Halitosis - bad breath presentation that i used in my presentation in college

1. HALITOSIS
(BAD BREATH)
Supervisor Dr. Mahitab Mamdouh
Presented to Dr. Reham Lotfy Agour
Section 1.2

2. WHAT IS HALITOSIS ?
 Bad breath is a common problem that can cause significant psychological distress.
 Anyone can suffer from bad breath. It is estimated that 1 in 4 people have bad breath on a regular
basis.
 Halitosis is the third most common reason that people seek dental care, after tooth decay and
gum disease.
 Simple home remedies and lifestyle changes, such as improved dental hygiene and quitting
smoking, can often remove the issue. If bad breath persists, however, it is advisable to visit a
doctor to check for underlying causes.

3. CLINICAL FEATURES OF HALITOSIS
90% originates from oral cavity
Age: More common in adults and increase with
age
Symptoms: bad odour – rotten egg/acetone/foul
odour/rotten meat
Gender: More common in Females more than
males due to higherVSC according to a study in
china but mostly they are equall

4.  Types and Causes
 Diagnosis
 Treatment

5. PATHOGENESIS OF MALODOUR
Putrefaction
products

7. TYPES AND CAUSES OF HALITOSIS
Types
Causes of
Genuine halitosis
Genuine (chronic) halitosis - extended amount of time
Due to physiologic and pathologic causes
Temporary (transitory) halitosis - Due to physiologic
Causes only e.g. food – lasts 24 : 72 hours
Physiologic
Pathologic
Intraoral (in oral cavity)
Extraoral and systemic
(out of oral cavity)

8. COMMON CAUSES OF HALITOSIS

9. PHYSIOLOGIC CAUSES
• Diet or food e.g. Spices,onion,garlic,carbohydrates
• Medications e.g. Alcohol
• Tobaco smoking
• Tongue coating (VCS)
Include desquamated epithelial cells, food debris, bacteria
And salivary proteins and provide an ideal environment
ForVolatile Sulfur Compounds “VCS” that contribute for
the malodour (most common cause) (dorsal – posterior part)
• Food impaction due to anatomical abnormalities

10. PATHOLOGIC CAUSES
1. Intraoral causes
• Poor oral hygiene
• Malodour pathologies
• Dry mouth (xerostomia)
Saliva has an important cleaning function in the oral cavity.
Patients with xerostomia often present with large amounts
of plaque on teeth and extensive tongue coating.
The increased microbial load and the escape ofVSCs
when salivary low is reduced explain the strong breath malodor
• Sinusitis andTonsillitis
• Bacterial infections andVSC (rotten egg)
• Oral sepsis
Dental caries
Periodontal diseases
periodontitis
pericoronitis
Oral carcinoma
Dry socket
Ulcerative lesions
Gingivitis

11. PATHOLOGIC CAUSES
2. Extraoral and systemic causes
• Gastrointestinal diseases (gastroesophageal reflux)
• Respiratory tract infections or malignancy
• ENT disorders e.g. post nasal drip (mucus secretions moving down the back of
• the throat)
• Stomach, intestine , liver or kidney diseases

12. PATHOLOGIC CAUSES – SYSTEMIC
CONDITIONS
Systemic condition or disease Odour
Diabetes Mellitus Acetone
Renal failure (kidney disease) Urine or ammonia
Liver failure Fresh cadaver (rotten meat)
T.B or Lung abscess Foul odour
Hemorrhage or Blood disorders Decomposed blood (rotten meat)
Fever or Dehydration Unpleasent odour due to
xerostomia and poor oral hygine
(rotten egg)

13. DIAGNOSIS OF HALITOSIS
-
• Halitosis affects a person's daily life negatively our
dentist will likely smell both the breath from your
mouth and the breath from your nose and rate the
odor on a scale.
-
• Because the back of the tongue is most often the source of
the smell, your dentist may there .also scrape it and rate
its odor are sophisticated detectors that can identify the
chemicals responsible for bad breath, though these aren't
always available.

14. DIAGNOSIS OF
HALITOSIS
Oral Examination:
Anaerobic Bacteria present in dental pockets and back
of tongue produceVSCs which cause bad breath
• Objective methods :
• (1) Halimeter :This detects low levels of sulfur.
• (2) Organoleptic measurement : measurement of
unpleasant odors.
• by smelling the exhaled
• air of the mouth
• (3) Gas chromatography: In this method, measurements
are performed and equipped with a flame photometric
detector.

15. DIAGNOSIS OF HALITOSIS
(4) Bana test: used to determine the proteolytic activity of certain oral
anaerobes that contribute to oral malodor.The test works on principle
that certain peri pathogenic bacteria have the capability to reduce n-
benzolyDL. arginine beta-napthylamine (Bana) which can be detect
using chair side test.
(5) Electronic nose: used to clinically assess oral malodor and examined
the association between oral malodor strength and oral health status.
(6) Chemical sensors: measure sulfur compounds from periodontal
pockets and on the tongue surface.
(7) Sulfide monitoring: developed to measureVSCs.

16. DIAGNOSIS OF HALITOSIS
Self assesment:
1. whole mouth malodor(cupped breath): through
cupping the hand over the mouth and breath through
the nose.
The present or absence of malodor is evaluated by
patient himself.
2. wrist lick test: the patient are asked to extend their
tongue and lick their wrist.The presence of odor is
judged by smelling the wrist after 5 seconds at the
distance of about 3 cm.

17. 3. Spoon scrape test: by used plastic spoon the finger is
used to scrape material from the back of region of the
tongue.The odor is judged by smelling.
4. Dental floss test:The dental floss is passed through
interproximalcontact. Odor is perceived after.
DIAGNOSIS OF HALITOSIS
5. saliva odor test: Subject expectorate 1-2ml of saliva
into a petri dish or cup. cup is covered immediately
incubated at 37 for 5 minutes. then presented for odor
evaluation.

18. TREATMENT OF HALITOSIS
The key to successful resolution of halitosis complaint is its objective diagnosis
• First, the physical nature of the complaint has to be verified Subsequently.
• The source of the malodor should be determined.
• Based on these, an appropriate treatment may be implemented.
The treatment starts with removal of causes by following:
i. Mechanical reduction of intraoral nutrients and microorganisms
ii. Chemical therapy
iii. Conversion ofVolatile Sulfur compounds to Non-volatile
iv. Masking the Malodour

19. I. MECHANICAL REDUCTION OF INTRAORAL
NUTRIENTS AND MICROORGANISMS
1. tongue cleaning, brushing and scrapping .
2. Interdental cleaning, tooth brushing and
flossing.
3. Elimination of causes.
4.The salivary flow.
has a mechanical cleaning capability
 Drugs can increase salivation
Biotene rinses systemic drugs—such as Evoxac.

20. i. II. CHEMICALTHERAPY
1. Antimicrobial agents e.g. Chlorohexidine
2. cetylpyridinium chloride
3. essential oils
4.Triclosan
Broad spectrum Anti-bacterial
Used as : toothpastes
5. chlorine dioxide
Anti-bacterial and antiseptic
6. hydrogen peroxide
Strong disinfectant
7. Baking soda
Remove surface stains for
deeper cleaning
8. Fluoride
Anti-bacterial and antiseptic

21. III. CONVERSION OFVOLATILE SULFUR
COMPOUNDS (VCS)
 Metal Salt solutions
 Toothpastes
 Chewing gum
vi. Masking the malodor
use of masking agents
• as rinsing products
• Sprays
• toothpaste containing fluoride
• mint tablets, or chewing gum—only have a short-term masking effect

22. V. REMOVAL OF CAUSES
Xerostomia medication that stimulates saliva
Post-nasal Drip Antibiotics, saline nasal sprays or irrigation
Correction of anatomical abnormalities