Halitosis, commonly known as bad breath, affects about half the population and can stem from physiological or pathological sources. It can be categorized into genuine halitosis and pseudo-halitosis, the latter being a false belief of malodor without actual presence. While transient halitosis often occurs from physiological causes, persistent halitosis may indicate underlying oral or systemic diseases, and treatment typically focuses on addressing these root causes.

3. Oral malodor or bad breath can originate from
physiologic or pathologic sources, and has been
estimated to occur chronically in approximately half the
population.
Odor-producing compounds are inspired into the lungs
and then expired.
halitosis is derived from the Latin word "halitus," which
means breath, and the Greek "osis " which means
condition

4.  This occurs when odors (from foods or tobacco)
are ingested and inhaled or when pathologically
produced odiferous compounds (intra oral or
systemic) are introduced into the lungs.
 Halitosis has been estimated to be from oral
sources in (40 - 90) % of case;however, it can
also arise from systemic diseases
 cause

5. Transitory halitosis
 Oral halitosis is a very common problem in dental
patients, in fact, most adult subjects have socially
unacceptable bad breath when waking up in the
morning.
This problem is transitory and
attributed to physiologic causes such as reduced saliva
flow during sleep.
 Although these transitory problems are easily
controlled, persistent bad breath may be indicative either
of oral diseases (i.e. periodontal diseases the presence of
bacterial reservoirs in the mouth) or indicative of
systemic diseases (i.e, hepatic cirrhosis or diabetes
mellitus

6. when dealing with the problem of halitosis or with the
halitosis patient:
it is important to distinguish between "genuine halitosis" and
"pseudo-halitosis.
" Genuine halitosis" is where the breath malodor is a real
problem that can be easily diagnosed either by organoleptic
or by physic-chemical means.
“Pseudo halitosis” is where the oral malodor dose not exist
but the patient believes that he or she has it
.
if after successful treatment for either genuine halitosis or
pseudo- halitosis the patient still believe that he or she has
halitosis .then the diagnosis is termed “halitophobia”

7. • physiologic halitosis also termed transient halitosis,, is
self-limited, does not prevent the patient from carrying
out a normal life, and usually does not need any
therapy. This situation, also termed ( morning breath) is
more a cosmetic problem than a health-related
condition. happens when a patient eats certain
aromatic foods such as herbs, spices,, onions,
garlic

8.  pathologic halitosis permanent does not resolve by
usual oral hygiene methods, and prevents he patient
from carrying out a(( normal)) life.
. This type of halitosis is not easily reversible
and tends to persist without treatment. The
best way to treat the bad breath caused by
pathological halitosis is to treat the underlying
condition

9. Classification of halitosis
1. Local:
 Pathological.
 Non pathological.
2. Systemic.
 Pathological.
 Non pathological.
3. Systemic drug administration.
4. Xerostomia.

10. Local(non pathoiogig)
 (morning breath ) This occure Due to
Decrease salivary flow
decrease tongue movement
Lead to food stagnation
 Denture:Poor maintenance & overnight use of dental
prostheses can produce malodors as a result of poor oral hygiene
or decrease night time salivary flow.
 In children under 4 years. (fermentation of milk)
 smoking : due to xerostomia and nicotin( substrate of mal
odour).
 food: spicy food,tea,coffe

11. Local pathologic
 Teeth condition: Although dental caries does not
produce bad breath, it creates food traps as do
overhanging, sub gingival and open restorations.
Debris remaining in these areas decomposes and
produces fetid odors
Decay inside a tooth provides an anaerobic environment and is thus a
great place to live if you are a sulfur metabolizing germ.

12.  Gingival condition: the gingival sulcus are reservoirs
for microbes that can produce VSCs. specifically
gram-negative anaerobic bacteria (e.g.,
porphyromonas gingivitis. Prevotella intermedia ,
Fusobacterium nucleatum, and Treponema denticola

13.  Several factors can result in a shift from gram-
Positive to gram negative bacteria in the oral
cavity:
diminished salivary flow, and inflammatory
diseases (i.e., gingivitis, periodontitis, major
aphthous stomatitis, and herpetic
gingivostomatitis) P.A abscees,p.D
disease,pericoronitis,cancer, R.c
filling,pemphigus,pemphegoid,dentigerous
cyst,E.multiform,healing trauma

14. Tongue:A fissured tongue provide'
reservoirs for food, bacteria, and
cellular debris, and stagnating saliva,
conditions conducive to oral
malodor .
Related structure: tonsillar crypts
provide reservoirs for food bacteria
&cellular debris & stagnating saliva,
leading to malodor

15. Systemic pathological include:
 It is a common systemic cause of halitosis. adiabetic patient
are at increased risk of infection and poor wound healing
predisposing them to odor producing perodontal diseases
and other intraoral infections.
 Dehydration component of diabetes, can result in
decreased. salivary flow and a subsequently increased risk
of developing halitosis
 Uncontrolled diabetes causes the accumulation of
abnormal metabolites in the bloodstream, and these
are excreted through the lungs. They include ketones
such as acetoacetic acid, hydroxybutyric acid and
acetone

16.  2)Liver disease, or Hepatitis--In particular,
Fetor Hepaticus, which is bad breath
caused by chronic liver failure. Also known
as "breath of the dead," Fetor hepaticus
liver cant convert VSC in to metabolic
product. It is a late sign in liver failure. The
breath has a sweet,
 3)Renal failure:ammonia breath

17. . Respiratorv diseases:
 are a common source of these odors. Infections
involving gram-negative anaerobic bacteria
(tuberculosis, pneumonia), obstructions (foreign
bodies) tumors (lung cancer) and the production
of pus (empyema. bronchiectasis) can all
contribute to the emission of foul odors on the
nasal cavity, sinuses, nasopharynx, pharynx, and
lungs.
 The postnasal drip associate with upper
respiratory viral infections and allergic or
infectious sinusitis-as a common source or
halitosis.

18. 4. gastrointestinal diseases:
 Individuals with gastrointestinal diseases suffer from
halitosis.
gastro esophageal reflux and pyloric
stenosis.
 This is generally controlled using H2 blockers like
Tagamet, Zantac or Pepsid.
 Pyloric Stenosis--This is a developmental
condition found in infants which causes vomiting,
and is corrected surgically permit the release of
gastric odors into the oral cavity

19. Achalasia:
It is a swallowing disorder in which there is a failure of
the contents of the esophagus to empty into the
stomach; these patients experience halitosis when
food debris and saliva are trapped and decay in the
esophagus. Gastric ulceration, infection, carcinoma,
and malabsorption can also contribute to oral
malodors.

20. 3- Systemic drug administration:
 medication radiotherapy and chemotherapy can
directly affect the oral cavity, resulting in
halitosis. The most common medications
associated with
halitosis are those that inhibit salivary output
Chronic use of inhaled corticosteroids alters the
respiratory tract flora and leads to malodors.
 Cancer treatments (chemotherapy, head and
neck radiation) have transient 'T persistent
effects on the salivary system, oropharyngeal
tissues, and oral flora, resulting in oral
malodors

21. 4- Xerostomia
 It is due to:
1. Electrolyte imbalance, such as diabetus insipidus.
2. Severely dehydrated pt.
3. Pt with cardiac failure, or uremia.
4. Sjogren’s syndrome.
5. Senile atrophy of salivary gl.
6. Radiation of the head & neck.
7. Salivery gl. diseases, such as: obstruction, ectopic gl.
or tumor.

22.  Certain medication that cause xerostomia:
1. Anti- hypertensive drugs.
2. TCA depressant.
3. Diuretics.
4. Lithium.
5. Chemotherapy.
6. anticholinergics( often used as
decongestants as well as surgical drying
agents like atropine

23.  Salivary hypo function diminishes the self
cleansing action of the oral cavity, and lower
levels overnight frequently result in "morning
breath." When saliva evaporates, non sulfur-
containing gases (e.g., cadaverine. putrescine,
butyic. indole) can be released in addition to the
VSCs. contributing to halitosis in the patient with
salivary hypo function.

24. Systemic non pathological:
 G.I.T:as garlic,onion,alochol
 Alcohol produce drying oral
mucosa,sloughing of the mucosa,and in
prescence of bacteria lead to halitosis
 Halitophobia :fear of halitosis will cause
halitosis

25. Diagnosis of halitosis:
1) Organoleptic measurement:
 A subjective test scored on the basis of the examiner's
perception of a subject's oral malodor. Different semi
quantitative scales has been used; however, at the most recent
International Workshop on Oral Halitosis (1999).
 there was consensus on using a scale ranging from 0 to 5.
Before the organoleptic assessment, both patients and examiner
must follow some instructions in order to obtain a more reliable
result. Patients are instructed to abstain from eating strong foods
at least 48 hours before the assessment and to avoid using
scented cosmetics for 24 hours before the assessment.
 Patients must abstain from ingesting any food or drink, omit
their usual oral hygiene practices, abstain from using oral rinse
and breath fresheners, and abstain from smoking for 12 hours
before the assessment.
 The oral malodor examiner is required to refrain from drinking
coffee, tea, or juice and to refrain from smoking and using
scented cosmetics before the assessment.

26. Organoleptic Scores
Organoleptic Scale (0-5).
0- no appreciable odor.
1- barely noticeable odor.
2- slight but noticeable odor.
3- moderate odor.
4- strong odor
5- extremely foul odor
2- Gas chromatographv (GC):
 GC is considered the gold standard for measuring oral
malodour since it is specific for VSCs, the main cause of
oral maloclour.
 The GC equipment is expensive, bulky, and' the procedure
requires a skillful operator. Therefore, this technology has
been. confined to research and not to clinical use.

27. 3-Sulphide monitoring:
 Sulphide monitors analyze for total sulphur content of
the subject's mouth air. Although compact sulphide
monitors are inexpensive and easy to use.
 The most reliable and practical procedure for
evaluating a patient's level of oral malodor is still
thorough Organoleptic assessment by : trained
clinician.
 Nevertheless, the use of a portable sulphide monitor is
of interest. since we can quantify the changes and the
patients are able to monitor their evolution through
therapy.
 This is an important factor, especially in those patients
with pseudohalitosis or halitophobia.

28. TREATMENT OF HALITOSIS
1. History from patient
2. Clinical examination
3. Identify and management of underlying cause
4. O.H.I
5. Tooth brushing,dental floss,tongue brush
6. Oxidizing agents (dioxide, peroxide), zinc chloride,
and triclosan rinses, and prescription antimicrobial
rinses

29.  Aviod smoking and alcohol
 If the source of the malodor is suspected to
arise from oral disorders, such as defective
dental restorations and prostheses, periodontal
diseases, or candidacies, definitive treatment
diminishes the number of oral microbes
salivary hypofunction contributes to halitosis;
sugarless candies mints, or gums, artificial
saliva, and pilocarpine(5 mg tid) can increase
salivary output and may improve malodor