Halitosis: the multidisciplinary approach

Abstract

Halitosis, bad breath or oral malodour are all synonyms for the same pathology. Halitosis has a large social and economic impact. For the majority of patients suffering from bad breath, it causes embarrassment and affects their social communication and life. Moreover, halitosis can be indicative of underlying diseases. Only a limited number of scientific publications were presented in this field until 1995. Ever since, a large amount of research is published, often with lack of evidence. In general, intraoral conditions, like insufficient dental hygiene, periodontitis or tongue coating are considered to be the most important cause (85%) for halitosis. Therefore, dentists and periodontologists are the first-line professionals to be confronted with this problem. They should be well aware of the origin, the detection and especially of the treatment of this pathology. In addition, ear–nose–throat-associated (10%) or gastrointestinal/endocrinological (5%) disorders may contribute to the problem. In the case of halitophobia, psychiatrical or psychological problems may be present. Bad breath needs a multidisciplinary team approach: dentists, periodontologists, specialists in family medicine, ear–nose–throat surgeons, internal medicine and psychiatry need to be updated in this field, which still is surrounded by a large taboo. Multidisciplinary bad breath clinics offer the best environment to examine and treat this pathology that affects around 25% of the whole population. This article describes the origin, detection and treatment of halitosis, regarded from the different etiological origins.

Oral manifestations in chronic uremia patients

“…VSCs seem to be produced by Gramnegative anaerobic oral bacteria. 29 Hydrogen sulfide (H 2 S), methyl mercaptan (CH 3 SH), and dimethyl sulfide (CH 3 ) 2 S are the VSCs that are primarily involved in halitosis. In approximately 85% of cases, bad breath is due to intraoral factors that include the following: tongue coating, dry mouth, poor oral hygiene, and the presence of prostheses and periodontitis.…”

Efficacy of Oral Refresher Strip Containing Five Types of Essential Oils on Oral Malodor

“…Therefore, EOS was not effective in reducing the tongue coating score. This was because some previous researchers revealed that tongue coating is difficult to eliminate even with mechanical approaches [8].…”

“…[19]. However, CH 3 SH was also found in patients with healthy periodontal tissue with a lower concentration than in patients with periodontal disease because bacteria on the tongue surface can produce those gases [8].…”

“…That is why an EOS strip can be a promising alternative therapy to reduce physiological oral malodor. However, the strip cannot substitute for mechanical oral hygiene procedures like brushing since traditional oral hygiene methods still provide the most reliable way to eliminate physiological oral malodor [7,8].…”

“…Approaches that can be taken to eliminate physiological oral malodor are conducting proper oral hygiene measures such as tooth brushing, interdental flossing, and scraping the dorsum of the tongue to clean the tongue coating [7,8]. Tongue coating is a white layer lying on the dorsum of the tongue where anaerobic bacteria that can produce VSCs are embedded [7,9].…”