HALITOSIS

(oral malodour)
Click to edit Master subtitle style Siti Chumaeroh

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Intr oduction
Halitosis from the Latin halitus for breath - is a problem analous to body odour - mainly in adult 30% over 60 year - not all persons who believe have halitosis have malodour appears to have psichogenic basis
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Oral bacterial activity arising from : * poor oral hygiene * gingivitis (especially necrotizing gingivitis) * periodontitis * pericoronitis * infected extraction sockets * residual blood postoperatively * debris under bridges or 5/27/12 appliances

Organisms (anaerobs)

Porphyromonas gingivalis Prevotella intermedia Fusobacterium nucleatum Bacteriodes forsythus Treponema denticola

produce the chemicals that cause malodour

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The tongue is often the location of

The chemicals include:

* volatile sulphur compounds (VSCs) mainly: - methyl mercaptan - hydrogen sulphide

- dimethyl sulphide
* polyamines : - putrescine - cadaverine * short-chain fatty acids :
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- butyric acids

Other causes of malodour

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

* Diabete * Respiratory disease Nasal sepsis Infection of paranasal sinuses Infection of respiratory tract : - tonsilitis -

bronchitis other lung infection tumors

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Causes of Malodour
Debris Blood Volatile sulphur compounds Hydrogen sulphide H S Methyl mercaptan CH SH Dimethyl disulphide (CH ) SH Psychogeni c

Aminoacid s Cysteine Methionine Oral Cysteine desulphydrase bacteri Methionine desulphydrase a P. gingivalis F. nucleatum Prev. intermedia B. forsythus T. denticola 5/27/12 SYSTEMIC Lungs Gastrointes tinal Hepatic Renal diabetes

Halitosis
HALITOSIS Psychogenic, psychosis or cerebral tumour Foods
Ye s

Is there objective halitosis?

Ye s

No

Recently ingested foods such as garlic, curry, onion, durian, etc? Drugs/smoking responsible? Oral sinus or pharyngeal infections? Xerostomia?

N o

Ye s

Drugs : alcohol, chloral, nitrites/nitrates, DMSO, cytotoxics, phenothiazines, amphetamines or smoking Abcess, dry socket, pericoronitis, acute ulcerative gingivitis, tonsilitis, sinusitis or nasal Seeforeign body or dry mouth Respiratory disease, hepatic disease, renal disease, gastrointestinal disease, diabetes mellitus, or other

N o

Ye s

N o

Ye s

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N o

Materia alba and marginal gingivitis

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Plaque accumulation and gingivitis

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DENTURE RELATED TO MALODOUR

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

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DIAGNOSIS

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

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Hand held halimeter

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MANAGEMENT
-

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
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DENTURE CARE

Wearing a denture encourage food accumulation , the denture plaque and fitting surface can be infected with microorganism usually C. albican - Keep the dentures 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
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dentures should be left out

If the denture is infested with microorganisme 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 5/27/12 infection by brushing the

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