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Module 6 - Periodontology > Halitosis > Flashcards

Halitosis Flashcards

1
Q

Define halitosis

A

Any noticeable unpleasant/ disagreeable odour of expired air.

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2
Q

Is halitosis a diagnosis or symptom?

A

NOT a diagnosis.
A SYMPTOM of a variety of conditions.

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3
Q

What is the instrument that measures the intensity of smells called?

A

Osmoscope

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4
Q

What is the prevalence (%) of halitosis?

A

15-50%

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5
Q

4 facts about halitosis? Age? Sex? Associations (2)?

A
  • Increase in prevalence with age.
  • More prevalent in males.
  • Associated with FASTING and HIGH PROTEIN DIETS.
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6
Q

What are the 2 main types of Halitosis?

A

Genuine and Psychogenic Halitosis.

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7
Q

What are the 2 types of genuine halitosis?

A
  • Physiological/ Transient.
  • Pathological.
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8
Q

What are the 2 types of psychogenic halitosis?

A
  • Pseudo-halitosis.
  • Halitophobia.
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9
Q

What is physiological/ transient halitosis?

A

Morning breath or food-induced.

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10
Q

What is pathologic halitosis?

A
  • Intra oral/ oral malodour (foetor oris).
  • Extra-oral.
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11
Q

What is pseudo-halitosis?

A

No objective evidence of malodour but the patient thinks they have it.

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12
Q

What is halitophobia?

A

The patient persists in believing they have halitosis despite firm evidence of the absence of halitosis.

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13
Q

Where does the majority of halitosis originate from?

A

90% originates from the MOUTH.

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14
Q

What type of halitosis is morning breath?

A

PHYSIOLOGICAL (genuine halitosis).

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15
Q

What causes morning breath (3)?

A
  1. Increased microbial activity during sleep.
  2. Reduced saliva flow during sleep (made worse by mouth breathing).
  3. Fasting and starvation.
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16
Q

4 management advices for morning breath?

A
  1. Eating.
  2. Routine OH regime.
  3. Rinsing with fresh water.
  4. Tongue brushing/ scraping.
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17
Q

What type of halitosis is food induced?

A

PHYSIOLOGICAL (genuine halitosis).

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18
Q

6 foods and 2 drinks that cause halitosis?

A
  • Garlic, onion, cabbage, cauliflower, radish, spicy foods.
  • Coffee, alcohol.
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19
Q

What is a general intraoral cause of genuine halitosis?

A

Oral sepsis/ disease

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20
Q

12 causes of intraoral-caused halitosis?

A
  • Periodontal disease/poor OHI/ food packing (gingivitis, periodontitis, NG).
  • Pericoronitis.
  • Alveolar osteitis/ dry socket.
  • Post extraction/surgery; blood clots.
  • Oral ulceration.
  • Acute herpetic gingivostomatitis.
  • Xerostomia.
  • Infected tonsils.
  • Oral malignancy.
  • Poor oral appliance hygiene.
  • Mouth breathing.
  • Tongue coating.
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21
Q

What is the surface area of the tongue? Relative to perio pockets?

A

197 cm2.
- 5 to 10 times greater than perio pockets.

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22
Q

What is the primary cause of intra-oral halitosis (specific)?

A

The production of VOLATILE COMPOUNDS by ORAL BACTERIA in tongue, perio pockets.

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23
Q

How do intra-oral bacteria produce volatile compounds?

A

Through breakdown of:
- Epithelial cells.
- Salivary proteins.
- Serum proteins via the gingival crevicular fluid (GCF).
- Food debris.

24
Q

Which bacterial species is responsible for intra-oral halitosis?

A

No SINGLE bacterial species responsible.
- Mainly GRAM NEGATIVE PROTEOLYTIC ANAEROBES.

25
8 bacterial species that may be responsible for intra-oral halitosis.
- Porphyromonas gingivalis. - Prevotella intermedia. - Tannerella forsythia. - Treponema denticola. - Fusobacterium nucleatum. - Selenomonas species. - Solobacterium species. - Eubacterium species.
26
What are the volatile compounds these bacteria produce?
When the bacteria degrade various SULPHUR CONTAINING AMINO ACIDS (methionine, cystine, cysteine) they produce **MALODOROUS VOLATILE SULPHUR COMPOUNDS (VSC).**
27
What 3 amino acids conatin sulphur?
Methionine. Cystine. Cysteine.
28
Name the 3 common volatile sulphour compounds responsible for intra-oral halitosis?
- Methyl Mercaptan. - Hydrogen sulphide. - Dimethyl sulphide
29
What is the PRIMARY compound responsible for intra-oral halitosis?
METHYL MERCAPTAN
30
What does methyl mercaptan smell like?
Pungent like ROTTEN CABBAGE.
31
What does hydrogen sulphide smell like?
rotten eggs.
32
What does dimethyl sulphide smell like?
Unpleasantly sweet.
33
What foods contain volatile sulphur compounds?
Onions, garlic.
34
What are volatile compounds implicated in halitosis (not sulphour)?
- Diamine. - Phenyl compounds. - Importance in halitosis LOW due to LOW VOLATILITY/ READILY DISSOLVE IN SALIVA.
35
What type of toothpaste may have some beneficial effects for intra-oral halitosis?
- Triclosan + polymer. - Baking soda containing (20% or more than sodium bicarbonate). - MINOR beneficial effects.
36
What is the key to managing intra-oral halitosis?
STANDARD ORAL HYGIENE. - Reduces bacterial deposits/ disturbs biofilms. - Removes food debris.
37
What is the effect of tongue cleaning/ scraping? What is its effect on halitosis?
- Mechanically disrupts tongue coating. - Reduces material for PUTREFACTION on the tongue rather than REDUCING BACTERIAL LOAD. - 2006 Cochrane review; small, short term reduction in VSC levels.
38
4 mouthwashes that may be helpful for intraoral halitosis?
- **Chlorhexidine**. (reduce levels of halitosis-causing bacteria on tongue). - **Cetylpyridinium chloride** (reduce levels of halitosis-causing bacteria on tongue). - **Chlorine dioxide** (ultraDEX - neutralize VSCs). - **Zinc containing** (neutralize VSCs).
39
What dietary advice would you give a halitosis patient?
- Remove food/ drink related causes. - Increase fluid intake (2L/ day - now contested). - Smoking cessation and alcohol reduction.
40
What is the link between probiotics and intraoral halitosis?
- Use of friendly bacteria (streptococcus salivarius strain K12) to repopulate the tongue following chlorhexidine. - Very limited research - routine use CANNOT be justified at present.
41
What % of halitosis is caused by EXTRAORAL factors?
10%
42
3 categories of aetiologic factors for extra oral halitosis?
- Drug induced. - Systemic disease. - Habits (smoking, alcohol).
43
4 areas which (when diseased) can caused ex
- Nasal and pharyngeal infections. - Respiratory pathology. - GI pathology. - Metabolic conditions.
44
Which part of the body may patients be convinced is causing their halitosis? Why is this rare?
- Patients convinced their halitosis is related to GIT problems. - RARE cause as the OESOPHAGUS is usually COLLAPSED.
45
What are the two principal methods of assessing for halitosis?
- Organoleptic assessment. - Laboratory methods
46
What are 2 laboratory methods for assessing for halitosis?
- **Halimeter** (portable sulphide monitor). - **Gas chromatography**.
47
What is the process for organoleptic assessment of halitosis (4)? What must be avoided?
1. Patient closes mouth for 1 minute. 2. Patient and dentist face each other (10cm apart). 3. Patient exhales slowly through their mouth. 4. Dentists assesses exhaled breath for odour. - Both: avoid smoking, drinking coffee/tea/juice and wearing perfumes/aftershaves. - Patient: avoid halitosis associated food (ex. garlic) for 48 hours.
48
What could malodour from air exhaled from the nose indicate?
Source of problem is from nose, sinuses, respiratory or GI tracts.
49
What is a halimeter?
Portable gas monitor (electrochemical sensor).
50
What does a halimeter do? 4 disadvantages?
- Objectively detects VSC. Disadvantages: - Cannot differentiate between different VSCs. - More sensitive to hydrogen sulphide than methyl mercaptan. - Very sensitive to alcohol (avoid for 12 hours). - Expensive.
51
What is the GOLD STANDARD assessment for halitosis?
Gas chromatography
52
1 advantage and 2 disadvantages of gas chromatography?
- Advantage: can differentiate and quantify specific compounds. - Disadvantage: expensive and time consuming laboratory testing, only available in specialist centers.
53
What is the portable gas chromatography machine called?
OralChroma.
54
What is the primary role of the dentist in managing halitosis? How is this achieved (4 elements to treatment plan)?
DIAGNOSE + MANAGE ORAL CAUSES OF HALITOSIS - Thorough patient/ medical history. - Dietary causes (dietary advice). - Habits (smoking and alcohol cessation). - Treat oral disease + maintain oral health.
55
When would a general dentist refer a patient to the GMP/ Oral medicine?
When history, diet advice, habit advcie and treatment of oral disease have been RULED OUT and halitosis is still present (either obvious to dentist or just the patient).
56
What are further investigations (after referral) that are done (2)?
- Rule out systemic problems (ex. diabetes). - Referal to ENT (nasopharyngeal conditions ex. pharyngeal pouches and foreign bodies).
57
When is a patient diagnosed with psychogenic halitosis? What is done in such cases?
- Once ALL other causes have been ruled out (both intra and extra oral). - Counselling and psychiatric referral.

Module 6 - Periodontology (3 decks)

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