Halitosis: Difference between revisions

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Revision as of 14:45, 23 December 2020

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mydah Sajid, M.B.B.S.

Synonyms and keywords: oral malodor; breath odor; foul breath; fetor oris; fetor ex ore; bad breath

Overview

Classification

Halitosis can be classified into physiologic, pathologic, or subjective.
Physiologic halitosis occurs due to decreased saliva production. It occurs in the morning when the mouth is dry, and there is an overgrowth of oral bacteria^[1]. Tobacco smoking and certain food items like garlic and onion also cause bad breath due to aromatic compounds. Physiological halitosis improves significantly by flossing, tooth brushing, rinsing with mouthwash, and drinking water.
Pathological halitosis occurs due to an underlying disease. The common causes include postnasal drip, sinusitis, gingivitis, and caries^[1]. The tonsillar inflammation and peri-tonsillar abscesses can also result in bad breath.

Pathophysiology

It is thought that halitosis is produced by bacterial overgrowth in the oral cavity.
Poor oral hygiene, dental caries, or gum infection results in the growth of gram-negative anaerobes in the mouth^[2].
These bacteria thrive on debris material entrapped between teeth and gums. Lysosomal enzymes secreted by the bacteria break down the glycoproteins in the food particles. It results in volatile compounds like hydrogen sulfide, dimethyl sulfide, and methyl mercaptan, resulting in halitosis^[3].
The Bacteroides, Prevotella, and Fusobacterium species are mainly responsible for halitosis^[4].

Epidemiology and Demographics

The prevalence of halitosis is approximately 32,000 per 100,000 individuals worldwide^[5].
Halitosis affects men and women equally^[6].
It is more common in middle and lower socioeconomic classes^[5].
The prevalence of halitosis is increasing with time.

Risk Factors

Common risk factors in the development of halitosis include^[7]:

Hepatic cirrhosis and hepatic failure
Chronic kidney disease
Diabetic ketoacidosis
Xerostomia
Gastritis due to Helicobacter pylori infection

Diagnosis

Diagnostic Study of Choice

Organoleptic measurement is the gold standard test for the diagnosis of halitosis^[8].

Organoleptic Measurement

It is one of the oldest techniques to detect a bad smell.
The air expelled from both nose and mouth is smelled to detect a foul odor.
The patient inspires from the nose with mouth close and then expires from the mouth, while the examiner detects it from a distance of 20 cm through a pipette^[9].
This diagnostic test is highly subjective, and the examiner grades the smell from a grade of 0 to 5, with zero being no smell and five being severe pungent smell^[10].

History and Symptoms

The hallmark of halitosis is a bad odor from mouth.
A detailed history should be taken from the patient to rule out physiological and pseudo-halitosis. The frequency, onset, time, duration, exacerbating and relieving factors should be asked. A detailed medication history, Alcholo consumption and smoking should also be inquired ^[10].

Physical Examination

Physical examination of patients with halitosis is usually remarkable for dental caries, gingivitis, post-nasal drip and sinusitis^[11].
A detailed oral examination should be carried out to rule out any dental or gum disease.
Upper Respiratory tract examination should be done to rule out nasal polyps, adenoids, post-nasal drip, and tonsillar hypertrophy. A detailed chest examination should be done to rule out chest infection.

References

↑ ^1.0 ^1.1 Rosenberg M (1996). "Clinical assessment of bad breath: current concepts". J Am Dent Assoc. 127 (4): 475–82. doi:10.14219/jada.archive.1996.0239. PMID 8655868.
↑ De Geest S, Laleman I, Teughels W, Dekeyser C, Quirynen M (2016). "Periodontal diseases as a source of halitosis: a review of the evidence and treatment approaches for dentists and dental hygienists". Periodontol 2000. 71 (1): 213–27. doi:10.1111/prd.12111. PMID 27045438.
↑ Tonzetich J (1977). "Production and origin of oral malodor: a review of mechanisms and methods of analysis". J Periodontol. 48 (1): 13–20. doi:10.1902/jop.1977.48.1.13. PMID 264535.
↑ Sterer N, Rosenberg M (2002). "Effect of deglycosylation of salivary glycoproteins on oral malodour production". Int Dent J. 52 Suppl 3: 229–32. doi:10.1002/j.1875-595x.2002.tb00930.x. PMID 12090458.
↑ ^5.0 ^5.1 Silva MF, Leite FRM, Ferreira LB, Pola NM, Scannapieco FA, Demarco FF; et al. (2018). "Estimated prevalence of halitosis: a systematic review and meta-regression analysis". Clin Oral Investig. 22 (1): 47–55. doi:10.1007/s00784-017-2164-5. PMID 28676903.
↑ Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA (1991). "Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor". J Dent Res. 70 (11): 1436–40. doi:10.1177/00220345910700110801. PMID 1960254.
↑ Messadi DV, Younai FS (2003). "Halitosis". Dermatol Clin. 21 (1): 147–55, viii. doi:10.1016/s0733-8635(02)00060-8. PMID 12622277.
↑ Nalçaci R, Sönmez IS (2008). "Evaluation of oral malodor in children". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 106 (3): 384–8. doi:10.1016/j.tripleo.2008.03.001. PMID 18602293.
↑ Aylıkcı BU, Colak H (2013). "Halitosis: From diagnosis to management". J Nat Sci Biol Med. 4 (1): 14–23. doi:10.4103/0976-9668.107255. PMC 3633265. PMID 23633830.
↑ ^10.0 ^10.1 Yaegaki K, Coil JM (2000). "Examination, classification, and treatment of halitosis; clinical perspectives". J Can Dent Assoc. 66 (5): 257–61. PMID 10833869.
↑ Kapoor U, Sharma G, Juneja M, Nagpal A (2016). "Halitosis: Current concepts on etiology, diagnosis and management". Eur J Dent. 10 (2): 292–300. doi:10.4103/1305-7456.178294. PMC 4813452. PMID 27095913.

[pmid8655868-1] 1.0 ^1.1 Rosenberg M (1996). "Clinical assessment of bad breath: current concepts". J Am Dent Assoc. 127 (4): 475–82. doi:10.14219/jada.archive.1996.0239. PMID 8655868.

[pmid27045438-2] De Geest S, Laleman I, Teughels W, Dekeyser C, Quirynen M (2016). "Periodontal diseases as a source of halitosis: a review of the evidence and treatment approaches for dentists and dental hygienists". Periodontol 2000. 71 (1): 213–27. doi:10.1111/prd.12111. PMID 27045438.

[pmid264535-3] Tonzetich J (1977). "Production and origin of oral malodor: a review of mechanisms and methods of analysis". J Periodontol. 48 (1): 13–20. doi:10.1902/jop.1977.48.1.13. PMID 264535.

[pmid12090458-4] Sterer N, Rosenberg M (2002). "Effect of deglycosylation of salivary glycoproteins on oral malodour production". Int Dent J. 52 Suppl 3: 229–32. doi:10.1002/j.1875-595x.2002.tb00930.x. PMID 12090458.

[pmid28676903-5] 5.0 ^5.1 Silva MF, Leite FRM, Ferreira LB, Pola NM, Scannapieco FA, Demarco FF; et al. (2018). "Estimated prevalence of halitosis: a systematic review and meta-regression analysis". Clin Oral Investig. 22 (1): 47–55. doi:10.1007/s00784-017-2164-5. PMID 28676903.

[pmid1960254-6] Rosenberg M, Kulkarni GV, Bosy A, McCulloch CA (1991). "Reproducibility and sensitivity of oral malodor measurements with a portable sulphide monitor". J Dent Res. 70 (11): 1436–40. doi:10.1177/00220345910700110801. PMID 1960254.

[pmid12622277-7] Messadi DV, Younai FS (2003). "Halitosis". Dermatol Clin. 21 (1): 147–55, viii. doi:10.1016/s0733-8635(02)00060-8. PMID 12622277.

[pmid18602293-8] Nalçaci R, Sönmez IS (2008). "Evaluation of oral malodor in children". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 106 (3): 384–8. doi:10.1016/j.tripleo.2008.03.001. PMID 18602293.

[pmid23633830-9] Aylıkcı BU, Colak H (2013). "Halitosis: From diagnosis to management". J Nat Sci Biol Med. 4 (1): 14–23. doi:10.4103/0976-9668.107255. PMC 3633265. PMID 23633830.

[pmid10833869-10] 10.0 ^10.1 Yaegaki K, Coil JM (2000). "Examination, classification, and treatment of halitosis; clinical perspectives". J Can Dent Assoc. 66 (5): 257–61. PMID 10833869.

[pmid27095913-11] Kapoor U, Sharma G, Juneja M, Nagpal A (2016). "Halitosis: Current concepts on etiology, diagnosis and management". Eur J Dent. 10 (2): 292–300. doi:10.4103/1305-7456.178294. PMC 4813452. PMID 27095913.

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@@ Line 48: / Line 48: @@
 * A detailed history should be taken from the patient to rule out physiological and pseudo-halitosis. The frequency, onset, time, duration, exacerbating and relieving factors should be asked. A detailed medication history, Alcholo consumption and smoking should also be inquired <ref name="pmid10833869">{{cite journal| author=Yaegaki K, Coil JM| title=Examination, classification, and treatment of halitosis; clinical perspectives. | journal=J Can Dent Assoc | year= 2000 | volume= 66 | issue= 5 | pages= 257-61 | pmid=10833869 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10833869  }} </ref>.
 ===Physical Examination===
-* Physical examination of patients with [[halitosis]] is usually remarkable for [[dental caries]], [[gingivitis]], [post-nasal drip] and [[sinusitis]]<ref name="pmid27095913">{{cite journal| author=Kapoor U, Sharma G, Juneja M, Nagpal A| title=Halitosis: Current concepts on etiology, diagnosis and management. | journal=Eur J Dent | year= 2016 | volume= 10 | issue= 2 | pages= 292-300 | pmid=27095913 | doi=10.4103/1305-7456.178294 | pmc=4813452 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27095913  }} </ref>.
+* Physical examination of patients with [[halitosis]] is usually remarkable for [[dental caries]], [[gingivitis]], [[post-nasal drip]] and [[sinusitis]]<ref name="pmid27095913">{{cite journal| author=Kapoor U, Sharma G, Juneja M, Nagpal A| title=Halitosis: Current concepts on etiology, diagnosis and management. | journal=Eur J Dent | year= 2016 | volume= 10 | issue= 2 | pages= 292-300 | pmid=27095913 | doi=10.4103/1305-7456.178294 | pmc=4813452 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27095913  }} </ref>.
+* A detailed oral examination should be carried out to rule out any dental or gum disease.
+* Upper Respiratory tract examination should be done to rule out nasal polyps, adenoids, post-nasal drip, and tonsillar hypertrophy. A detailed chest examination should be done to rule out chest infection.
 ==References==
 {{Reflist|2}}