Halitosis, or bad breath, is caused by volatile sulfur compounds produced by bacteria in the mouth. It affects a majority of the adult population at some point. Causes include poor oral hygiene, dental issues, dry mouth, tonsil stones, food like onions and garlic, smoking, and underlying health conditions. Diagnosis involves medical history, oral examination, smell tests, and equipment to measure sulfur compounds. Treatment depends on the cause but generally involves improving dental hygiene, dietary changes, mouthwashes, and treating any underlying medical issues. Some people suffer from halitophobia, an exaggerated fear of having bad breath.

1. Halitosis

2. Origin of HALITOSIS
NewLatin,fromLatinhalitus breath,fromhalare to
breathe — moreat exhale
FirstKnownUse:1874

3. Definition of Halitosis
Bad breath (halitosis) can be embarrassing and may
cause anxiety. It's no wonder store shelves are
overflowing with gum, mints, mouthwashes and
other products designed to combat this condition.
But many of these products are mere temporary
measures.a condition of having fetid breath
Certain foods, health conditions and habits are
among the causes of bad breath. In many cases,
that can improve bad breath with proper dental
hygiene

4. Pathogenesis of Halitosis
It is generally known and agreed that VSC's
(Volatile Sulfur Compounds), are responsible for the
odor and that 80-90% of these come from oral
sources VSC's are produced by bacterial,and
cellular degradation, and include hydrogen sulphide.
methyl mercaptan and dimethyl sulphide . The nature
of the odor may vary in intensity
(strength of the smell) and quality (the type of odor)

5. Epidemiology
 Extremely common.
Majority of adult population have had it at
some point in time.
Unpleasant condition which creates huge
embarrassment with potentially grave
consequences.

6. Etiology of Halitosis
1. Oral & Throat Causes
2. Nasal/ Nasopharyngeal problems
3. Systemic disease
4. Physiologic considerations
5. Drugs
6. Food
7. Psychologic disorders

7. Oral & Throat Causes
1 .Poor dental hygiene & food impaction
2 .Dental & Gum diseases
3.Bacteria accumulation on the posterior dorsum of
tongue & tonsils
4 .Post nasal drip
5 .Chronic tonsillitis &Tonsilloliths(Tonsil Stones)
6 .Dry mouth
7 .Oral sepsis
8 .Oral Ulcerative lesions
9 .Oral malignancy

8. Dental & Gum
Disease
 Periodontal disease
 Dental caries
 Faulty restoration
 Denture
Impacted or abscessed
tooth
 Infected extraction sites
Residual post-operative
blood
Debris under bridges or
appliances kept in mouth at
night or not cleaned properly.
Oral & Throat Causes

9. The real reason for the bad breath is
bacteria that accumulate on back of
tongue,in pockets of gum or in thethroat.
Anaerobic bacteria produce volatile
sulphur compounds (VSC) such as methyl
mercaptan & hydrogen sulphide.
These VSC’s are source of malodor
Oral & Throat Causes

10. Tonsil Stones(tonsilloliths) are caused by
an accumulation of sulfur-producing bacteria,
post nasal drip, and debris that become
lodged in the tonsil crypts
When this debris combines with the Volatile
Sulfur Compounds produced by the anaerobic
bacteria beneath the surface of the tongue, it
can also create chronic Halitosis
Oral & Throat Causes

11. Tonsillolith
Oral & Throat Causes

12. Dry Mouth is a Leading Cause of Bad Breath
Dry mouth is naturally occurring in elderly, most
cases are caused by medications, adult beverages
and mouthwashes with alcohol
Saliva contains Oxygen, which helps oxygenate the
mouth keep it healthy and fresh
Dry mouth with less saliva and less oxygen, makes
bad breath gets worse by creating an anaerobic
environment, perfect for the bacteria to produce more
of these odorous compounds.
Oral & Throat Causes

13. Gingivitis
Acute necrotizing ulcerative gingivitis (ANUG)
or Trench mouth

14. Chronic Tonsillitis

15. Black
Hairy
Tongue
Oral & Throat Causes

16. Patients with fissured tongue dorsum
may have elongated filiform papillae
along the fissure walls
Black Hairy Tongue
Oral & Throat Causes

17. Nasal/Nasopharyngeal
problems
1 .Sinusitis & Nasopharyngitis
2 .Chronic nasal airway obstruction
3 .Adenoid hypertrophy
4.Rhinolithiasis & Nasopharyngeal
lithiasis
5.Nasal & Sinus granulomas
6 . Nasal & Sinus tumors.
7 .Nasopharyngeal Carcinoma

18. Diseases. In about 10 percent of bad
breath cases, the bad odors do not come
from the mouth (extra-oral halitosis). For
example, illnesses, such as some cancers
and metabolic disorders, can cause a
distinctive breath odor as a result of
chemicals they produce. Diabetes and kidney
or liver failure can lead to a fishy smell.

19. Systemic diseases
 Diabetes mellitus, Diabetic ketoacidosis,
 Renal failure, Bowel obstruction, etc.
 Liver failure
 Lung abscess, Bronchiectasis
 Severe GERD with H. Pylori
 Pharyngeal pouch
 Gastric & Esophageal carcinoma
Carcinoma of the Larynx & Tracheobronchial
Tree
Granuloma of the Larynx & Tracheobronchial
Tree
 Sjogren syndrome & Post irradiation therapy
 Trimethylaminuria

20. Physiologic considerations
1.Reduction of
salivation
2. Dehydration
3. Vitamin deficiency
4. Hunger
5. Morning breath
6. Aging
7. Gastroesophageal
reflux
8. Menstruation

21. Physiologic considerations
It must be kept in mind that bad breath under the following circumstances
is normal :
Morning breath because the function of salivary glands slows down over
night and saliva thickens, which stops it from bathing mouth tissues
properly, therefore mouth breathers face the problem more often, but it
disappears when you eat or drink .
Hunger breath accompanies morning breath and arises from putrefaction
of pancreatic juice, which pours into the stomach when nothing is eaten or
drunk. Hunger breath is more apparent even after brushing, if morning
meals are omitted .
Menstrual breath is caused because of hormonal disturbances, which
trigger sloughing of the body’s lining tissues and oral tissues and creates
more ridges for bacteria, leading to halitosis

22. Drugs
1. Antihistamines
2. Anticholinergics
3. Antihypertensives
4. Anorectics
5. Antidepressants
6. Antiparkinson
7. Diuretics
8. Sulfa drugs
9. Long term use of antibiotics

23. Medications can cause bad breath
An unfortunate side effect of a number of medications is halitosis.
.Here are a few medications that are known to cause bad breath
Triamterene - This diuretic, which is used to treat highblood
pressure and edema, lists halitosis as one of its side effects,
Paraldehyde - It treats seizures and may also be usedby
healthcare professionals as a sedative,
Disulfiram - Used to treat alcoholism, this drug has a number of
unpleasant side effects, including high blood pressure, restlessness and
halitosis.
Antihistamines –

24. Causes , Prevalence ofHalitosis
Food. The breakdown of foodparticles in
and around your teeth can cause a foul odor.
Eating foods containing certain oils is another
source of bad breath. Onions and garlic are
the best-known examples, but other
vegetables and spices also can cause bad
. breath

25. Foods
1.Food eaten (onions, garlic, cabbage, etc)
2.High protein diet like Fish,red meat
3.Dairy food
4.Acidic food
5.Sugars
6.Coffee
7.Tobacco
8.Alcohol

26. Trimethylaminuria-TMA“ Fish Odour
Syndrome”
A rare problem occurs in people who have
an inability to breakdown certain proteins
found in beans.The odour produced is
similar to decaying fish .
The odor consists of sulfur
compounds & nitrogen compounds
(amines)
People with this condition must abstain
from beans and other dense protein foods.

27. Smoking (nicotine)
Smoking has a drying effect on
oral tissues
Destroys ascorbic acid (vitamin C)
which is essential for immunity
Odor associated with smoking
depends on a number of factors,
directly related to the tar, nicotine,
and other foul smelling substances
that accumulates on teeth and soft
oral tissues (tongue, cheeks,
gums)There is no effective way to
totally eliminate smoker's breath,
although oral hygiene can help to
minimize it .

28. signs and symptoms of bad breath
You frequently have a bitter taste in your
mouth
A white or yellow coating on your tongue
People seem to avoid direct contact with you
and they step back from you when you are
talking to them
People around you offer mints or chewing
gum
A smelly odor when you open your mouth

29. Diagnosis and classificationof
halitosis
Oral Malodor Patient Types
Type I—Those who have it and know it
Type II—Those who have it but deny or do not
know they have it
Type III—Those that do not have it, but think
they do.

31. Some specific pieces of equipment
have been developed to help the
dentist diagnose halitosis. These
are known as the halimeter and
. the periotemp
!Device For Halitosis

32. DIAGNOSIS
1. Oral examination
2. History taking
3. Smelling
4. Sampling by spoon, gauze, cotton
5. Information from family, friend
6. Self examination
7. Use of the halimeter

33. Medical History
Due to many possible causes of bad
breath, diagnosis of the origin of
halitosis is essential for its treatment.
The first step to making a proper
diagnosis is the taking of a complete
medical history. Some of the
questions you may ask are:
?

34. When is the last time you visited the dentist?
What are your oral hygiene habits? a) Brush
daily b) Brush & floss daily c)Brush, floss,
and rinse daily
Do you use an over-the-counter mouth rinse
regularly? a)Yes? What brand? b) No?
?

35. When you sleep do you breathe through your
mouth?
Are you taking any medication?
Are you on a special diet?
Do you smoke?
?

36. INVESTIGATIONS
Halimeter
Level of intra oral Volatile
Sulphur Compounds can be
estimated using portable sulphide
monitors.Concentration of VSC’s
correlate well with level of
malodour reported by observers.

37. Management
 Identify & eliminate obvious causes
 Dental & Oral hygiene
 Dietary advice
 Neti pot is an instrument used for
irrigation of nasal passages
 Laser Tonsillectomy or tonsillectomy
 Adenoidectomy
Neti pot

38. Treating halitosis
There is no one treatment for halitosis. The
treatment will depend on what is causing the
problem
Dental & Oral hygiene
Raise the problem with patients directly
Dental expertise required
professional dental cleaning
tongue cleaning for mechanical removal
of tongue coatings

39. Dental & Oral hygiene
Regular Dental Consultation
Regular proper tooth brushing
Interdental flossing
Tongue cleaning, brushing, scraping
Tongue cleansing by tongue scrapper ,
gauze, tooth brush without paste
Mouth rinses
Baking soda etsaphtoot or mouthwash. This changesthe
acidity of the mouth
Denture care & soaking in antiseptic solution over night

40. Dietary advice
Avoid odiferous foods: Onion, Garlic,
Spices
Avoid habits: Smoking, Alcohol, Coffee
Take regular meals, fresh fruits
Eat fresh, fibrous vegetables such as
carrots
Drink tea regularly: aet ni slonehpyloP
htworg lairetcab tibihni
Do not drink too much coffee

41. Management
Dietary advice
Don't miss breakfast. Hunger lead to killing-breath .
Drink plenty of liquids/ 8 glasses of water a day .
Eat parsley or wintergreen with your main meals.
These herbs release pleasant oils as they chew them
which linger for hours .
Avoid fats - cheese, butter, milk, fat meats - in your
diet if indigestion is the source of your bad breath
Avoid beans &high protein diet in Trimethylaminuria

42. Management
Dietary advice
Stay away from candies, mints, and chewing gum if they
contain sugar.
Chew sugar-free gum for a minute or two at a time, especially
if your mouth feels dry, chewing parsley, mint, cloves or fennel
seeds may also help.
In Xerostamia, increase your fluid intake( at least 20-18
glasses per day ,)suck on sugarless lozenges.
Citrus fruits, Vitamin C makes you resistant to coughs and
colds

43. Halitosis Drugs

44. Halitosis Drugs
Chlorhexidine
Chlorhexidine is a chemical antiseptic, prescribed for gingivitis, cleansing skin and
wound areas
Cimetidine
Cimetidine is a histamine H2-receptor antagonist, prescribed for heartburn and peptic
ulcers. ...
Ranitidine
Ranitidine is an antacid, antireflux agent & antiulcerant, prescribed for peptic ulcer. ..
. Cetylpyridinium chloride (CPC): It is used in most lozenges, mouthwashes,
toothpastes, breath sprays, throat sprays, and nasal sprays. It is a chemical
antiseptic and acts mostly by the bactericidal mode of action i.e. it kills the bacteria.
Chlorine dioxide: It is used as a disinfectant and oxidizer and is very effective in
killing pathogenic microbes like fungi
List of drugs used to treat the medical condition called Halitosis

45. Halitophobia ” Delusion halitosis
One quarter of the patients seeking professional
advice on bad breath suffer from a highly
exaggerated concern of having bad breath, known
as halitophobia, delusional halitosis, or as a
manifestation of Olfactory Reference Syndrome.
These patients are sure that they have bad breath,
although many have not asked anyone for an
objective opinion. Halitophobia may severely affect
the lives of some 0.5–1.0% of the adult population

46. That’s it
Thank you