Oral Malodor or Halitosis or Bad Breath: Classification, Etiology, Diagnosis, Management | Dentistry. What is Oral Malodor or Halitosis or B...

Oral Malodor or Halitosis or Bad Breath: Classification, Etiology, Diagnosis, Management | Dentistry.

What is Oral Malodor or Halitosis or Bad Breath?

Oral Malodor is the unpleasant odour or smell come out from our mouth while breathing or talking. Oral Malodor or Halitosis is also known as Bad Breath. It is the medical term used to describe the Bad breath. These oral Malodor are not only arised due to not brushing our teeth, there are numerous etiological factors are behind the Oral Malodor.

Etiology of Oral Malodor/Halitosis/Bad Breath

We can divide the Etiological Factors into Physiological and Pathological. Now, We Can See the both in detail.

Causes for Physiological Halitosis

Mouth Breathing is the most common physiological factor for Halitosis. Halitosis is most commonly seen in those who breath through mouth instead of nose. Certain Drugs intake can cause bad odour from the mouth. This is because, over medications can cause ulceration in the stomach, which further causes bad breath. Fasting/Starvation is another most common factor for the bad breath. It is the same mechanism like the medication intake. Tobacco, Smoking, Foods and Alcohol are responsible for the Halitosis. Poor Oral Hygiene is also Known factor for Halitosis.

Causes for Pathological Halitosis

If a person suffering from periodontal infections such as ANUG and Pericoronitis, there is high chances of Oral Malador. It is also seen in the condition of Xerostomia and Stomatitis. And the accumulation of food in the faulty restoration causes bad breath. Unclean dentures also can cause halitosis. Oral pathological lesions such as candidiasis and oral cancer in which halitosis is seen. Dental abscess and Aphthous ulcers are favourable for the Halitosis.

Classification of Oral Malador/ Halitosis/ Bad Breath

It is Broadly Classified into two types. They are

I. Genuine Halitosis

a.  Physiologic Halitosis

     (i) Oral

     (ii) Extra Oral

II. Pseudo-Halitosis

a. Halitophobia 

Diagnosis of Oral Malodor/ Halitosis/ Bad Breath

First of all diagnosis involves taking proper case history which includes medical, dental and personal history of the patient. Then we can go further to the clinical examination, where we take Intra oral examination and complete periodontal examination. Then the last step is to measure the oral malodor with some instruments related to halitosis.

Intra-oral examination involves examining the coating of tongue, present of mouth breathing or not, Xerostomia is present or not, and find out the other oral causes. Whereas, periodontal examination involves the personal care and oral hygiene of the patient.

As i told earlier, measuring oral malodor is done with certain equipments related to halitosis. Before we start the measurement, patient should avoid eating, chewing and smoking two hours prior to the measurement. If patients taking some medications such as antibiotics, they should come once, they discontinued medications for two weeks. Following are the tests used in the measurement of Oral Malodor or Halitosis.

Halimeter

It is used to detect the sulphur compounds in the breath, which is behind the present of bad odour. It is sensitive to alcohol, so patient avoid alcohol before the measurement.

Chemiluminescence

It is the method, in which the sample breath is collected and mixed with the mercury, if patient has bad odour, it leads to fluorescence.

Subjective organoleptic method

It is the most common test for detecting or measuring oral malodor.

BANA Test

BANA stands for N-benzoyl-DL-arginine-naphthylamide. Some bad odour producing micro organisms such as P.gingivalis, T.denticola and B.forsythus produces quite waste products. Those waste products can easily breakdown the compound N-benzoyl-DL-arginine-naphthylamide. If a sample containing these micro organisms are placed in the BANA testing, it results in breakdown of compounds and colour change indicates positive reactions.

Gas Chromatography is the another method to measure the oral malodor.

Management of Oral Malador or Halitosis

Before managing the halitosis, we have to determine where the bad odour is come from, whether it is from nose or mouth. If it is from nose, patient are referred to the concerned specialist and if it is from mouth, patient is referred to the dentist for further treatment.

Management involves suggesting proper tooth brushing. If halitosis present even after proper tooth brushing, then tongue brushing is advised. Chlorhexidine mouth wash is recommended to maintain good oral environment. Halita is the solution containing Chlorhexidine (0.55%), Zinc Lactate (0.14%) and Cetyl Pyridium (0.05%) with Zero Percent Alcohol is effective in Halitosis.