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Module 6 - Periodontology > Halitosis > Flashcards

Halitosis Flashcards

1
Q

Define halitosis

A

Any noticeable unpleasant/ disagreeable odour of expired air.

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2
Q

Is halitosis a diagnosis or symptom?

A

NOT a diagnosis.
A SYMPTOM of a variety of conditions.

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3
Q

What is the instrument that measures the intensity of smells called?

A

Osmoscope

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4
Q

What is the prevalence (%) of halitosis?

A

15-50%

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5
Q

4 facts about halitosis? Age? Sex? Associations (2)?

A
  • Increase in prevalence with age.
  • More prevalent in males.
  • Associated with FASTING and HIGH PROTEIN DIETS.
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6
Q

What are the 2 main types of Halitosis?

A

Genuine and Psychogenic Halitosis.

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7
Q

What are the 2 types of genuine halitosis?

A
  • Physiological/ Transient.
  • Pathological.
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8
Q

What are the 2 types of psychogenic halitosis?

A
  • Pseudo-halitosis.
  • Halitophobia.
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9
Q

What is physiological/ transient halitosis?

A

Morning breath or food-induced.

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10
Q

What is pathologic halitosis?

A
  • Intra oral/ oral malodour (foetor oris).
  • Extra-oral.
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11
Q

What is pseudo-halitosis?

A

No objective evidence of malodour but the patient thinks they have it.

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12
Q

What is halitophobia?

A

The patient persists in believing they have halitosis despite firm evidence of the absence of halitosis.

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13
Q

Where does the majority of halitosis originate from?

A

90% originates from the MOUTH.

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14
Q

What type of halitosis is morning breath?

A

PHYSIOLOGICAL (genuine halitosis).

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15
Q

What causes morning breath (3)?

A
  1. Increased microbial activity during sleep.
  2. Reduced saliva flow during sleep (made worse by mouth breathing).
  3. Fasting and starvation.
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16
Q

4 management advices for morning breath?

A
  1. Eating.
  2. Routine OH regime.
  3. Rinsing with fresh water.
  4. Tongue brushing/ scraping.
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17
Q

What type of halitosis is food induced?

A

PHYSIOLOGICAL (genuine halitosis).

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18
Q

6 foods and 2 drinks that cause halitosis?

A
  • Garlic, onion, cabbage, cauliflower, radish, spicy foods.
  • Coffee, alcohol.
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19
Q

What is a general intraoral cause of genuine halitosis?

A

Oral sepsis/ disease

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20
Q

12 causes of intraoral-caused halitosis?

A
  • Periodontal disease/poor OHI/ food packing (gingivitis, periodontitis, NG).
  • Pericoronitis.
  • Alveolar osteitis/ dry socket.
  • Post extraction/surgery; blood clots.
  • Oral ulceration.
  • Acute herpetic gingivostomatitis.
  • Xerostomia.
  • Infected tonsils.
  • Oral malignancy.
  • Poor oral appliance hygiene.
  • Mouth breathing.
  • Tongue coating.
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21
Q

What is the surface area of the tongue? Relative to perio pockets?

A

197 cm2.
- 5 to 10 times greater than perio pockets.

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22
Q

What is the primary cause of intra-oral halitosis (specific)?

A

The production of VOLATILE COMPOUNDS by ORAL BACTERIA in tongue, perio pockets.

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23
Q

How do intra-oral bacteria produce volatile compounds?

A

Through breakdown of:
- Epithelial cells.
- Salivary proteins.
- Serum proteins via the gingival crevicular fluid (GCF).
- Food debris.

24
Q

Which bacterial species is responsible for intra-oral halitosis?

A

No SINGLE bacterial species responsible.
- Mainly GRAM NEGATIVE PROTEOLYTIC ANAEROBES.

25
Q

8 bacterial species that may be responsible for intra-oral halitosis.

A
  • Porphyromonas gingivalis.
  • Prevotella intermedia.
  • Tannerella forsythia.
  • Treponema denticola.
  • Fusobacterium nucleatum.
  • Selenomonas species.
  • Solobacterium species.
  • Eubacterium species.
26
Q

What are the volatile compounds these bacteria produce?

A

When the bacteria degrade various SULPHUR CONTAINING AMINO ACIDS (methionine, cystine, cysteine) they produce MALODOROUS VOLATILE SULPHUR COMPOUNDS (VSC).

27
Q

What 3 amino acids conatin sulphur?

A

Methionine.
Cystine.
Cysteine.

28
Q

Name the 3 common volatile sulphour compounds responsible for intra-oral halitosis?

A
  • Methyl Mercaptan.
  • Hydrogen sulphide.
  • Dimethyl sulphide
29
Q

What is the PRIMARY compound responsible for intra-oral halitosis?

A

METHYL MERCAPTAN

30
Q

What does methyl mercaptan smell like?

A

Pungent like ROTTEN CABBAGE.

31
Q

What does hydrogen sulphide smell like?

A

rotten eggs.

32
Q

What does dimethyl sulphide smell like?

A

Unpleasantly sweet.

33
Q

What foods contain volatile sulphur compounds?

A

Onions, garlic.

34
Q

What are volatile compounds implicated in halitosis (not sulphour)?

A
  • Diamine.
  • Phenyl compounds.
  • Importance in halitosis LOW due to LOW VOLATILITY/ READILY DISSOLVE IN SALIVA.
35
Q

What type of toothpaste may have some beneficial effects for intra-oral halitosis?

A
  • Triclosan + polymer.
  • Baking soda containing (20% or more than sodium bicarbonate).
  • MINOR beneficial effects.
36
Q

What is the key to managing intra-oral halitosis?

A

STANDARD ORAL HYGIENE.
- Reduces bacterial deposits/ disturbs biofilms.
- Removes food debris.

37
Q

What is the effect of tongue cleaning/ scraping? What is its effect on halitosis?

A
  • Mechanically disrupts tongue coating.
  • Reduces material for PUTREFACTION on the tongue rather than REDUCING BACTERIAL LOAD.
  • 2006 Cochrane review; small, short term reduction in VSC levels.
38
Q

4 mouthwashes that may be helpful for intraoral halitosis?

A
  • Chlorhexidine. (reduce levels of halitosis-causing bacteria on tongue).
  • Cetylpyridinium chloride (reduce levels of halitosis-causing bacteria on tongue).
  • Chlorine dioxide (ultraDEX - neutralize VSCs).
  • Zinc containing (neutralize VSCs).
39
Q

What dietary advice would you give a halitosis patient?

A
  • Remove food/ drink related causes.
  • Increase fluid intake (2L/ day - now contested).
  • Smoking cessation and alcohol reduction.
40
Q

What is the link between probiotics and intraoral halitosis?

A
  • Use of friendly bacteria (streptococcus salivarius strain K12) to repopulate the tongue following chlorhexidine.
  • Very limited research - routine use CANNOT be justified at present.
41
Q

What % of halitosis is caused by EXTRAORAL factors?

A

10%

42
Q

3 categories of aetiologic factors for extra oral halitosis?

A
  • Drug induced.
  • Systemic disease.
  • Habits (smoking, alcohol).
43
Q

4 areas which (when diseased) can caused ex

A
  • Nasal and pharyngeal infections.
  • Respiratory pathology.
  • GI pathology.
  • Metabolic conditions.
44
Q

Which part of the body may patients be convinced is causing their halitosis? Why is this rare?

A
  • Patients convinced their halitosis is related to GIT problems.
  • RARE cause as the OESOPHAGUS is usually COLLAPSED.
45
Q

What are the two principal methods of assessing for halitosis?

A
  • Organoleptic assessment.
  • Laboratory methods
46
Q

What are 2 laboratory methods for assessing for halitosis?

A
  • Halimeter (portable sulphide monitor).
  • Gas chromatography.
47
Q

What is the process for organoleptic assessment of halitosis (4)? What must be avoided?

A
  1. Patient closes mouth for 1 minute.
  2. Patient and dentist face each other (10cm apart).
  3. Patient exhales slowly through their mouth.
  4. Dentists assesses exhaled breath for odour.
  • Both: avoid smoking, drinking coffee/tea/juice and wearing perfumes/aftershaves.
  • Patient: avoid halitosis associated food (ex. garlic) for 48 hours.
48
Q

What could malodour from air exhaled from the nose indicate?

A

Source of problem is from nose, sinuses, respiratory or GI tracts.

49
Q

What is a halimeter?

A

Portable gas monitor (electrochemical sensor).

50
Q

What does a halimeter do? 4 disadvantages?

A
  • Objectively detects VSC.

Disadvantages:
- Cannot differentiate between different VSCs.
- More sensitive to hydrogen sulphide than methyl mercaptan.
- Very sensitive to alcohol (avoid for 12 hours).
- Expensive.

51
Q

What is the GOLD STANDARD assessment for halitosis?

A

Gas chromatography

52
Q

1 advantage and 2 disadvantages of gas chromatography?

A
  • Advantage: can differentiate and quantify specific compounds.
  • Disadvantage: expensive and time consuming laboratory testing, only available in specialist centers.
53
Q

What is the portable gas chromatography machine called?

A

OralChroma.

54
Q

What is the primary role of the dentist in managing halitosis? How is this achieved (4 elements to treatment plan)?

A

DIAGNOSE + MANAGE ORAL CAUSES OF HALITOSIS

  • Thorough patient/ medical history.
  • Dietary causes (dietary advice).
  • Habits (smoking and alcohol cessation).
  • Treat oral disease + maintain oral health.
55
Q

When would a general dentist refer a patient to the GMP/ Oral medicine?

A

When history, diet advice, habit advcie and treatment of oral disease have been RULED OUT and halitosis is still present (either obvious to dentist or just the patient).

56
Q

What are further investigations (after referral) that are done (2)?

A
  • Rule out systemic problems (ex. diabetes).
  • Referal to ENT (nasopharyngeal conditions ex. pharyngeal pouches and foreign bodies).
57
Q

When is a patient diagnosed with psychogenic halitosis? What is done in such cases?

A
  • Once ALL other causes have been ruled out (both intra and extra oral).
  • Counselling and psychiatric referral.

Module 6 - Periodontology (3 decks)

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