
 Infections/ hemorrhage
 Malignant tumours

 Nose and pharynx

 Pharyngitis/ tonsillitis/ sinusitis
 Foreign bodies and malignant tumours
 Systemic causes

 Lower respiratory tract infections

 Diabetic ketoacidosis
 Kidney and liver failure
 Febrile illness (dehydration)
 Sever reflux
 Drugs
 Paraldehyde
 Isosorbide dinitrate
 Disulfiram
 Alcohol
 Cytotoxic and xerogenic drugs (indirectly)
 Delusional halitosis / halitophobia
 HISTORY

 Is malodour justified; is the presenting odour

originating in the mouth or elsewhere?

 Think about systemic causes.

 Physiological halitosis, oral pathological

halitosis or pseudo halitosis ??
 EXAMINATION

 Try to distinguish oral from non-oral.

 Compare smell coming from mouth with that exiting the nose.

 Examine oral cavity, dentition, look for tonsilloliths, dentures etc.

 Examination of nose, post nasal space & all mucosal surfaces of

pharynx.
 Can take scraping from posterior dorsum of tongue.
 INVESTIGATIONS

 Instrumental analysis

 Level of intra oral Volatile Sulphur Compounds can be estimated using

portable sulphide monitors. (Halimeter)

 Gas Chromatography.

 Oral flora, such as by the BANA (benzoyl-arginine-

naphthyl-amide] test or dark field microscopy, which
can be helpful, at least for patient education.
 Management
Management of halitosis includes:
 Patient education.
 Treating the cause (medical assistance may
be required).
 smoking, foods such as onions, garlic and
durian, and vegetable such as cabbage,
cauliflower and raddish.
 Regular meals and good oral hygiene, the
latter involving dental prophylaxis tooth
brushing, flossing and tongue cleaning (with a
scraping done before going to bed )
 Oral antiseptics. These include products
containing chlorhexidine , cetylpyridinium,
triclosan or zinc chloride.

 Such products include a mouthwash which

(phases consisting of natural essential oils,
triclosan and a water solution of cetylpyridinium
chloride, plus sodium fluoride, and a tooth-paste
containing triclosan and a copolymer. In
addition, chewing gum,
parsley mint cloves or fennel seeds and the use
of proprietary 'fresh breath preparations may
help
 Generally, it is recommended that
mouthwashes should be used two - three
times daily for at least 30 seconds.

 In recalcitrant cases, the specialist

empirically may use a 1-week course of
metronidazole 200 mg three times daily in
an effort to eliminate anaerobic infection