ORAL MALADOR/ HALITOSIS

                ORAL MALADOR

Halitosis is a term used to describe noticeably unpleasant odor exhaled in breathing. 

Synonym-

Breath malodor, foul breath, fetor oris Or simply bad breath.

CLASSIFICATION OF HALITOSIS-

1) GENUINE HALITOSIS-

A) Physiological halitosis

B) Pathological halitosis

a) Oral

b) Extra oral

2) PSEUDO-HALITOSIS-

Obvious malodor is not perceived by others, although the patient stubbornly complains of its existence. 

HALITOPHOBIA-

After treatment for genuine halitosis or pseudo-halitosis the patient persist in believing that he or she has halitosis.

ETIOLOGY-

At least 90% of all malodor originates from the oral cavity. Whereas, the remaining 10% has systemic or normal causes. 

The most common physiological and pathological causes of halitosis are-

CAUSES FOR PHYSIOLOGICAL HALITOSIS-

1) MOUTH BREATHING. 

2) MEDICATION

3) AGING AND POOR DENTAL HYGIENE. 

4) FASTING/  STARVATION. 

5) TOBACCO

6) FOODS( ONION, GARLIC) AND ALCOHOL. 

CAUSES FOR PATHOLOGICAL HALITOSIS-

Oral and other contributing factor such as:

A) PERIODONTAL INFECTION-

odor from Subgingival dental biofilm. Specific disease like acute necrotizing  ulcerative  gingivitis and pericoronitis. 

B)  TONGUE COATING HARBOR       MICROORGANISMS. 

C)  STOMATITIS, XEROSTOMIA. 

D) FAULTY RESTORATION RETAINING FOOD AND BACTERIA. 

E)  UNCLEAN DENTURES. 

F) ORAL PATHOLOGICAL LESION LIKE ORAL CANCERS, CANDIDIASIS. 

G) PAROTITIS, CLEFT PALATE. 

H) APHTHOUS ULCERS, DENTAL ABSCESSES. 

SYSTEMIC AND EXTRA- ORAL FACTORS INCLUDE-

A) Nasal infections-

Like Rhinitis, sinusitis, tumors and foreign bodies. 

B) Diseases of gastrointestinal tract-

Like hiatus hernia, carcinoma, GERD( gastroesophagel reflux disorder. 

C)  Pulmonary infection-

Like Bronchitis, pneumonia, tuberculosis and carcinoma. 

D) Certain hormonal changes that occur during ovulation, Menstruation, pregnancy, and menopause. 

E) Systemic diseases-

Like Diabetes mellitus, hepatic failure, renal failure, uremia, blood dyscrasias, dehydration and fever, cirrhosis of liver. 

DIAGNOSIS OF HALITOSIS-

a) Review of medical, dental and personal history. 

b) Clinical examination-

1) Intraoral examination-

Intraoral examination-

1) Tongue coating

2) Evidence of mouth breathing

3) Xerostomia

4) Other oral causes. 

2) Complete periodontal examination-

1) General personal care, state of oral hygiene.

2) Probing for attachment levels, probing depths.


3) Evidence of neglect past history of dental hygiene care. 

c) Measurement of oral malodor-

Patient should not eat, chew, rinse or smoke for at least two hours before examination. Patients who are on antibiotic should be seen 2 weeks after discontinuation of medicines. 

TESTS USED TO DETECT HALITOSIS ARE AS FOLLOWS-



1) SUBJECTIVE  ORGANOLEPTIC METHOD

This has been used as a bench mark for oral malodor measurement.



2) GAS CHROMATOGRAPHY
A portable industrial monitor are specifically designed to digitally measure molecular levels of three major volatile sulfur compounds in a sample of mouth air( hydrogen sulfide, methyl mercaptan and dimethyl sulfide). 


3) HALIMETERS

These machine measure the level of sulfide gas found in a person breath.  Certain drawbacks of halimeters in clinical application are-

1) Mercaptan are not easily recorded and can be misrepresented in test results. 

2) The halimeters is also very sensitive to alcohol, so one should avoid drinking alcohol or using alcohol containing mouthwashes for
atleast 12 hours prior to being tested. 
4) BANA TEST

( Benzoyl-d, L- arginine-naphthylamide) 

Some of the bacteria like P. gingivali, T. denticola and B. forsythus produce  waste products that are quiet odiferous and as a result  contribute in causing bad breath. These bacteria have the characteristics of being able to produce an enzymes that degrades the compound Benzoyl-d, L- arginine-naphthylamide) . When a sample of patients saliva that contains these bacteria is placed within the BANA testing compond they cause it's breakdown.As a result of this degradation the test compound changes its colour indicating a positive reaction. 

5) CHEMILUMINESCENCE

This test involves mixing a sample containing sulfur compound with the mercury compound and the resultant reaction causes flourescence. 

TREATMENT AND MANAGEMENT OF ORAL MALODOR-

There are no standard protocol for the treatment of oral malodor, however, the possible protocol contains the basic elements including the standard dental and periodontal treatment.

For genuine halitosis with oral causes the treatment is as follows-

1) Reduction of anaerobic load by improving oral hygiene and periodontal health through basic dental care. 

2) If oral malodor persists in spite of adequate  conventional oral hygiene, tongue brushing should be advised.



3) Chemical reduction of oral microbial load-

This includes rinsing or gargling with an effective mouthwash.

4) Another treatment strategy for oral malodor is conversion of volatile sulfur compound by using various metal ions.