Halitosis: Current concepts on etiology, diagnosis and management

Abstract

Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view.

Halitosis: prevalence, risk factors, sources, measurement and treatment – a review of the literature

“…Dry mouth has been found to be associated with oral malodour, which can be explained by the reduced salivary flow favouring anaerobic bacterial putrefaction of food debris that remains in the oral cavity after eating . Dry mouth also results in an increased Gram‐negative bacterial load, which increases VSC production, the main contributor to halitosis . This is especially evident in the morning as salivary flow has decreased during the sleeping period; as demonstrated in 70% of participants in a study in Baghdad, Iraq…”

“…The VSCs also aid bacterial invasion of the connective tissue by their toxic effects on epithelial cells, while methyl mercaptan hinders epithelial cell growth and proliferation . This is accentuated by decreasing oxygen tension arising from an increase in periodontal pocket depth, with a concomitant decrease in pH, which is necessary for the putrefaction of amino acids that create VSCs . It has also been suggested that saliva from patients that suffer from periodontal disease might produce increased amounts of VSCs …”

“…In terms of treatment, the recommendation for delusional halitosis is to carefully explain the actual situation to the patient and send them for psychological or psychiatric support as soon as possible . A multidisciplinary approach involving dentists, health care practitioners, psychologists and psychiatrists is thus necessary for these conditions …”

“…Testing should be undertaken in the morning before eating and hygiene procedures are performed to obtain the correct measurement of the condition . The patient should also count aloud from 1 to 10 before measurement commences to promote drying of the palate and tongue mucosa and facilitate the release of VSCs . The use of a panel of judges is likewise recommended to improve the reliability of the results but this can increase cost for the test and might be difficult in a practice setting.…”

“…These portable sulphide monitors are currently being employed in many clinical practices, mainly due to their ease of use in generating a quantitative measure of VSCs chairside . It must be noted though, that this method of sulphide monitoring has a major disadvantage in not being able to measure dimethyl sulphide accurately . In addition, the presence of compounds like alcohols and phenyl compounds and polyamines can interfere with readings…”