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Oral malodor (halitosis, bad breath) is a condition affecting millions of Americans. In healthy individuals complaining of bad breath, the mouth is the main source of their oral malodor, more specifically the posterior dorsum of the tongue. Nonoral sources should also be considered. It is always easy to recognize halitosis, but identifying the exact cause is more complex.
Oral rinses are increasingly becoming an important treatment option for halitosis. There are few products on the market that have been thoroughly evaluated in clinical trials designed to test for the long-term efficacy of mouthrinses in the management of this disorder. This review looks at some of the potential causes and detection methods or oral malodor along with the bacterial, microbiological and biochemical processes involved. The article presents the available literature on clinical trials evaluating the efficacy and mechanisms of action of the different types of oral rinses used in the reduction of plaque and gingivitis, in addition to rinse studies geared more specifically to the treatment of halitosis.
Imagined halitosis is poorly documented in the psychiatric literature. It is perhaps best thought of as a symptom rather than as a specific syndrome (a collection of symptoms that co-vary together). Many of the cases with imagined halitosis described in the literature resemble the psychiatric syndrome of social phobia.
A local dental association, Hakodate Dental Association, has been conducting an oral health promotion campaign, 'Good-bye Bad Breath', in a local community since April 1998. The purpose of this campaign was not only to prevent oral malodour but also to raise people's awareness about oral health. Oral health education has been provided at schools and through television commercials, radio programmes and newspaper articles. Campaign posters and leaflets on bad breath have also been distributed to drug stores, medical clinics and schools, as well as dental clinics. It has been emphasised that oral malodour is a preventable condition and that the dentist can provide adequate advice and suitable treatment. Medical and pharmaceutical associations have cooperated with the Dental Association in running the campaign. Dental care was provided free of charge to the local residents. The free services provided included the assessment of oral malodour using a portable sulphide detector, instructional programmes, and consultations with dentists. This campaign offered a good opportunity to encourage people to visit the dentist for regular check-ups. The number of regular check-ups and halitosis patients has increased in 70% of the clinics belonging to the Dental Association.
OBJECTIVE: The objective of this study was to investigate the relationship between halitosis parameters in patients with and without cleft lip and/or palate. STUDY DESIGN: Forty-two subjects were examined. They were divided into group I, postgraduate students of Bauru Dental School (FOB); and group II, individuals with repaired cleft lip and/or palate. The concentration of volatile sulfur compounds (VSC) was assessed with a portable sulfide monitor and the values were correlated to the salivary flow rate and weight of tongue coating. RESULTS: There was a relationship between the presence of tongue coating and VSC levels, as well as between salivary flow rate and VSC levels in group II. The same group also revealed a significant correlation between weight of tongue coating and salivary flow rate. There were no significant differences between groups as regards the Halimeter oral measurement. CONCLUSIONS: Individuals with repaired cleft lip and/or palate can have the same VSC levels as subjects without clefts.
OBJECTIVE: To determine the relationship between oral parameters and halitosis in children whose parents complained of malodorous breath. METHODS: Twenty-four children (ages 5 to 14) were examined at 3 appointments. After the second appointment oral hygiene instructions were given. Malodor-related parameters included odor judge scores (whole mouth, tongue, nose, and interdental areas), sulfide levels, and microbiologic tests (Oratest and BANA). Dental-related parameters included plaque index, dental index (DMFT), food impaction, bleeding, and tongue coating. Statistical analyses included analysis of variance, paired t tests, Pearson correlations, and multiple regression. RESULTS: Whole mouth odor was significantly associated with plaque index levels (r = 0.64, P =.001) and Oratest (r = -0.57, P =.003). Whole mouth malodor was significantly associated with tongue dorsum posterior odor (r = 0.641, P =.001) and was higher in subjects with interdental odor (P =.003). Tongue odor was also significantly associated with nasal malodor (r = 0.57; P =.004). Sulfide levels were correlated with oral malodor levels only at the second appointment (r = 0.46, P =.02). CONCLUSIONS: The data suggest that, as in adults, oral malodor in children is related primarily to oral factors. Correlations between nasal and oral malodor were evident, suggesting that postnasal drip plays a major role.
Piper betle L. (Piperaceae) leaves which are traditionally used in India and China in the prevention of oral malodor was examined by bioassay-guided fractionation to yield allylpyrocatechol (APC) as the major active principle which showed promising activity against obligate oral anaerobes responsible for halitosis. The biological studies with APC indicated that the potential to reduce methylmercaptan and hydrogen sulfide was mainly due to the anti-microbial activity as established using dynamic in vitro models.
AIM: To report the data from a multidisciplinary bad breath consultation in Germany. MATERIALS AND METHODS: In this cross sectional study, 407 patients attending a bad breath consultation were examined by a specially trained dentist, with an ENT-specialist, an internist, and a psychologist on call. RESULTS: All patients reported suffering from bad breath but only 72.1% showed detectable signs of breath malodour. Within this group, 92.7% revealed an oral cause, 7.3% revealed an extra-oral cause. Within the group without malodour, 76.3% had received prior diagnostics and treatments from other doctors, whereby 36% had received one or more gastroscopies and 14% had undergone an ENT operation. In only ten cases had an organoleptic evaluation of the putative malodour been performed. CONCLUSION: Our data reveal that breath malodour is mainly of oral origin and that patients with pseudo-halitosis are frequently not diagnosed correctly by doctors, resulting in a considerable amount of over-treatment.
A 38-year-old tuberculous male Pakistani presented with halitosis and a cough especially marked when lying on his left side. Barium swallow demonstrated a fistula between oesophagus and left main bronchus. Anti-tuberculous therapy and repeated cauterization failed to close the fistula. Thoracotomy confirmed a congenital oesophago-bronchial fistula. Division and suture resulted in cure.
Two siblings with extrinsic duodenal obstruction caused by congenital peritoneal bands are reported. Attention is drawn to the unusual physical sign of halitosis as a presenting feature. It is suggested that this physical sign may be an indication for barium studies.
This article discusses halitosis, and disorders of taste, orofacial movement or sensation.
Halitosis (bad breath) has been defined as offensive odors emitted from the mouth. Although bad breath is a common complaint, identifying the cause and developing an appropriate treatment plan can be difficult. A thorough examination must be performed to rule out an oral source.
Bad breath, or halitosis, affects between 50 and 65% of the population. Despite its frequency, this problem is often unaccepted and declared taboo. In about 8% of the cases, bad breath is related to an ENT pathology (sinusitis, tonsillitis, ...). More rarely it is caused by a metabolic (diabetes, trimethylaminuremia, ...) or gastric dysfunction. Ninety percent of the cases however, are associated to an oral disease: either gingivitis due to an inadequate removal of dental plaque, especially from interdental spaces, or periodontitis (alveolar bone destruction), or bacterial accumulation on the dorsum of the tongue. In most cases, an intensive disinfection of the mouth by scaling and root planing and/or instruction of a perfect oral hygiene will be sufficient to solve the problem. Perfumed mouthwashes or toothpastes will only give a short-term masking effect. An effective collaboration between a dentist or a periodontist and an ENT specialist is of great importance to dealt with bad breath.
Subphrenic abscess is a recognised complication of splenectomy, but fistulation into the stomach is extremely rare. This report describes a delayed complication of splenectomy presenting as offensive and socially disabling halitosis.
About 15% of the Dutch population has, in a more or lesser degree, complaints about bad breath. This is caused particularly by the anaerobic metabolism of a number of oral microorganisms, in which putrefaction occurs and volatile sulfur compounds will be formed. Some of these compounds are also possibly involved in the pathogenesis of periodontitis. A good oral hygiene is of primary importance to prevent halitosis and to reduce bad breath. Antiseptic mouth-waters can be helpful in the reduction of the bacterial metabolism. In addition, stimulation of the salivary secretion has a dual favourable effect, firstly because of its antimicrobial salivary proteins, and secondly by reduction of the retention of nutrients in the oral cavity.
From an epidemiologic perspective halitosis concerns a large section of the population. Reports from affected people go back to ancient times. The causes may be both oral and non-oral changes. Oral causes are predominantly the coat of the tongue as well as marginal periodontitis. The non-oral causes include disorders in the field of the ear, nose and throat specialist, some general disorders, several drugs, smoking, special nutritional habits as well as disorders in the gastro-intestinal tract. Psychosomatic causes play an important role. Bacterial decomposition processes are decisively responsible for the development of halitosis.The occurring volatile sulphur compounds increase the permeability of oral mucosa, for example for endotoxins, and damage the periodontal tissue.
Halitosis may be diagnosed organoleptically or instrumentally. The latter method employs gas chromatography, sulphide monitors or electronic noses. Therapy is strictly cause-related. Non-oral causes must be examined by a specialist in accordance with the diagnosed syndrome. Where oral causes prevail, the therapy focuses on a reduction of microorganisms and the bacterial nutrient supply as well as the conversion of VSC into non-volatile sulphur compounds and, if required, the additional application of oral cosmetics.
Halitosis in older adults is a common condition that may have oral or nonoral sources, result from a number of different etiologies, and have more than just social consequences. In some cases, bad breath may reflect serious local or systemic conditions, including gingivitis, periodontal disease, diabetic acidosis, hepatic failure, or respiratory infection. Your role as the primary care physician is first to determine whether the odor has an oral or nonoral cause. Odors can be distinct in their quality and thus can help make this determination. Management of nonoral sources requires treatment of the underlying cause, whereas suspected oral sources require referral for a dental evaluation.