PERIO - halitosis Flashcards
what does the term halitosis derive from?
halitus - latin for breath
osis - greek for abnormal or diseased
what is halitosis?
a symptom caused by a wide range of intra and extra oral conditions
what is the epidemiology of halitosis?
increased prevalence with age
more prevalent in males
associated with fasting
associated with high protein diets
what us halitosis classified in to?
genuine halitosis
sub divided into
- physiological
- pathological
Psychogenic halitosis
sub divided into
- pseudo-halitosis
- halitophobia
what is pseudohalitosis?
no objective evidence of malodour, but pt thinks they have it
what is haitophobia?
pt persists in believing they have halitosis despite firm evidence for the absence of halitosis
where does most halitosis originate from?
90% from the mouth
what is physiological halitosis?
morning breath - common and transient
resolves after eating and OH
how is physiological halitosis caused?
increased microbial activity during sleep
reduced saliva flow during sleep (circadian rhythm)
fasting and starvation can also cause
what advice is given for physiological halitosis?
eating
OHI
rinsing with fresh water
tongue brushing/ scraping
what foods are associated with halitosis?
garlic
onion
cabbage
cauliflower
radish
spicy foods
coffee
alcohol
what are intra oral causes of halitosis?
perio disease/ poor OH/ food packing
pericoronitis
oral ulceration
acute herpetic gingivostomatitis
dry sockets
post xLA blood clots
xerostomia
tonsilitis
oral malignancy
poor oral appliance hygiene
mouth breathing
tongue coating
why does tongue coating cause halitosis?
chronic bacterial growth and putrefaction
what is the primary cause of halitosis?
production of volatile compounds by oral bacteria
- excessive bacterial reservoir on the tongue
- periodontal bacterial deposits
bacteria produce these compounds as the result of the breakdown of:
- epithelial cells
- salivary proteins
- serum proteins vie GCF
- food debris
what bacterial species are responsible for halitosis?
no single bacterial species responsible
mainly gram-negative proteolytic anaerobes
what are the volatile sulphur compounds? and what do they smell like?
methyl mercaptan - rotten cabbage smell
hydrogen sulphide - rotten egg smell
dimethyl sulphide - unpleasantly sweet smell
what are the major compounds responsible for halitosis?
VSCs - if the compounds are completely dissolved in the saliva they wont cause halitosis
what VSC are associated with garlic and onions?
garlic
allyl mercaptan
allyl methyl sulphide
onion
methyl propyl sulphide
what type of toothpaste may have beneficial effects on halitosis?
triclosan and copolymer containing
baking soda containing
what types of mouthwashes may be helpful for halitosis?
chlorhexidine and cetylpyridinium containing
chlorine dioxide (ultraDEX) - neutralises VSCs
what are the general extra oral factors causing halitosis?
drugs
systemic disease
smoking and alcohol
what are the drug induced extra oral causes of halitosis?
alcohol
tobacco
betel
solvents
disulfiram
cytotoxins
phenothiazines
amphetamines
what systemic diseases may cause halitosis?
nasal and pharyngeal infections
respiratory pathology
GI pathology
metabolic conditions
what type of metabolic conditions may cause halitosis?
diabetes (ketoacidosis)
renal failure (uremic breath)
hepatic failure
what are the 2 principle assessment methods of halitosis?
organoleptic assessment
laboratory methods: halimeter, gas chromatography
describe organoleptic assessment for halitosis?
pt closes mouth for 1min
pt and dentist face each other 10cm away
pt exhales
how do you assess intra or extra oral cause of halitosis through organoleptic assessment?
malodour exhaled from nose with mouth closed - may indicate source of problem from nose, sinuses, resp or GI tracts
what is the gold standard lab method of assessing halitosis?
gas chromatography - differentiates and quantifies specific compounds
what is the OralChroma sensitive too when assessing halitosis?
hydrogen sulphide
methyl mercaptan
dimethyl sulphide
