B A D B R E A T H ( H A L I T O S I S )
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Halitosis or bad breath or breath melador is caused by
the presence of volatile sulfur compounds on the breath, principally
methylmercaptan and hydrogen sulfide compounds. The nature of the odour
may vary in intensity and quality i.e. strength and type respectively.
Though studies have shown that 85% of the patients suffering from
halitosis have an oral condition as a source but there are other non
oral conditions which are also the cause of halitosis. The factors
associated with halitosis can be summarised into two broad groups ORAL
and NONORAL.
Risk Factors Associated With Halitosis |
Non-disease related |
Disease related |
Oral |
- Inadequate oral hygiene
- Long period of mouth closing (i.e., morning breath after sleep)
- Xerostomia (e.g. Dry mouth, due to mouth breathing, medication)
- Tongue coatings
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- Candidiasis
- Cancer
- Gingivitis
- Mouth Infection, Inflammation, Ulceration
- Periodontitis
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Non-Oral |
- Aging (reduced salivary flow)
- Alcohol
- Hunger
- Pungent foods ( i.e. onion, garlic)
- Tobacco
- Therapeutics (Amphetamines, anticholinergics,
antidepressants,antihistamines/decongestants, antihypertensive drugs,
antiparkinsonian agents, antipsychotics, anxiolytics, chemotherapeutic
agents, diuretics, narcotics/analgesics, radiation therapy)
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- Gastrointestinal (gastroesophageal reflux, hiatus hernia, cancer)
- Nasal (rhinitis, sinusitis, tumors, foreign bodies)
- Pulmonary (bronchitis, pneumonia, tuberculosis, cancer)
- Systemic (cirrhosis, dehydration, . diabetes, fever, hepatic disease, leukemias, uremia, rheumatalogic disease)
- Psychogenic (delusions, depression; hypochondriasis suicidal
tendencies, schizophrenia also associated with temporal lobe epilepsy)
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Regardless of the type of halitosis, proper diagnosis
is important. Some self-monitoring tests and in-office tests are
available to aid in the diagnosis.
Self-monitoring tests generally involve obtaining feedback from a spouse
or friend. Individuals may have difficulty in detecting halitosis
themselves, because the brain has the ability to suppress odours
stemming from ourselves. The patient can scrape the posterior region of
the tongue with a spoon or place saliva on the wrist by licking it. The
spoon or wrist can then be smelled and assessed by the odour judge.
There is also a home microbial test which is comprised of cotton-tipped
applicators and test tubes containing a specific medium. After the
applicators are placed on the tongue, they are inserted in the test
tubes. If the color in the test tube changes within a certain time
period, this is an indication that you have chronic bad breath.
In-office testing can include odour judge testing, microbial and fungal
testing, the salivary incubation test, volatile sulfur detection test,
and, in the future, artificial noses. Among other problems, the current
tests lack specificity, i.e. it is difficult to determine the existence
or the cause of chronic halitosis. There is a portable sulfide monitor
available in the market for detecting halitosis by measuring sulfur
content in the breath, but it can be inaccurate. Hence it is better to
monitor a patient's progress, than obtaining an initial diagnosis. Most
dental clinics do not have the facility yet to perform these tests.
Organoleptic measurements, over all assesment of odour emanating from
whole mouth, tongue, and saliva or chemical analysis of odour are also
used to identify halitosis.
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One of the easiest and most efficient treatments for
halitosis is by regular flossing and brushing of your teeth and tongue.
By using a tongue scraper, it is best to clean as far back on the
tongue as possible, starting from the back and moving toward the front.
This scraping motion is done several times in row. Other management
tools include antibiotics, nasal mucous control methods, avoidance of
certain foods and medications, salivary substitutes, and management of
systemic diseases. One of the most potentially promising and lucrative
areas of bad breath control is the development of various oral rinses.
Effective oral rinses must eliminate the problematic bacteria while
maintaining the balance of normal bacteria in the oral environment. The
assorted types of rinses being developed and marketed contain quaternary
ammonium, zinc, chlorhexidine (already in use to help treat
periodontitis), chlorine dioxide, or triclosan. Chlorhexidine is a
strong antimicrobial hence it is advised to use this type of rinse as a
short-term adjunct for treatment. At present, chlorine dioxide can be
used on a long-term basis.
Currently, many of these rinses provide limited effectiveness in the
treatment of chronic halitosis. Regular dental care and proper oral
hygiene including tongue cleaning are the most effective. The detection
and treatment of halitosis is a relatively new aspect of dentistry. The
future is sure to bring better diagnostic techniques and treatments. |