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Abstracts

Abstracts

Clinical Assessment

Clinical Assessment

Bad breath typically originates in the mouth, often from the back of the tongue.

Nasal problems also can cause bad breath; odor generated in this manner can be easily distinguished from mouth odor by comparing the odor exiting the mouth and nose.

In most cases, good professional oral care combined with a daily regimen of oral hygiene--including interdental cleaning, deep tongue cleaning and optional use of an efficacious mouthrinse---will lead to improvement.

Rosenberg M:J: Clinical assessment of bad breath: current concepts. Am Dent Assoc, 1996 Apr, 127:4, 475-82

Diagnosis and Treatment

Diagnosis and Treatment

Diagnostic and treatment services for patient complaints of "bad breath" are currently being offered in many dental offices. There are no accepted standards of care for these services, and clinical protocols for the diagnosis and treatment of breath malodor vary widely.

Review the biological and psychological bases of patients' complaints of bad breath and describe a clinical protocol for the evaluation and treatment of such complaints. This protocol resulted in a 99% success rate in eliminating objectively measured breath malodor.

However, 24% of patients continued to believe that at least some of their bad breath persisted after treatment. The merits of various diagnostic procedures are discussed in light of the psychogenic component of the symptomatology of halitosis sufferers.

Richter JL: Diagnosis and treatment of halitosis. Compend Contin Educ Dent, 1996 Apr, 17:4, 370-2, 374-6 passim; quiz 388

Halitosis - Oral Causes

Halitosis - Oral Causes

Halitosis is caused primarily by bacterial putrefaction and the generation of volatile sulfur compounds. Ninety percent of patients suffering from halitosis have oral causes, such as poor oral hygiene, periodontal disease, tongue coat, food impaction, unclean dentures, faulty restorations, oral carcinomas, and throat infections.

The remaining 10 percent of halitosis sufferers have systemic causes that include renal or hepatic failure, carcinomas, diabetes or trimethylaminuria. Modern analytical and microbiological techniques permit diagnosis of bad breath.

Management of halitosis involves maintaining proper oral hygiene, and periodontal treatment, including tongue brushing.

Spielman AI et al., Halitosis. A common oral problem. N Y State Dent J, 1996 Dec, 62:10, 36-42

Oral Malodor

Oral Malodor

Although oral malodor, or bad breath, is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodor, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment.

The mouth air of chronic malodor sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodor with mints and chewing gum, compulsive brushing, and repeatedly rinsing with commercial mouthwashes.

While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor.

Proteolytic activity by microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodor. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air.

Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodor over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodor research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.

Bosy A: J: Oral malodor: philosophical and practical aspects. Can Dent Assoc, 1997 Mar, 63:3, 196-201.

Self-Estimation

Self-Estimation

Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such.

The present investigation determined whether objective self-measurement of oral malodors is possible.

Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters.

Results suggest that:
(i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and
(ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.

Rosenberg M et al., Self-estimation of oral malodor. J Dent Res, 1995 Sep, 74:9, 1577-82

Self-Management

Self-Management

A degree of halitosis is common in healthy people, particularly after sleep.

It seems to originate from the mouth, resulting from the "metabolic" activity of bacteria present in oral "plaque".

Scully, C, Porter, S. & Greenman, J.: What to do about halitosis. BMJ 1994, Jan 22; 308: 217 - 18.

Tongue

Tongue

Research suggests that the tongue plays an important role in the production of oral malodor.

Data indicate that the proteolytic, anaerobic flora residing on the tongue plays an essential role in the development of halitosis.

De Boever, E. H. & Loesche, W.J.: Assessing the contribution of anaerobic microflora of the tongue to oral malodor. JADA 1995,126:1384.

 


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