Halitosis

containing amino acids such as methionine, cysteine and cystine. The resulting volatile reported complaint. Whether in the form of occasional ‘morning breath’, which nearly every otherwise healthy adult encounters, dimethyl sulphide and dimethyl disulphide) or rarer and more serious problems ranging from metabolic disorders to chest tumours, putrescine, foul-smelling diamines) are at halitosis is said to affect nearly 50% of the least partially responsible for the odours of adult population. To judge from the size of VSC concentrations associated withhalitosis, with over 80 species from VSCs are found in higher concentrations in particles, cells, blood and some chemical components of saliva. Thus 90% of causes of halitosis arise in the mouth1. As proteins that subjects complaining of oral malodour and other chemicals in these materials are had significantly more bleeding sites and as amino acids and peptides, many volatile bacteria than subjects who did not report compounds) related to their decomposition implicated in a feedback loop which begins (smelling of rancid butter or rotting meat), inflammation, creating oxygen-poor pockets in the mouth (e.g. between the gingiva and anaerobic bacteria in them. These bacteria then begin the proteolysis of salivary and This is particularly true of the sulphur- odour, these VSCs increase the permeability of the oral mucosa, speed the degradation of wounds, and also affect gingival and other periodontal cell function1,4. All of these which led to the growth conditions of the halitotic anaerobes in the first place.
while the dorsal third of thetongue, the spaces between implicated in halitosis are also encountered chemical, mechanical, and even biological flux. While salivary proteins are suitable mechanical interaction with the hard palate for bacterial proteolysis, saliva also contains and the teeth (in contrast to the anterior two-thirds of the tongue). This area is also mouthwashes and antibacterial rinses either because it triggers a gag reflex or helps to fluid motion. Saliva also contains immune close off the nasal cavity to the liquid with factors like specific immunoglobulins.
which the patient gargles. The tongue is an because of its large, continuous surface area which features taste and filiform papillae two-thirds of the tongue into contact with and crevices related to mucous glands and lingual tonsils1. Bacterial flourishing on the scrape this portion of the tongue clean.
tongue is not unlike dust accumulation on a large, wrinkled shag carpet; this is why, even though periodontitis is linked with halitosis in one-third of patients (and some studies suggest this is a weak association at best5), pathogens create. For example, sugar in the than to periodontitis1 (particularly, one system’s pH below the range at which the relief for those patients whose gag reflex is with the normal circadian rhythms of sleep is responsible for the ‘morning breath’ with It is important to note that, while poor oral hygiene and poor oral health may often be sufficient conditions for the development of associated with either xerostomia or sleep halitosis, they are not necessary conditions.
chewing or other oral-mechanical activity) abnormal) metabolites from non-oral bodily indicates the critical role saliva plays in the processes and functions; this is the case with control of halitosis. Bacterial putrefaction of chemicals in the mouth is largely responsi- Syndrome,” which results from the body’s ble for halitosis. Saliva contains proteins, inability to completely break down choline patient’s blood and other bodily fluids of bacterial adherence to oral surfaces, and which in some cases are actually bactericidal for the fishy odour of the patient’s breath, Moreover, saliva’s role as a solvent in the urine and sweat. People are probably more oral chemical environment carries over to familiar with the acetone-smell of diabetic its role in controlling mouth odour: Volatile patients’ breath, and the ketone smell of compounds dissolved in saliva don’t smell anorexics’ (and some dieters’) breath.
until they’re evaporated into mouth air and Problems with the renal system leading to smell, while gall bladder problems and liver decreasing their concentrations in saliva by disorders like cirrhosis give the breath a stimulating salivary flow makes it more difficult disorders have associated effects as well.
mouth caused by inhalation or exhalation to Halitosis is a common secondary complaint of patients with xerostomia, or chronic dry mouth, which is often a result of advanced age or of the irradiation of the head and neck which constitutes treatment for many as antihistamines, antihypertensives, and Parkinson’s disease, can cause xerostomia as a side effect. Xerostomic patients’ salivary function is impaired, which either aggravates or precipitates periodontitis or simply raises the salivary concentration of the VSCs so their concentration in exhaled mouth air is increased. A drop in salivary flow associated Other oral causes include ulceration from basis with the recent development of H.
diabetes, herpes, or trauma; postoperative complications from tonsillectomy8 or oral reconstructive surgery9; oral cancers, dental between H. pylori infection and halitosis abscesses, candidiasis, impacted food, improp- erly performed restorations to teeth, use of tobacco products, and dirty dentures. Foods the disappearance of halitosis (measured by rich in sulphur compounds, such as garlic, eradication double therapy that eliminated other, established halitotic bacteria. The study also found that in the presence of H.
dinitrate, ammonium trichlorotellurate10, even completely effective against halitosis.
tetracycline11) can cause halitosis as a sideeffect.
judge’s assessment, through own sense of smell, of the odour of the patient’s breath or saliva. While experienced odour judges may have developed a degree of acuity in sensing sinus cavity, and simple sore throat. Possible particular compounds (odour judges are still gastrointestinal causes for halitosis are a used in current research), the process was highly subjective and now seems unfit as a argue that because of the gastrointestinal sensory processing also places a limit on the respiratory pathway, and since the normal ability of a judge to isolate a particular state of the oesophagus is one of collapse, breath odour should not necessarily indicate linear relationship between the number of Self-diagnosis seems particularly flawed, since colonogastric fistula (a rare complication of becomes desensitized to odours it encounters fistula13, and with various diverticula14,15.
continually. Additionally, psychological factors Other researchers (in work that has yet to be widely reproduced) studied patterns of obsessive-compulsive disorder may distort the halitosis in couples and suggested a possible patient’s own sense of his personal mouth link between the bacterium Helicobacter pylori odour, potentially leading to a form of hypo- (implicated in stomach ulcers) and breath chondria known as ‘delusional halitosis’18. A 1996 study found that self-ratings of mouth odour were significantly higher than the ratings associated with periodontal health. Complain- the narrow but convenient to the expensive ants had a relatively higher psychopathological score on an SCL-90 profile than an age- and research concerns itself with establishing gender-matched reference group not reporting markers for halitosis. Levels of substances A recent Japanese clinical study is indicative of the problems with self-diagnosis: It finds microflora) are used as ‘instruments’ for that patients entering Japanese dental clinics levels of chemicals implicated in halitosis were significantly less likely (by a factor of those patients who had a different primary complaint (say, periodontitis or gingivitis) and a secondary complaint of halitosis. The researchers concluded that “the majority of patients with primary complaints of halitosis zinc-oxide and nitrogen chemiluminescence at the dental clinic did not actually have detectors. The chemiluminescence detector, halitosis, but suffered from an imaginary for example, permits the precise measure- others’ attitudes.” Not surprisingly, the indole and cadaverine) in organic matrices.
researchers found that the patients whose unconfirmed by diagnosis at the clinic were present in heretofore-undetectable concen- more likely to be dissatisfied with the quality A 1996 Japanese study utilising a zinc-oxide Another study on self-assessment21 made use thin film semiconductor shows that this sensor of a new microbiological test to differentiate technology may be fruitfully employed in the between psychogenic and organic halitosis.
The test involved observing lead sulphide precipitation on an applicator tip imbedded considerable power for classifying patients halitosis) had previously been established by ments, which significantly correlated with Among ‘more objective measures’ are the 9. Finkelstein, Y. et al. Endoscopic diagnosis and Cost-effective and reliable management of treatment of persistent halitosis after pharyngeal flap surgery.” Plastic and Reconstructive Surgery 92(6): toothbrushing, flossing, and cleaning of the 10. Tichler, T., et al. Hair preservation and platelet/ tongue’s coat. These techniques aid in the granulocyte sparing effect using AS101 with chemotherapy: A randomized study (Meeting control of the oral microflora that cause both abstract). 18th International Congress of Chemotherapy.
halitosis and dental caries. Research has shown that salivary concentrations of thiols (such as 11. Ogunwande, S.A. Halitosis and abuse of antibiotics.
Report of a case. Ceylon Medical Journal 34(3):131– mercaptans), which are precursors of foul mouth odour, can be significantly reduced 12. Logio, T., et al. The management of Crohn’s colitis with colonogastric fistula. Report of a case. Diseases of the Colon and Rectum 30(9):699–704.
solutions or hydrogen peroxide-containing 13. Mosimann, F. Faecaloid breath heralding secondary toothpastes. Mouthwashes and mouth rinses aorto-enteric fistula. Vasa 24(1):77–78.
containing chlorhexidine gluconate have also 14. Tolliver, B.A. J.A. DiPalma. Zenker’s Bezoar.
Southern Medical Journal 88(7):751–752.
proven effective in controlling oral microbes, 15 .Cirillo, F., A. Scurelli, P. Alquati. Zenker’s but not without side effects such as tooth diverticulum in the elderly. Description of a case staining. More advanced treatments, such as and surgical treatment. Minerva Chirurgica 47 (23– 24):1813–1817. (Published in Italian).
the use of antibiotics, are rarely indicated, 16. Tiomny, E., et al. Halitosis and Helicobacter pylori.
A possible link?Journal of Clinical Gastroenterology 17. E. Ierardi et al. Halitosis and Helicobacter Pylori: A Strong Relationship. University of Bari. Paper presented at the Third International Conference 1. Spielman, A.I., P. Bivona, B.R. Rifkin,Halitosis: A on Breath Odour, Vancouver, BC, 1997.
Common Oral Problem. New York State Dental 18. Iwu, C.O., O. Akpata. Delusional halitosis. Review of the literature and analysis of 32 cases. British 2. Moss, S.J. Halitosis, Malodor. Report submitted to the FDI Commission, October 1996, pp.1–6.
19. Eli, I., et al. The complaint of oral malodor. Possible 3. De Boever, E.H., M. De Uzeda, W.J. Loesche.
psychopathological aspects. Psychsomatic Medicine Relationship between volatile sulfur compounds, BANA-hydrolyzing bacteria and gingival health in 20. Iwakura, M., et al. Clinical characteristics of patients with and without complaints of oral halitosis: Differences in two patient groups with malodor. Journal of Clinical Dentistry 4(4):114–119.
primary and secondary complaints of halitosis.
4. Johnson, P.W., W. Ng, J. Tonzetich. Modulation of Journal of Dental Research 73(9):1568–1574.
human gingival fibroblast cell metabolism by methyl 21. J.L. Richter. A comparison of the validity of four mercaptan. Journal of Periodontal Research 27(5): tests in differentiating between organic and psycho- genic halitosis. Paper presented at the Third 5. Bosy, A., et al. Relationship of oral malodor to International Conference on Breath Odour.
periodontitis: Evidence of independence in discrete subpopulations.” Journal of Periodontology 65(1): 22. Kozlovsky, A., et al.Correlation between the BANA test and oral malodor parameters. Journal of Dental 6. Miyazaki, H., et al. Correlation between volatile sulphur compounds and certain oral health 23. J. Tonzetich. Current Methods for the Detection measurements in the general population. Journal of and Quantification of Oral Malodour. University of British Columbia. Paper presented at the Third 7. Kleinberg, I., G. Westbay. Salivary and metabolic International Conference on Breath Odour, factors involved in oral malodor formation. Journal 24. Shimura, M., et al. A new monitor with a zinc-oxide 8. Lee, W.C., J.F. Sharp. Complications of paediatric tonsillectomy post-discharge. Journal of Laryngology measurement of volatile sulfur compounds in mouth air. Journal of Periodontology 67(4):396–402.

Source: http://www.mouthodor.co.kr/research/fdi/96-6.pdf