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Halitosis (Bad breath or Oral malodor)
Etiology
Volatile sulfide compounds(H2S, methyl mercaptan, dimethyl sulfideCauses
Systemic conditions
• Odor from nasopharynx
• From lung and bronchi
• Diseases of GIT
• Metabolic disorders like diabetes,uremia and liver disease
• Blood disorders
• Salivary gland dysfunction causing xerostomia
• Dehydration states
• Drugs:isosorbide dinitrate,iodine derivative, etc
• Trimethylamnuria
DIAGNOSIS OF MALODOR
- Medical history
- Clinical and laboratory examination
1. Self examination
2. Organoleptic rating
3. Portable volatile sulfide monitor
4. Gas chromatography
5. Dark field or phase contrast microscopy
6. Saliva incubation test
Organoleptic rating
Gold standard
0 = no odor
1 = barely noticeable odor
2 = moderate odor
4 = strong offensive odor
5 = extremely foul odor
Specific character of breath odor
• Rotten egg : VSCs• Sweet/dead mice : liver insufficiency
• Rotten apples : insulin dependent diabetes(ketones)
• Fish odor : kidney in sufficiency(dimethylamine, trimethyleamine)
TREATMENT OF ORAL MALODOR
- Mechanical reduction of intra oral nutrients and microorganism
- Chemical reduction of oral microbial load
- Rendering malodor gases non volatile
- Masking mal odor
MCQ's
1.The most important cause of halitosis is;
a) Gingivitis and periodontitis
b) Tongue coating
c) Pericoronitis
d) Deep dentinal caries with food impaction
Answer: b
2.Which part of the tongue is responsible for most causes for oral malodor;
a) Dorsal-anterior
b) Dorsal-posterior
c) Dorsolateral
d) Dorsoventral
Answer:b
