halitosis...halitosis , a common complaint is a general term used to describe any kind of unpleasant...
TRANSCRIPT
![Page 1: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/1.jpg)
HALITOSIS
DR JEBIN,MDS.,D.ICOI
1
![Page 2: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/2.jpg)
INTRODUCTION
Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour emitted from the mouth
2
![Page 3: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/3.jpg)
DEFINITIONAn offensive odour emanating from the oral
cavity (Klienberg &Westbay 1990)
3
![Page 4: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/4.jpg)
SYNONYMS
• Fetor exore
• Fetor oris
• Bad breath
• Bad odour
• Mal odour
4
![Page 5: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/5.jpg)
EPIDEMIOLOGY
• Age range can be from 5‐80 yrs• Oral causes‐90%• ENT – 8%• Other aetiologies ‐5%
5
![Page 6: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/6.jpg)
ETIOLOGY
• The main cause for oral malodour production is protein degradation by the bacteria covering oral hard & soft tissues, especially the tongue
6
![Page 7: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/7.jpg)
THE MAIN CONSTITUENTS
SULFUR CONTAING VOLATILES (VSC)
[Tonzetich]
• Hydrogen sulfide [H2S]
• Methyl mercaptan [CH3SH]
• Dimethyl sulfide [(CH3)2S]
7
![Page 8: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/8.jpg)
OTHER COMPOUNDS
• Fatty acids
• Ammonia
• Diamines
• Organic acids _ Butyric & Propionic acid
[Goldberg et al – J Dent Res 1994]
8
![Page 9: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/9.jpg)
FACTORS –ORAL MALODOUR
BACTERIA
PH
AMINO ACIDS
INTRA ORAL OXYGEN LEVEL
![Page 10: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/10.jpg)
CAUSES
10
PHYSIOLOGIC PATHOLOGIC
![Page 11: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/11.jpg)
PHYSIOLOGIC CAUSES
11
![Page 12: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/12.jpg)
MORNING BAD BREATH
• Habitually experienced during awakening
• Caused by salivary flow and putrefaction during night & spontaneously disappears on oral hygiene measures
12
![Page 13: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/13.jpg)
PATHOLOGIC CAUSES
13
![Page 14: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/14.jpg)
DISORDERS OF ORAL CAVITY
Poor oral hygieneDental plaqueDental cariesOpen gangrenous pulpPutrefaction of salivaGingivitisStomatitisPeriodontitisCoated tongueOral carcinomaDenturesHealing surgical & extraction wounds
![Page 15: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/15.jpg)
DRY MOUTH
In xerostomic pts there is ed amounts of plaque accumulation over teeth, prosthesis & tongue dorsum
microbial load & escape of VSC’s
15
![Page 16: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/16.jpg)
ANATOMICAL VARIATIONS
Fissurated –Tongue with deep fissures on dorsal surface
Hairy –Formed due to irregular desquamation of filliform papillae
Ulcerated
16
![Page 17: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/17.jpg)
17
FISSURATEDTONGUE
HAIRY TONGUE
![Page 18: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/18.jpg)
DEPAPILLATED TONGUE
18
ULCERATED TONGUE
![Page 19: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/19.jpg)
DISORDERS OF RESPIRATORYTRACT
LRTCarcinoma-lungBronchiectasisNecrotising pneumonitisPulmonary Abscess
URTMouth breathingChronic sinusitisAtrophic rhinitisWegener GranulomatosisTBSyphilisNasopharyngeal abscess
![Page 20: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/20.jpg)
DISORDERS OF ENT
• Acute pharyngitis [Bacterial/Viral]
• Chronic/Purulent tonsillitis
20
![Page 21: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/21.jpg)
DISORDERS OF GIT
LGITHiatus HerniaEnteric infectionsPyloric stenosisHepatic failure
UGITDehydrationPeritonsillar abscessVincent’s anginaRetropharyngeal abscess
![Page 22: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/22.jpg)
SYSTEMIC DISORDERS
Leukemia
Agranulomatosis
Ketoacidosis
Renal failure
![Page 23: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/23.jpg)
DIABETES
Insulin dependant/type I• Accumulation of ketones
Uncontrolled diabetes‐may b’cme insulin dependant
23
![Page 24: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/24.jpg)
HORMONAL
• Progesterone levels VSC in expired air 2‐4 fold during ovulation compared to mid‐follicular phases [Bosy et al 1997]
24
![Page 25: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/25.jpg)
MEDICATIONS
Metronidazole
Dimethyl sulfoxide
Penicillamine
![Page 26: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/26.jpg)
DIAGNOSIS
26
![Page 27: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/27.jpg)
PATIENT QUESTIONARE
27
![Page 28: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/28.jpg)
QUESTIONARE
MEDICAL HISTORY:• Time of appearance (after/before meals)• Any medications?• Dryness?
![Page 29: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/29.jpg)
SPECIFIC CHARACTER OF BREATH ODOUR
VSCRotten egg
Liver insufficiencySweet odour [dead mice]
Unbalanced IDDM [KETONE BODIES]
Rotten apples
Kidney insufficiencyUraemia Arsenic medications
Fish odour
Rotten onions
![Page 30: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/30.jpg)
CLINICAL & LABORATORYEXAMINATION
30
![Page 31: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/31.jpg)
SELF EXAMINATION
Motivates pt to continue OHI & self evaluateSmelling a metallic/plastic spoon after scraping back of tongueSmelling a toothpick after introducing into interdental areasSmelling saliva spit in a cup [after drying]Licking the wrist & allowing it to dry
![Page 32: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/32.jpg)
SELF EXAMINATION
32
![Page 33: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/33.jpg)
• OSMOSCPOE: Instrument to measure intensity of bad breath
33
![Page 34: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/34.jpg)
ORGANOLEPTIC RATING
Assessment done by a judge
A trained judge sniffs the expired air & assess whether it is unpleasant using an intensity rating, (0‐5) [Rosenberg & Mccolloch]
Based on olfactory organs of the judge
![Page 35: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/35.jpg)
35
![Page 36: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/36.jpg)
TONGUE COATING‐SAMPLE
36
![Page 37: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/37.jpg)
37
PLAQUE SAMPLE
NASAL CAVITY ODOUR
![Page 38: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/38.jpg)
PORTABLE VOLATILE SULFIDE MONITORElectronic device
Analyses H2S & Methyl mercaptan
Commercially available as Halimeter (Inter scan corporation USA)
![Page 39: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/39.jpg)
HALIMETER
39
![Page 40: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/40.jpg)
The straw is kept about 2cm behind the lips without touching any surface & while the pt keeps the mouth slightly open & breathes normally
The sulphide meter uses a Volta metric sensor that generates a signal when exposed to sulphur containing gases
![Page 41: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/41.jpg)
41
![Page 42: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/42.jpg)
OROPHARYNGEAL EXAMINATION
The examination should involve all possible retention areas for bacteria/debris
Any ulceration [Herpes, Recurrent oral ulcerations, Trauma]
Extraction wounds – sweet fetid odour
42
![Page 43: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/43.jpg)
ULCERATIVE LESION
43
NUG
Tissue necrosis-typical offensive odour
![Page 44: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/44.jpg)
GINIGIVITIS
44
PERIODONTITIS
![Page 45: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/45.jpg)
TONGUE COATING
45
COATED TONGUE
NORMAL TONGUE
![Page 46: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/46.jpg)
TONSIL WITH NORMAL CRYPTS
46
TONSIL-PURULENT EXUDATE
![Page 47: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/47.jpg)
TREATMENT
47
![Page 48: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/48.jpg)
MECHANICAL REDUCTION
• Tongue & interdental cleaning
• One stage full mouth disinfection combining scaling & root planing
CHEMICAL REDUCTION
Antimicrobial agents like chlorhexidine,& triclosan
48
![Page 49: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/49.jpg)
• CONVERSION OF VOLATILE SULFIDE COMPOUNDS
salt solutions
Toothpastes
Chewing gum
MASKING THE MALODOR
By salivary flow [ chewing gum]
49
![Page 50: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/50.jpg)
• GIT,ENT,RESPIRATORY,& OTHER SYSTEMIC DISORDERS ARE TREATED RESPECTIVELY
50
![Page 51: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/51.jpg)
CONCLUSION
Dealing with malodour is fascinating b’coz of diversity in causes & treatment
51
![Page 52: HALITOSIS...Halitosis , a common complaint is a general term used to describe any kind of unpleasant odour ... MORNING BAD BREATH • Habitually experienced during awakening • Caused](https://reader034.vdocuments.us/reader034/viewer/2022042409/5f267c9b617f76065f374aba/html5/thumbnails/52.jpg)