Causes and sources of halitosis Flashcards
List 2 the things that malodour should not be confused with
- Momentarily disturbing odor caused by food intake (garlic), smoking or medication
- “Morning” bad breath habitually experienced on awakening, disappearing after routine oral hygiene
• Persistent malodour reflects pathology to some degree.
Define halitosis and list the 2 main causes
• An unpleasant odour exhaled through the mouth and upper airways
Causes:
• It can be caused by biofilm accumulation on the dorsum of the tongue, and/ or the interdental spaces
• Periodontal disease
• However the condition is multifactorial and may involve both oral and non-oral conditions
List the 4 classifications of halitosis
• Pseudo- halitosis • Halitophobia • Intra-oral Halitosis • Extra-oral Halitosis ○ Blood borne ○ Non-blood-borne
Define pseudo- halitosis and halitophobia
Pseudo-halitosis:
• A condition in which there is an absence of halitosis but the patient believes that they have oral malodour
Halitophobia:
• A condition in which there is no readily apparent disease or pathological condition
List the 3 general pathways for bad breath
- Systemic disease: blood-gas exchange
- Increase in the bacterial load or the amount of substrates in the oropharyngeal cavity, respiratory tract, or oesophagus
- All types of infections ulcerations, or tumors in one of the above areas can also lead to bad breath
Describe what causes intra- oral malodour and list the (two) primary VSCS and the smells they produce
Cause of intra- oral malodour:
• Comes from of microbial activity
• Attributed to gram negative anaerobic flora
• Caused by the bacteria releasing gaseous by- products known as volatile sulphur compounds (VCSs)
Primary VSCs:
• Primary VSCs are hydrogen sulphide and methyl mercaptan
• Hydrogen sulphide: rotten egg odour
• Methyl mercaptan: odour of faeces
List the 2 conditions in the mouth that provides the ideal environment for bacteria to proliferate, purificate, and produce odour
- Reduced salivary flow
* Alkaline pH
List the 3 intra- oral “niches” of malodour and the 3 intra- oral “sources” of malodour
Niches (described as places of residence)
• Pocket depths of greater than 4mm help produce VSCs
• Tongue and tongue coating
• Tonsils
Intra- oral sources (conditions which may allow for VSCs bacteria to grow)
• Periodontal infections
• Dental Pathologies
• Oral cavity considerations: dry mouth
Explain how increased GCF contributes to halitosis
- Perio pockets of 4mm help produce VSCs
* It leads to an increased GCF which causes increased methionine production and thus, methyl mercaptan
Explain the intra- oral niche of the “tongue” as a source of intra- oral malodour in terms of:
- Site and causes
- Tongue coating
- Morphology
Site and causes:
• Most common cause/ site of malodour, especially posterior surface of tongue
• Ideal surface for to bacterial accumulation/ food debris accumulation (around tissues and lesions as well)
• Metabolic activities of anaerobic bacteria are responsible for odours produced
Tongue coating:
• The tongue coating made up of complex biofilm containing dead epithelial cells, food debris, blood cells, and bacteria which contributes to the smell
Morphology:
• The filiform, fungiform, foliate papillae and fissured tongue on the dorsal surface causes grooves/ bacterial traps
• This traps halitosis-causing bacteria and food residues at the back - these are then broken down into VSCs
Explain the intra- oral niche of the “tonsils” as a source of intra- oral malodour and define “tonsilloliths”
- Palatine tonsils with deep crypts can harbor food and bacteria
- This leads to the formation of “tonsilloliths”- semi-calcified masses of bacteria and food
- Odour is emitted when air is exhaled
Explain why “periodontal infections” are a source of intra- oral malodour and:
- Mention the responsible bacteria
- The responsible vehicles of delivery of VSCs (3)
- Other contributing periodontal conditions (2)
• Periodontal conditions favour the growth of organisms associated with oral malodour
Responsible bacteria:
• Periodontal disease associated biofilms (a.k.a. orange and red complexes) produce VSCs as end-products of metabolism
Responsible vehicles of delivery of VSCs:
• Sources of sulphur-related compounds include saliva, plaque biofilm and GCF
Other periodontal conditions can be causative agents of halitosis:
• Pericoronitis
• Necrotising gingivitis/ Periodontitis because the sloughing of the tissues can proliferate other malodour factors
Explain why “dental pathologies” are a source of intra- oral malodour and mention the 4 types of dental pathologies
Because they serve as areas that are retentive to biofilm.
They include: • Deep carious lesion leading to food impaction • Extraction wounds/ dry socket • Crowding of teeth • Acrylic dentures
Explain why “dry mouth” contributes to intra- oral malodour
- Lack of saliva means that there are less antibacterial substances being produced, allowing for more pathogenic bacterial activity and growth
- Medications usually cause dry mouth
Explain how VSC’s contributes to oral malodour and periodontal disease (4)
- Contribute to invasion: VSCs are associated with an increase in mucosa permeability permitting bacteria and endotoxin invasion
- Decrease wound healing: VSCs interfere with collagen, protein and DNA synthesis, impeding wound healing
- Mediate LPS entry: they allow entry of LPSs into inflamed and healthy epithelium
- Severity of disease: A higher concertation of methyl mercaptan compared to hydrogen sulphide leads to more severe periodontal disease
