Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
clinical assessment and treatment of oral malodour and halitosis.
includes microorganisms causing halitosis, volatile sulphur compounds and its relation to periodontal destruction.
The wasting diseases of teeth, namely attrition, abrasion and dental erosion have taken their toll in the population around the world due to the changing lifestyles, increase in the stress levels and many others factors that were persistent earlier but have suddenly increased drastically. This presentation brings to light the new factors that have attributed to this condition as well as discusses the previous ones.
The presentation expalin major anomilies terminology and it's classification according to the site as: jaws, palate, lips gingivae, tongue, salivary gland, line of fusion and teeth
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
clinical assessment and treatment of oral malodour and halitosis.
includes microorganisms causing halitosis, volatile sulphur compounds and its relation to periodontal destruction.
The wasting diseases of teeth, namely attrition, abrasion and dental erosion have taken their toll in the population around the world due to the changing lifestyles, increase in the stress levels and many others factors that were persistent earlier but have suddenly increased drastically. This presentation brings to light the new factors that have attributed to this condition as well as discusses the previous ones.
The presentation expalin major anomilies terminology and it's classification according to the site as: jaws, palate, lips gingivae, tongue, salivary gland, line of fusion and teeth
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Probiotics and prebiotics/certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
MedActive Oral care products are for people suffering from dry mouth conditions because of chronic medical issues or the taking of multiple medications. We service pharmacy and senior/ LT care facilities. Join the MedActive Team and provide your patients with the most effective products on the market for Dry Mouth.
Halitosis, a common complaint, is very general term which is used to describe any king of unpleasant odor emitted from the mouth regardless of the source of this odor i.e whether it is form an oral source or non-oral sources like the nasal passages or lungs.
Halitosis caused by a variety of reasons including periodontal disease, bacterial coating of tongue, systemic disorders and different types of food.
Regardless of the cause, affecting 50 to 65% of the world’s population
Oral malodor is a generic description term for foul smell emanating from the mouth. The term does not imply any source or causation, perse. It is an aid to diagnosis
Halitosis may lead to significant personal discomfort and social embarrassment.
Halitosis is an extremely unappealing characteristic of sociocultural interactions and may have long‑term detrimental aftereffects on psychosocial relationships.
With proper diagnosis, identification of the etiology, and timely referrals when needed, steps can be taken to create a successful individualized therapeutic approach for each patient seeking assistance.
It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required.
Since halitosis is a recognizable common complaint among the general population, the primary healthcare clinician should be prepared to diagnose, classify, and manage patients that suffer from this socially debilitating condition. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Breath malodor has important socioeconomic consequences and can reveal important diseases. A proper diagnosis and determination of the etiology allow initiation of the proper etiologic treatment.
External modifying factors of periodontal diseasesMonika
Terminologies
Periodontitis
Risk indicator, risk factor & risk predictor
Socioecological model of periodontal diseases
Introduction
External modifying factors
a. Role of tobacco products
Evidence from cross sectional studies
Evidence from longitudinal studies involving periodontal attachment loss & periodontal healing
Role of low socioeconomic status
Evidence from cross sectional studies
Evidence from longitudinal studies
c. Role of lifestyle & dental care habits
Evidence from cross sectional studies
Evidence from longitudinal studies
Role of Acquired Systemic & Infectious disease
Role of psychosocial stress
Effect of Allergies
Effect of epilepsy & phenytoin therapy
Effect of Human immunodeficiency virus
e. Conclusion
f. References.
Infection control in orthodontics /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Inflammatory n infectious diseases of salivary gland- Dr Sanjana RavindraDr. Sanjana Ravindra
SALIVARY GLAND
Introduction
Classification
Composition of saliva
Properties of Saliva
Functions of Saliva
Salivary gland examination
Classification of Salivary gland diseases
INFLAMMATORY and INFECTIOUS DISEASES OF SALIVARY GLAND
Introduction
Classification
Various diseases
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. Halitosis: Current concepts
on etiology, diagnosis
and management
E U R J D E N T 2 0 1 6 ; 1 0 : 2 9 2 - 3 0 0 .
Journal club : 12
2. PROLOGUE
An unpleasant or
offensive odour
emanating from the
breath regardless of
whether the odour
originates from oral
or non-oral sources.
G Campisi, A Musciotto. Halitosis: could it be more than mere bad breath?; Intern Emerg
Med (2011) 6:315–319.
3. AIM
Succinctly focuses on the
development of a systematic
flow of events to come to the
best management of the
halitosis from the primary care
practitioner’s point of view.
4. INTRODUCTION
It was described as a clinical entity
by HOWE (1874).
Halitosis should not be confused
with the generally temporary oral
odour caused by intake of certain
foods, tobacco, or medications.
Originates from two
Latin words
◦ Halitus → breath
◦ Osis → disease
Armstrong BL, Sensat ML, Stoltenberg JL. Halitosis: A review of
current literature. J Dent Hyg 2010;84:65-74.
6. DEFINITIONS
Halitosis is the general
term used to describe a
foul odor emanating
from the oral cavity, in
which proteolysis,
metabolic products of
the desquamating cells
and bacterial
putrefaction are
involved.
• Marita et al., 2001
Halitosis is the general
term used to describe
any disagreeable odor in
expired air, regardless of
whether the odorous
substances originate
from oral or non-oral
sources.
• -Tangerman, 2002
Halitosis is also
termed as fetor ex
ore or fetor oris. It
is a foul or
offensive odor
emanating from
the oral cavity.
• Carranza(2003)
Unpleasant odor of
the expired air
whatever the origin
may be. Oral
malodor specifically
refers to such odor
originating from the
oral cavity itself.
• Jan Lindhe(2003)
J lindhe. Clinical periodontology and implant dentistry; vol 1: 5th edition
Newman ,Takei, Carranza. Clinical periodontology ; 10th and 11th edition
7. DEFINITION
S
Breath malodor, defined as foul or offensive odor of expired air, may be
caused by a number of factors, both intra-oral & extra-oral (gingivitis/
periodontitis, nasal inflammation, chronic sinusitis, diabetes mellitus, liver
insufficiency etc.,) & can be linked to more serious underlying medical
problems including primary biliary cirrhosis, uremia, lung carcinoma,
decompensated liver cirrhosis & trimethylaminuria.
Quirynen, Zhao, Avontroodt et al., 2003
8. HISTORY
The problem of halitosis has been
reported for many years.
References were found in papyrus
manuscripts dating back to 1550
BC.
During Christianity, the devil's
supreme malignant odor smelled
of sulfur & it was presumed that
sins produced a more or less bad
smell.
Rayman S, Almas K. Halitosis among racially diverse populations: An update. Int J Dent Hyg 2008;6:2-7
9. A treaty in Islamic
literature from the year
850 talked about
dentistry, referring to
the treatment of fetid
breath & recommended
the use of siwak when
breath had changed or
at any time when
getting out of bed.
Buddhist monks in
Japan also
recommended teeth
brushing & tongue
scraping before the first
morning prayers.
HISTORY
Rayman S, Almas K. Halitosis among racially diverse populations: An update. Int J Dent Hyg 2008;6:2-7
10. HISTORY
The Hindus consider the mouth as
the body's entry door and, therefore,
insist that it be kept clean, mainly
before prayers. The ritual is not
limited to teeth brushing, but
includes scraping the tongue with a
special instrument and using
mouthwash.
Rayman S, Almas K. Halitosis among racially diverse populations: An update. Int J Dent Hyg 2008;6:2-7
11. EPIDEMIOLOGY
Miyazaki concluded that
there was increased
correlation between older
age and malodour with
aging resulting in greater
intensity the of odor. In
above 60 years age group
of the Turkish individuals,
the incidence was around
28%.
A recent study had
revealed a prevalence
of self-reported
halitosis among Indian
dental students ranging
from 21.7% in males to
35.3% in females.
In the general
population, halitosis
has a prevalence
ranging from 50%
in the USA to
between 6% and
23% in china,
12. Japan study 2,672
Individuals 6-23% of
subjects had oral
malodour (VSC) as in
expired air at some period
during the day (Miyazaki
1996).
Another study in the
United States involving
individuals older than 60
years found 24% had oral
malodour (Rosenberg
1996).
Epidemiology
The prevalence of persistent oral malodor in a Brazilian study was reported to
be 15%, was nearly three times higher in men than in women (regardless of
age) and the risk was slightly more than three times higher in people over 20
years of age compared with those aged 20 years or under, controlling for
gender .
20. OTHER ORIGINS OF
HALITOSIS
The resulting breath takes on a different odor that may last
several hours
Transient oral malodor
Porter SR, Scully C. Oral malodour (halitosis). BMJ 2006;333:632-5.
21. • 10-20%
• gastro intestinal diseases
• infections or malignancy in respiratory tract
• Chronic sinusitis and tonsillitis
• stomach, intestine, liver or kidney affected by
systemic diseases
Extra oral origin
Pathologic halitosis
22. Maximally 10% of the oral malodor cases originate from the ears, nose and throat (ENT)
region, from which 3% finds its origin at the tonsils.
The presence of acute/chronic tonsillitis and tonsilloliths represents a 10-fold increased
risk of abnormal VSC levels due to deep tonsillar crypts formation.
Foreign bodies in the nose can become a hub for bacterial degradation and hence
produce a striking odor to the breath
Pathologic halitosis
25. Condition in which a subject believes that their breath odor is
offensive and is a cause of social nuisance, however, neither
any clinician nor any other confidant can approve
of its existence
• Monosymptomatic
• Hypochondriasis
• Imaginary halitosis
Interestingly, advertisements of oral hygiene products are responsible for the
increase in a number of patients with delusional halitosis.
IMAGINARY OR
DELUSIONAL HALITOSIS
26. IMAGINARY OR
DELUSIONAL HALITOSIS
•Pseudo halitosis
– Apparently healthy individuals
•Haltophobia
– exaggerated fear of having halitosis
– also referred as delusional halitosis
– considered variant of monosymptomatic hypochondrial
psychosis.
Yaegaki K, Coil JM. Genuine halitosis, pseudo-halitosis and halitophobia: classification,
diagnosis, and treatment. Compend Cont Educ Dent 2000; 21(10A):880–886
27. Pseudo-halitosis patients complain of
having oral malodor without actually
suffering from the problem and
eventually gets convinced of a disease
free state during diagnosis and therapy
28% of patients
complaining of bad
breath did not show
signs of bad breath
IMAGINARY OR
DELUSIONAL HALITOSIS
28. Halitophobia is fear of having bad breath seen in at least 0.5–1% of adult
population
Such patients need psychological
counseling and should be given
enough time during
the consultation.
IMAGINARY OR
DELUSIONAL HALITOSIS
30. Halitosis generally arises as a result of the bacterial
decomposition of food particles, cells, blood and
some chemical compounds of the saliva.
Moss, 1998
Etiology
Yaegaki K, Sanada K. Volatile sulphur compounds in mouth air from clinically healthy
subjects and patients with periodontal disease. J Periodontol Res 1992;27:233-8.
31. Volatile sulphur compounds → hydrogensulphide [H2S,
rotten egg smell], dimethyl sulphide [(CH3)2S, rotten
cabbage smell, and methyl mercaptan [CH3SH, fecal smell].
Non - sulphur containing substances → diamines
[cadaverine (cadaver smell) and putrescine (rotten meat
smell), acetone and acetaldehyde
ETIOLOGY
Yaegaki K, Sanada K. Volatile sulphur compounds in mouth air from clinically healthy
subjects and patients with periodontal disease. J Periodontol Res 1992;27:233-8.
32. ROLE OF VOLATILE SULPHUR COMPOUNDS
IN THE PATHOGENESIS OF HALITOSIS
MAJOR COMPOUNDS IMPLICATED IN HALITOSIS
VSC’s - Methylmercaptan, Hydrogen sulfide, dimethyl sulfide
& Dimethyl disulfide.
Polyamides - Putrescein, Cadaverine, Skatole, Indole.
Short chain FA - Butyric, Propionic, Valeric & Isovaleric acid.
Others - Acetone, Acetaldehyde, Ethanol diacyl.
Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulphur compounds
and certain oral health measurements in the general population. J Periodontol 1995;66:679-84
33. It increases the permeability of oral mucosa and crevicular epithelium. It
impairs oxygen utilization by host cells, and reacts with cellular proteins, and
interferes with collagen maturation.
It also increases the collagen solubility.
It decrease the DNA synthesis.
It increases the secretion of collagenases, prostaglandins from
fibroblasts.
VSC reduce the intracellular pH; inhibit cell growth, and
periodontal cell migration.
Miyazaki H, Sakao S, Katoh Y, Takehara T. Correlation between volatile sulphur compounds
and certain oral health measurements in the general population. J Periodontol 1995;66:679-84
34. Pathogenesis of oral malodor
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
35. The role of tongue coatings in the
aetiology of oral malodour has been
extensively documented.
Tongue coatings include desquamated
epithelial cells, food debris, bacteria
and salivary proteins and provide an
ideal environment for the generation
of VSCs and other compounds that
contribute to malodour
36. The purulent discharge from the paranasal sinuses, seen in regurgitation
esophagitis, gets collected at the dorsum of the tongue resulting in halitosis.
Atrophic rhinitis is caused by Klebsiella ozenae, which inhibits the self-cleaning
property of nasal mucosa. Acute pharyngitis and sinusitis, caused by streptococcal
species, are also responsible for producing halitosis.
Carcinoma of the larynx, nasopharyngeal abscess, and lower respiratory tract
infections such as bronchiectasis, chronic bronchitis, lung abscess, asthma, cystic
fibrosis, bronchiectasis, interstitial lung diseases, and pneumonia have been known
to cause halitosis
Pathologic halitosis
37. Kinberg et al. published a review in 2010, in which they examined 94 patients having
halitosis out of which 54 had gastrointestinal pathology suggesting that gastrointestinal
is one of the common extra oral causes of halitosis.
Gastrointestinal causes like Zenker’s diverticulum, Gastro-esophageal reflux disease
(GERD),Gastric and peptic ulcers have been known to cause halitosis.
Helicobacter pylori is known to cause a gastric and peptic ulcer and is recently
associated with oral malodor.
Congenital broncho esophageal fistula, gastric cancer, hiatus hernia, pyloric stenosis,
enteric infections, dysgeusia, duodenal obstruction, and steatorrhea are some of the
sources of pathological mouth odor
Pathologic halitosis
38. Metabolic disorders like Trimethylaminuria (fish odor syndrome) is characterized by the
presence of trimethylamine (TMA), whose odor resembles of rotting fish in the urine,
sweat and expired air.
Individuals with TMAuria have diminished the capacity to oxidize the dietary-derived
amines TMA to its odorless metabolite TMA N-oxide resulting in an increased excretion
of large amounts of TMA in body fluids.
In hypermethioninemia the body produces a peculiar odor, which resembles that of,
boiled cabbage and is emanated through sweat, breath and urine.
If this condition is present, the extraoral origin should be determined, because the latter
requires medical investigation and support in therapy.
Pathologic halitosis
42. Discretely and intermittently recorded.
Questions such as frequency, duration, time of appearance within a day,
Whether others have identified the problem (excludes pseudo-halitosis
from genuine halitosis),
List of medications taken,
Habits (smoking, alcohol consumption)
Other Symptoms (nasal discharge, anosmia, cough, pyrexia, and weight
loss) should be carefully recorded
DIAGNOSIS
43. DIRECT
1. By directly sniffing the bad breath
2. Determination of odoriferous sulfur
containing substances by gas
chromatography or halimetry and other
methods
INDIRECT
These methods assess the products
produced by microorganisms in vitro or
identify odor producing microorganisms.
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
44. 1. Self-assessment,
2. Whole mouth
breath test,
3. Spoon test,
4. Dental floss odor
test,
5. Saliva odor test.
Direct tests - Organoleptic
Direct sniffing of the expired air
(“organoleptic” and “hedonic”
assessment) is the simplest, most
common method to evaluate oral
malodor. An organoleptic
examination involves the dentist
assessing the odor at a range of
distances from the patient
Organoleptic measurement is highly recommended for initial diagnosis.
One potential risk of the organoleptic measurement is the transmission of
diseases via the expelled air
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
45. ORGANOLEPTIC MEASUREMENT
(SNIFF TEST)
Organoleptic measurement is a sensory test scored on the
basis of the examiner’s perception of a subject’s oral
malodor.
Organoleptic measurement can be carried out simply by
sniffing the patient’s breath and scoring the level of oral
malodor.
By inserting a translucent tube (2.5 cm diameter, 10 cm length) into the patient’s mouth and having the
person exhale slowly, the breath, undiluted by room air, can be evaluated and assigned an organoleptic
score.
The tube is inserted through a privacy screen (50cm-70cm) that separates the examiner and the patient.
The use of a privacy screen allows the patient to believe that they have undergone a specific malodor
examination rather than the direct-sniffing procedure.
46. Organoleptic Scores
(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
By Rosenberg ,
Mulloch Et Al
1991.
48. DIAGNOSIS
The subjects are instructed to smell the
odor emanating from their entire mouth
by cupping their hands over their
mouth and breathing through the nose.
The presence or absence of malodor can
be evaluated by the patient
himself/herself.
SELF ASSESSMENT TESTS
Whole mouth malodor (Cupped breath)
49. Subjects are asked to
extend their tongue
and lick their wrist
in a perpendicular
fashion.
The presence of odor
is judged by
smelling the wrist
after 5 seconds at a
distance of about 3
cm.
Wrist lick test
50. Plastic spoon is used to
scrape and scoop material
from the back region of
the tongue.
The odor is judged by smelling
the spoon after 5 seconds at a
distance of about 5 cm
organoleptically.
Spoon test
51. Unwaxed floss is passed through interproximal contacts.
Dental floss test
52. Involves having the subject
expectorate approx. 1-2 ml of
saliva into a petridish.
The dish is covered immediately,
incubated at 370 C for five
minutes and then presented for
odor evaluation at a distance of
4 cm from the examiner’s nose.
Saliva odor test
53. BANA TEST
If any of the these species are present, they hydrolyze the BANA
enzyme-producing B-naphthylamide which in turn reacts with
imbedded diazo dye to produce a permanent blue color indicating a
positive test
It is a chair side, enzyme-based assay, which is
used to determine the proteolytic activity of
certain oral anaerobes that contribute to oral
malodor and which are considered as active
H2 SO4 producers.
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
54. VOLATILE SULFIDE MONITOR
This electronic (Haiimeter,
InterScan, Chatsworth, Calif)
analyzes concentration of hydrogen
sulfide and methyl-mercaptan , but
without discriminating between
them.
55. GAS CHROMATOGRAPHY (GC):
GC, performed
with apparatus
equipped with a
flame photometric
detector, is specific
for detecting
sulphur in mouth
air.
It measures
directly the three
VSC methyl
mercaptan,
hydrogen sulfide
and dimethyl
sulfide.
GC is considered
the GOLD
STANDARD for
measuring oral
malodor.
This device can
analyze air, saliva,
crevicular fluid for
a volatile
component.
56. DIAMOND PROBE
The Probe is placed directly into the
periodontal pocket or tongue.
The sulfide-sensing element
generates an electrochemical voltage
proportional to the concentration of
sulfide ions present.
The control unit reports the sulfide
level at each site in a digital score
from: 0.0 to 5.0
57. NINHYDRIN METHOD OF
DETECTING AMINE
COMPOUNDS
Iwanicka et al (2005)
showed that amine levels
were higher in the saliva of
subjects suffering from
halitosis and lower in
healthy controls.
Tanaka M et al used these electronic
noses to clinically assess oral malodor and
examined the association between oral
malodor strength and oral health status.
ELECTRONIC NOSE
59. TOPAS
It detects both VSC and
polyamines in the
sample.
The absorbent point
given with the kit is
inserted into the pocket.
Left in place for 1
minute.
Submerge the absorbent
point tip in the toxin
reagent .
Wait for 5 minutes and
see for yellow color in
the specimen on the
scale of 0-5, which is
directly proportional to
the level of toxins in the
sample.
60. PREVENTIVE MEASURES
Visit dentist regularly
Periodical tooth cleaning by dental
professional.
Brushing of teeth twice daily with
appropriate brushing techniques and
for a duration of 2-3 mins.
Use of a tongue scraper to get rid of
the lurking odour causing bacteria in
the tongue surface.
Preventive measures rather than curative aspects are highly recommended.
61. Flossing after brushing to remove food particles
stuck in between the tooth surfaces.
Limit intake of strong odour species.
Limit sugar and caffeine intake.
Drink plenty of liquids.
Chew sugar free gum for a minute when mouth
feels dry.
Eat fresh fibrous vegetables such as carrots.
62.
63.
64. MANAGEMENT AND
TREATMENT
1. Confirm the diagnosis,
2. Identify and eliminate the predisposing and modifying factors,
3. Identify any contributing medical conditions and refer for management,
4. Review and reassure.
The management of halitosis entails four steps:
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
65. MANAGEMENT
Treatment needs (TN) for halitosis have been categorized into 5 classes in order to provide guidelines
for clinicians in treating halitosis patients:
Rosenberg M, McCulloch CA. Measurement of oral malodor: Current methods and future prospects. J Periodontol
1992;63:776-82.
Category Description
TN- 1 Explanation of halitosis and instruction of
oral hygiene
TN- 2 Oral prophylaxis, Professional cleaning and
treatment for oral diseases
TN- 3 Referral to a physician or medical specialist
TN- 4 Explanation of examination data, further professional instruction,
education and reassurance
TN- 5 Referral to a clinical psychologist , a psychiatrist or other
psychology specialist
68. Mechanical reduction of intraoral nutrients and micro-organisms
- Tongue cleaning
- Tooth brush
- Inter-dental cleaning
- Professional periodontal therapy
- Chewing gum
MANAGEMENT
69. 2. Chemical reduction of oral microbial load
- Chlorhexidine
- Essential oils
- Chlorine dioxide
- Two-phase oil- water rinse
- Triclosan
- Aminefluoride/ Stannous fluoride
- Hydrogen peroxide
- Oxidising lozenges
-Roldan S 2005,2004,2003 scully 2006
MANAGEMENT
70. CHLORHEXIDINE (CHX)
Mouth rinses containing antibacterial agents such as CHX and cetylpyridinium chloride (CPC) may
play an important role in reducing the levels of halitosis producing bacteria on the tongue.
Chlorine dioxide and zinc containing mouth rinses can be effective in neutralization of odoriferous
sulfur compounds.
Roldan. S et al. evaluated five different commercial mouth rinses with respect to their anti-halitosis
effect and anti-microbial activity on salivary bacterial counts.
Formulations that combine CHX and CPC achieved the best results, and a formulation combining CHX
with NaF resulted in the poorest.
Essential oils: Listerine was found to be only relatively effective against oral malodor (±25% reduction
vs. 10% of placebo) and caused a sustained reduction in level of odorigenic bacteria
Chlorine dioxide: It is a powerful oxidizing agent that oxidizes the sulfides of the VSC’s to nonodorous
sulfates and raises the oxidation/reduction ratio of the saliva toward the more oxidizing state.
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
71. TWO-PHASE
OILWATER
RINSE: The
efficacy of
oilwater CPC
formulation is
thought to result
from the
adhesion of a
high proportion
of
microorganisms
to the oil droplet
which is further
enhanced by the
CPC.
TRICLOSAN: A
broad-spectrum
antibacterial
agent, has been
found to be
effective against
most oral
bacteria and has
a good
compatibility
with other
compounds used
for oral home
care
AMINEFLUORID
E/STANNOUS
FLUORIDE
(AMF/SNF2 ): The
association of
AmF/SnF2
resulted in
encouraging
reduction of
morning breath
odor, even when
oral hygiene is
insufficient
HYDROGEN
PEROXIDE:
Suarez et al.
reported that
rinsing with 3%
H2 O2 produced
impressive
reductions
(±90%) in sulfur
gas that persisted
for 8 h.
OXIDIZING
LOZENGES: The
anti-malodor effect
of lozenges may be
caused by the
activity of
dehydroascorbic
acid which is
generated by
peroxide-mediated
oxidation of
ascorbate present in
the lozenges.
Marawar PP, Sodhi NA, Pawar BR, Mani AM. Halitosis: A silent affliction!. Chron Young Sci 2012;3:251-7.
MANAGEMENT
72. 3.Conversion of volatile sulfide compounds
- Metal salt solutions
- Toothpastes
- Chewing gum
MANAGEMENT
73. Metal salt solutions: Metal ions with affinity for sulfur are rather efficient
in capturing the sulfur-containing gases. Zinc is nontoxic,
noncumulative, and gives no visible discoloration
Tooth paste: Baking soda dentifrices have been shown to be effective,
with a 44% reduction of VSCs level 3 h after tooth brushing versus a
31% reduction for fluoride dentifrices (Brunnet et al. 1998)
Chewing gums: Tsunoda et al. (1996) investigated the beneficial effects
of chewing gums containing tea extract for its deodorizing mechanism.
MANAGEMENT
75. Herbs and essential
oils can be made into very
effective mouthwash
remedies to sweeten
breath and help
keep gums and teeth
healthy fennel not only
improves digestion, but
also can reduce bad
breath and body odor that
originates in the intestines.
Give raw carrots as a
midday treat to help scour
teeth of bacteria-laden
plaque, a common cause
of bad breath.
Cardamom tea contains
cineole, a potent antiseptic
that kills bad-breath
bacteria and sweetens
breath.
Herbal treatment: MANAGEMENT
76. Thymol, one of the
constituents of thyme, is
contained in antiseptic
mouthwashes.
Neem leaf powder can be used
as an effective tooth powder to
fight plaque and gingivitis
when mixed with astringent
herb powders and/or baking
soda.
A few drops of Tea tree oil
, lemon or peppermint
essential oils can be added to
warm water for an
effective mouth
rinse to freshen breath
Herbal treatment: MANAGEMENT
77.
78. CONCLUSION
It’s a common complaint that may periodically affect most of the
adult population.
Oral maldor, which is commonly noticed by patients, is an
important clinical sign and symptom that has many etiologies
which include local and systemic factors.
It is often difficult for the clinician to find the underlying
pathologies.
Although consultation and treatment may result in dramatic
reduction in bad breathe, patients may find it difficult to sense the
improvement themselves
The field of halitosis research would benefit from: • More
reliable, portable instruments for measuring VSC’s, • A
standard scale for assessing oral malodor, • Further studies
with larger sections of the population, and • Development of
site-specific measurements.
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Halitosis, also commonly known as “bad breath,” is a concern of many patients seeking help from health care professionals
Halitosis is a general term used to define an
Odors are essential clues in the creation & conservation of social bonds, as they are loaded with cultural values.
Bad breath has been a common problem for thousands of years.
It is a considerable social problem.
Its incidence remains poorly documented in most countries.
In vast majority- The cause is originated from the oral cavity i.e. gingivitis, periodontitis, and tongue coating.
There are few studies documenting the prevalence of halitosis in population‑wide or community‑based samples.
Physiological halitosis (foul morning breath, morning halitosis) is caused by stagnation of saliva and putrefaction of entrapped food particles and desquamated epithelial cells by the accumulation of bacteria on the dorsum of the tongue, recognized
clinically as coated tongue and decrease in frequent liquid intake
Intra oral or extra oral origin
80-85% of patients → oral cavity
Bacteria, volatile sulphur compounds.
Transient oral malodor can also arise after someone has eaten volatile foods such as garlic, onions, condiments, pickles, radish, spices and consumption of tobacco, betel nut and alcohol.
Since it was poorly documented, it
was recently added under miscellaneous disorder
classification of “psychosomatic disorders pertaining to dental practice
Delusional halitosi s (monosymptomatic hypochondriasis; imaginary halitosis) is a condition in which a subject believes that their breath odor is offensive and is a cause of social nuisance, however, neither any clinician nor any other confidant can approve of its existence.
Increase permeability of oral mucosa
Speed the degradation of collagen
Delay the healing of existing wounds
Affects gingival and other periodontal cell function
VSCs are mainly produced through putrefactive activities of bacteria present in saliva, the gingival crevice, the tongue surface, and other areas.[14] The substrates are sulfur-containing amino acids which are found free in saliva, gingival crevicular fluid, or produced as a result of proteolysis of protein substrates. Apart from the presence of gram-negative anaerobic bacteria, certain physical-chemical conditions are needed for the production of odoriferous gases. These conditions such as pH, pO2 , and Eh are usually determined by the bacterial metabolism [VSC’s are highly toxic to tissues even at extremely low concentrations and, therefore, may play a role in the pathogenesis of inflammatory conditions affecting the periodontium. Different in vitro studies have demonstrated that VSC’s alter the permeability of oral and junctional epithelium.[15] They are toxic to fibroblasts, altering their morphology and function,[16-18] alter the metabolism of fibronectin43, and interfere in the enzymatic and immunological reactions leading to tissue destruction while showing an increase in the release of interleukin-1 and prostaglandin E2 . Takeuchi et al.[19] indicated that H2 S inhibits cell proliferation and induces cell cycle arrest via the expression of p21Cip1 in Ca9-22 cells.
The dorsum of the tongue provides a suitable environment
for the growth of these anaerobic organisms,as favourable redox potentials are found in the deep crypts of the tongue associated with the structure of the papilla
The patient history should contain main complaint,
medical, dental and halitosis history, information
about diet and habits, and third part confirmation
confirming an objective basis to the complaint
Halitosis history should be discretely and intermittently
recorded. Questions such as frequency, duration, time
of appearance within a day, whether others have
identified the problem (excludes pseudo‑halitosis
from genuine halitosis), list of medications taken,
habits (smoking, alcohol consumption) and other
symptoms (nasal discharge, anosmia, cough, pyrexia,
and weight loss) should be carefully recorded
Organoleptic
assessment is considered as the “gold standard”
to diagnose halitosis in a clinical setting
Benzoyl-DL-arginine-a-naphtylamide
Mechanical reduction of microorganisms: The best way to treat bad breath is to instill in patients good oral hygiene practices.[20,21] Common methods include tongue brushing, tongue scraping, and chewing gum. Because bad breath is worse when the mouth dries out (e.g. at night, while fasting), subjects should also be encouraged to maintain a good hydration
Chemical reduction of oral microbial load: Even with the implementation of good oral hygiene, many patients continue to have halitosis of oral origin. In such instances, rinsing and gargling with an efficacious mouthwash may be advised. These compounds decrease the bacterial load and thus decrease the VSC and VOC production.
The usage of masking agents like rinsing products,
sprays, toothpaste containing fluorides, mint tablets or
chewing gum only have a short‑term masking effect.[61]
Peppermint oil can also increase salivation, which is
useful because dry mouth may result in halitosis