Oral malodor, also called halitosis or bad breath, is universally experienced condition that has a variety of etiologic factors. It is extremely common and majority of adult population have had it at some point in time. Halitosis may be physiological, pathological, and sometimes psychological also. Although numerous non-oral sites and many different causes have been correlated to bad breath, an estimated 80 percent to 90 percent of all bad breath odors originate from the mouth, and bacteria are directly responsible for most of the offensive gases. Specific groups of bacteria have been identified with the production of oral malodor, in particular, gram-negative, anaerobic bacteria. The unpleasant smell of breath mainly originates from volatile sulfide compounds (VSCs), especially hydrogen sulfide (H 2 S), methylmercaptan (CH3SH), and dimethylsulfide [(CH 3 ) 2 S] result from the proteolytic degradation of peptides present in saliva, shed epithelium, food debris and gingival crevicular fluid (GCF). This article reviews the etiology, diagnosis, and treatment of oral malodor and gives a brief description of Halitosis Associated Life-quality Test (HALT) questionnaire, a specific 20-item quality-of-life measure for halitosis.
The tongue plaque coatingResearch suggests that the tongue is the primary site in the production of oral malodor. The dorsoposterior surface of the tongue has been identified as the principal location for the intraoral generation of VSCs [12]. A variety of index systems for tongue coating has been developed over the years. Miyazaki et al divides the tongue into three sections and the presence or absence of tongue coating is registered as follows: Score 0 = none visible, Score 1 = less than one third of tongue dorsum is covered, Score 2 = between one and two thirds, Score 3 = more than two thirds [13]. Winkel et al divides the tongue into six sections, three in the posterior and three in the anterior part of the tongue. Each sextant is categorized as: Score 0 = no coating present, Score 1 = presence of a light coating, Score 2 = presence of a distinct coating. The resulting Winkel tongue coating index (WTCI) is obtained by adding all six scores (Figure 1) [14].
A 24-year-old female patient reported with a mutilated maxillary left central incisor. The coronal tooth structure remaining was very less, discolored, and brittle. She gave history of trauma about 15 years back when the tooth got fractured. An intraoral periapical radiograph revealed an open apex and a large periapical lesion. The case was managed successfully by conservative means using intracanal calcium hydroxide and mineral trioxide aggregate (MTA) apical barrier followed by a fiber post and a core. The final crown restored back esthetics and function. A 6-month follow-up demonstrated a clinically asymptomatic and adequately functional tooth, with radiological signs of healing.
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