Halitosis Flashcards
Local cases of halitosis?
Oral
Naso-pharyngeal
systemic causes of halitosis?
Gastro-oesophageal, liver, renal
Metabolic
psychogenic causes of halitosis?
Olfactory reference syndrome
oral Cases of halitosis?
Poor oral hygiene
Salivary hypo function
Gingivitis
Periodontitis
- chronic periodontitis
- necrotising ulcerative
- raid-severe periodontitis
Pericoronitis
why does halitosis arise from poor oral oral hygiene?
Gran negative anaerobes, give off bad smelling bi-products
Food trapping
why does plaque build up on teeth?
Non-shedding surface where no regernatation occurs
No shedding of cells
gcf ad smell?
Sulphur and smell
how does respiratory tract cause halitosis?
Nasal obstruction - foreign body
- due to build up, bacteria and bad smell
Sinusitis
Tonsillitis, tonsiloliths
Lower respiratory tract infection (pseudomonas)
assessment of halitosis?
Organoleptic method
through Mouth or nose
organoleptic method?
Objective measurement of volatile sulphur compounds
- methyl mercaptan
- hydrogen sulphide
- dimethyl sulphide
other causes of halitosis?
H. Pylori
Gastro-oesophogeal disease
Pharyngeal-oesophageal diverticulum
Hepatic renal failure (factor hepaticus)
Renal failure (end stage)
Diabetic Ketoacidosis
Hypermethioninaemia
Drugs causing halitosis?
Alcohol
Tobacco
Can I as
Betel
Solvent misuse
Chloral hydrate
Disulphiram
Phenothiazines
Amphetamines
aeitiology of trimethylaminuria?
Mutataion in the flavin-containing FMO3
Autosomal recessive trait
Heterogenous
Can also be acquired: TMAU and liver disease
drugs causing trimethylaminuria?
cholinesterase inhibitors
presentataion of trimethylaminuria?
Distinctive ‘rotten fish’ smell in sweat, saliva, urine
Devastating impact o quality of life - depression, social isolation, paranoia, attempted suicide
how to diagnose trimethylaminuria?
urinalysis
Genetic testing
Differential diagnosis of trimethylaminuria?
acidaemia
T2D
Maple syrup urine disease
Is trimethylaminuria a metabolic probelm?
Yes
Management of trimethylaminuria?
Avoidance diet via dietician - foods containing TMA and precursors and inhibitors of FMO3
FMO supplements
Antibiotic tx to suppress colonic bacteria
olfactory reference syndrome?
Includes perceived halitosis
Psychological disorder
Prolonged depressive episodes
Social phobia
tx of olfactory reference syndrome?
SSRIs
Olanzapine
CBT
clinical approach to halitosis?
Optimise oral hygiene
- oral rinse for fungal/bacterial culture
- mouth washes - chlorhexidine
Ensure adequate hydration (3L, reduce caffeine, sugar, etOH)
Identify and treat oral disease
Consider has-pharyngeal source including pharyngeal pouch
Consider gastrointestinal source
Routine serology for common systemic disease
Consider metabolic disease
Identify olfactory reference syndrome and consider referral
