Written by - Dr.Urusa I Inamdar

Also called as oral malodor.

” Halitosis may rank only behind dental caries and periodontal disease as the cause of the patients visit to the dentist.”

Origin

Oral

• Poor oral hygiene

1. Retention of odoriferous food particles on and between the teeth.
2. Coated tongue.
3. Artificial dentures.

• Acute Necrotizing Ulcerative Gingivitis.
• Pericoronitis.
• Abscess.
• Dehydration states.
• Ulceration in the oral cavity.
• Hyposalivation/Xerostomia.
• Bone disease ( dry socket , Osteomyelitis , osteonecrosis and malignancy )
• Smoker’s breath.
• Healing oral wounds.
• Chronic periodontitis with pocket formation.

Extraoral ( Conditions that can contribute to presence of oral malodor )

• Sinusitis and other bacterial infections.
• Dry nasal mucosa.
• Blocked nose ( which can cause mouth breathing )
• Tonsillitis/ tonsil stones.
• Various carcinomas.
• Infections of the respiratory tract ( bronchitis , pneumonia , bronchiectasis )
• Alcoholic breath.
• Uremic breath of kidney dysfunction.
• Acetone odor of Diabetes.

It is important for the dental professional to eliminate systemic conditions that may be contributing to the presence of oral malodor.

The clinical assessment of oral malodor is either subjective or objective . Subjective assessment is based on smelling the exhaled air of the mouth and nose and comparing the two ( organoleptic assessment ).

Organoleptic scoring scale

• Absence of odor.
• Questionable to slight malodor. Odor is deemed to exceed the threshold of malodor detection.
• Moderate malodor. Odor is definitely detected.
• Strong malodor. Malodor is objectionable but examiner can tolerate.
• Severe malodor. Overwhelming malodor. Examiner cannot tolerate.

Various scoring systems, such as 0 to 5 point scale and a 0 to 10 point scale can be used to estimate the intensity of exhaled oral odor, tongue odor and nasal odor , among others.

Methods for objective measurement of the breath include :

• Detection of sulphides with an appropriate monitor- simple but may fail to detect oral malodor caused by nonsulphide components. Halimeter is a instrument that can be used chair side to measure volatile sulfur compounds in the exhaled air.
• Gas chromatography- not applicable for routine clinical practice.
• Bacterial detection ( such as benzoylarginine – naphthylamide test – BANA test ) , polymerase chain reaction, dark field microscopy ) – not applicable for routine clinical practice.

References

• Dental notes.
• A practical manual of Public Health Dentistry – C M Marya.