Halitosis

HALITOSIS

Siti Chumaeroh

Halitosis from the Latin halitus for breath = malodour = foetor ex ore

- unpleasent odors in breathing - mainly in adult 30% over 60 year - psichogenic basis - to be the third most frequent reason for

seeking dental aid - 85-90% orginates in the mouth itself

Introduction

- morning breath - a low salivary flow - oral cleansing during sleep

- during the day : - foods : garlic, onion or spices - habits (smoking, drinking alcohol)

- oral bacterial activity anaerobes

Oral bacterial activity arising from : * poor oral hygiene * gingivitis (especially necrotizing

gingivitis) * periodontitis * pericoronitis * infected extraction sockets * residual blood postoperatively * debris under bridges or appliances * ulcers * dry mouth

Porphyromonas gingivalis Prevotella intermedia Fusobacterium nucleatum Bacteriodes forsythus Treponema denticola produce the chemicals that cause malodour The tongue is the location of organisms

above

Organisms (anaerobs)

The chemicals include:

* volatile sulphur compounds (VSC’s) mainly: - methyl mercaptan - hydrogen sulphide - dimethyl sulphide * polyamines : - putrescine - cadaverine * short-chain fatty acids :

- butyric acids - valeric acids - propionic acids

Odors are due to the breakdown of certain proteinsindividual amino acids

Certain aminoacids foul gases Forexamples : breakdown cystein &

methionine hidogen sulfide methyl mercaptan Volatile sulfur compounds stastically

associated with malodour

Starvation Drugs : - amphetamines - chloral hydrate - cytotoxic agents - dimethyl sulphoxide (DMSCO) - disulfiram - nitrates and nitrites - phenothiazines - solvent abuse

Other causes of malodour

* Diabetes diabetic acidosis aceton * Respiratory disease Nasal sepsis Infection of paranasal sinuses Infection of respiratory tract : - tonsilitis - bronchitis - lung infect. - tumors, etc

* Gastrointestinal disease : intestinal bleeding * Hepatic failure: chronic rare * Renal failure : uremia in saliva amonia * Psychosomatic factors (halitophobia ) 0,5-1%

Volatile sulphur compounds

Cysteine desulphydrase Methionine desulphydrase

M A L O D O U R URu R

Causes of Malodour

Debris Blood

Aminoacids Cysteine Methionin

e

Oral bacteri

a

P. gingivalisF. nucleatum

Prev. intermediaB. forsythusT. denticola

SYSTEMICLungs

Gastrointestinal

HepaticRenal

diabetes

Dimethyl disulphide (CH₃)₂SH

Methyl mercaptan

CH₃SH

Hydrogen sulphide

H₂S

Psychogenic

Halitosis

HALITOSIS

Is there objective halitosis?

Recently ingested foods such as garlic, curry, onion, durian,

etc?Drugs : alcohol, chloral, nitrites/nitrates, DMSO,

cytotoxics, phenothiazines, amphetamines or smoking

Foods

Psychogenic, psychosis or cerebral tumour

Drugs/smoking responsible?

Oral sinus or pharyngeal infections?

Xerostomia?Respiratory disease,

hepatic disease, renal disease, gastrointestinal

disease, diabetes mellitus, or other condition

See “dry mouth”

Abcess, dry socket, pericoronitis, acute ulcerative gingivitis,

tonsilitis, sinusitis or nasal or foreign body

No

Yes

Yes

Yes

Yes

No

Yes

No

No

No

Materia alba and marginal gingivitis

Plaque accumulation and gingivitis

Dentures can produce accumulation of microbial plaque ( bacteria and/or yeast) on and in the fitting surfaces of the denture and underlying mucosa

The plaque undergoes sequential development is colonized by organisms

The decreased salivary flow A low PH under the denture inflammation denture –related

stomatitis

DENTURE RELATED TO MALODOUR

- full history - examination - assessment of halitosis - volatile sulphur compounds halimeter - oral flora

DIAGNOSIS

Hand held halimeter

- Patient education- Treating the cause- Avoiding smoking, foods such as onion,

garlic etc- Good oral hygiene : tooth brushing,

flossing, tongue cleaning (before going to bed)

- Oral antiseptics- Denture care

MANAGEMENT

Wearing a denture encourage food accumulation , the denture plaque and fitting surface be infected with microorganism usually C. albican

- Keep as clean as natural teeth - Clean both surfaces inside and outside

after meal and at night using washing up liquid , toothbrush and warm water hold it over a basin containing water

DENTURE CARE

- should be left out overnight and keep them in water it may distort if allowed to dry out

- An infection are increased if the denture are worn 24 hours a day

If the denture is infested with microorg should be removed Denture left out the mouth at night Clean , disinfected Stored in an antiseptic denture cleanser Denture soak solutions containing

benzoic acid eradicate C albicans from denture surface internal surface of prosthesis

Chlorhexidine : reduction palatinal infection Mucosal infection by brushing the palate using antifungal for 4 weeks

TERIMA KASIH