Oral Malodor
Question 1. Write short note on halitosis.
Or
Write short note on oral malodor.
Answer. Halitosis is the term used to describe noticeably unpleasant odor exhaled in breathing.
Classification of Halitosis
- Genuine Halitosis
- Physiologic halitosis
- Oral.
- Extraoral.
- Physiologic halitosis
- Pseudo-Halitosis
- Halitophobia.
Oral Malodor Etiology
Volatile sulphur compounds are the main cause of breadth malodor. These consist of hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Various other compounds which are implicated in etiology are putrescine, indole, skatole, butyric acid and propionic acid.
Unpleasant breadth is due to intraoral or extraoral causes which are as follows:
Read And Learn More: Periodontics Question And Answers
Causes for Physiologic Halitosis
- Mouth breathing
- Medications
- Aging and poor dental hygiene
- Fasting/Starvation
- Tobacco
- Foods and alcohol.
Causes for Pathologic Halitosis
- Periodontal infection: Odor from subgingival dental biofilm. Specific diseases such as ANUG and pericoronitis.
- Tongue-coating harbors microorganisms.
- Stomatitis, xerostomia.
- Faulty restorations retaining food and bacteria.
- Unclean dentures.
- Oral pathologic lesions such as oral cancer, candidiasis.
- Parotitis, clef palate.
- Aphthous ulcer, dental abscess.
Extraoral Causes
- Nasal infections: Rhinitis, sinusitis, post nasal drip, tumors and foreign bodies. Crypts of tonsils also lead to accumulation of microorganisms and putrefaction which produces malodor.
- Diseases of gastrointestinal tract: Zenker’s diverticulum, hiatus hernia, carcinomas, GERD and intestinal gas production.
- Pulmonary infections: Chronic bronchitis, pneumonia, tuberculosis and carcinomas.
- Hormonal changes: Hormonal changes occur during ovulation, menstruation, pregnancy and menopause.
- Systemic diseases: Various systemic diseases which contribute to halitosis are liver and kidney insufficiency, diabetes mellitus, renal failure, blood dyscrasias, rheumatologic diseases, dehydration, fever and liver cirrhosis.
Management of Halitosis
The treatment of halitosis is a step-by-step problem-solving procedure.
- The simplest way from distinguishing oral from nonoral origin is to compare smell from mouth and nose. If origin is from nose, patient is referred to concerned specialist and if origin is from mouth, patient is referred to the dentist for treatment.
- For genuine halitosis with oral causes, the treatment is as follows:
- Reduction of anabolic load by improving oral hygiene and basic periodontal health by basic dental care, if necessary incorporate advanced oral hygiene methods including oral irrigation and sonic or ultrasonic toothbrushes.
- If halitosis persists in spite of adequate conventional oral hygiene, tongue brushing is advised.
- Use of chlorhexidine mouth rinses causes reduction of microorganisms which leads to reduction of halitosis.
- Conversion of volatile sulphur compounds by using various metal ions. Zinc is an ion which bond to twice negatively charged sulphur radicals to reduce expression of volatile sulphur compounds. Halita is a new solution containing 0.55% Chlorhexidine, 0.05% cetyl pyridium chloride and 0.14% zinc lactate with no alcohol is more effient than 0.2 percent. Chlorhexidine formulation in reducing volatile sulphur compounds.
- Reduction of anabolic load by improving oral hygiene and basic periodontal health by basic dental care, if necessary incorporate advanced oral hygiene methods including oral irrigation and sonic or ultrasonic toothbrushes.
Question 2. Write short note on BANA Test.
Answer. BANA Test (N-benzoyl-DL-arginine-naphthylamide)
- BANA test is highly sensitive, inexpensive and is easy to use chair side test for periodontal risk.
- In just 5 minutes BANA test can detect bacteria associated with periodontal disease simply by applying tongue swabbing or sub – gingival plaques to a small test strip.
- BANA test is the modifiation of BANA hydrolysis test which is developed by Dr. Walter Loesche and colleagues at University of Michigan School of Dentistry.
- It exploits an unusual tyrosine like enzyme which is found in Treponema denticola, porphyromonas gingivalis and bacteroides forsythus, three anaerobic bacteria which are highly associated with adult periodontitis.
- Of 60 subgingival plaque species, only these three possess an enzyme capable of hydrolyzing the synthetic trypsin substrate, benzyol-DL-arginine-naphthylamide (BANA) present on the BANA test strips.
- If any of three species is present, they hydrolyze BANA enzyme producing B-naphthylamide which in turn reacts with embedded diazo dye to produce a permanent blue color which indicate a positive test.
How the Test Works
For periodontal risk assessment, subgingival plaque is obtained with a curett. Samples are placed on BANA test strip, which is then inserted into the slot on a small toaster-sized incubator. The incubator automatically heats the sample to 55°C for 5 minutes.
If P. gingivalis, B. forsythus or T. denticola are present, test strip turns blue. The blue it turns, higher is the concentration and the greater is the number of organisms.
Question 3. Write short note on etiology of halitosis.
Answer. Volatile sulphur compounds are the main cause of breadth malodor. These consist of hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Various other compounds which are implicated in etiology are putrescine, indole, skatole, butyric acid and propionic acid.
Unpleasant breadth is due to intraoral or extraoral causes which are as follows:
Intraoral Causes
Causes for Physiologic Halitosis
- Mouth breathing
- Medications
- Aging and poor dental hygiene
- Fasting/Starvation
- Tobacco
- Foods and alcohol
Causes for Pathologic Halitosis
- Periodontal infection:
- Actinobacillus actinomycetemcomitans, P. gingivalis, C. rectus and T. forsythia leads to pathogenesis of periodontitis and production of volatile sulphur compounds. Odor from subgingival dental biofim.
- As there is increase in the depth of periodontal pocket, the concentration of malodourous chemical increases. Deep pockets also lead to the formation of putrescine and cadavarine.
- Tongue-coating harbors microorganisms
- Dorsum of the tongue is the primary etiologic factor for halitosis.
- Since the dorsum of tongue is irregular, it accommodates microorganisms and the food debris.
- Both desquamated cells and the food remnants entrap over the surface and get decomposed which leads to halitosis.
- Stomatitis, xerostomia.
- Dry mouth causes volatile sulphur compounds to escape.
- Number of microorganisms which produce volatile sulphur compounds increase in the saliva.
- Faulty restorations retaining food and bacteria.
- Unclean dentures.
- Oral pathologic lesions: Such as oral cancer, candidiasis, infected extraction wounds, dental abscess and purulent discharge leads to malodor.
- Parotitis, clef palate
- Crowding of teeth: They leads to accumulation of food debris which produces halitosis.
Physiologic Halitosis Extraoral Causes
- Nasal infections: Rhinitis, sinusitis, post nasal drip, tumors and foreign bodies. Crypts of tonsils also lead to accumulation of microorganisms and putrefaction which produces malodor.
- Diseases of gastrointestinal tract: Zenker’s diverticulum, hiatus hernia, carcinomas, GERD and intestinal gas production.
- Pulmonary infections: Chronic bronchitis, pneumonia, tuberculosis and carcinomas.
- Hormonal changes: Hormonal changes occur during ovulation, menstruation, pregnancy and menopause.
- Systemic diseases: Various systemic diseases which contribute to halitosis are liver and kidney insufficiency, diabetes mellitus, renal failure, blood dyscrasias, rheumatologic diseases, dehydration, fever and liver cirrhosis.
Question 4. Write short note on diagnosis of oral malodor.
Answer. It is diagnosed under the following:
- By reviewing of medical, dental and personal history.
- Clinical examination
- Intraoral examination
- Coating of tongue
- Presence of mouth-breathing
- Xerostomia
- Other oral cause
- Complete periodontal examination
- Personal care and oral hygiene
- Evidence of neglect and past status of dental hygiene.
- Intraoral examination
- Measuring oral malodor: Before measuring, patient should be instructed not to rinse, eat, chew or smoke for two hours before measurement. Patients on antibiotic therapy should be seen two weeks after the discontinuation of medicine. Following are the tests used for measurement of oral malodor:
- Subjective organoleptic method: It is a benchmark for measurement of oral malodor.
- Halimeter: Measure the sulphide gas found in person’s breadth. It is very sensitive to alcohol, so one should avoid drinking alcohol before 12 hours of test.
- Gas chromatography: It is a monitor which digitally measure molecular level of three major volatile sulphur compounds in sample of mouth.
- Chemiluminescence: It involves mixing of sample containing sulphur compound with mercury which leads to florescence.
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