Oral malodour or halitosis (Latin halitus = breath) describes any disagreeable breath odour. Genuine halitosis is where breath malodour is verified objectively. Pseudo-halitosis is where objective evidence of malodour is unobtainable. Halitophobia is where patients persist in believing they have halitosis despite firm evidence for absence of it.
Malodour originates from the mouth, mainly from poor oral hygiene, ulcers or infections, in about 85% of patients affected. Halitosis is much less frequently associated with extra-oral causes (e.g. respiratory, gastrointestinal, hepato-renal drugs, metabolic).
The odiferous products responsible appear to be (partly) produced endogenously and/or in the mouth and usually arise from microbial action involving a range of micro-organisms. They include volatile sulphur compounds - VSCs (such as hydrogen sulphide and methylmercaptan) - indoles such as indole and skatole, and polyamines (putrescine and cadaverine). Short chain fatty acids (e.g. valerate, propionate and butyrate) may also arise. Acetone, 2-butanone, 2-pentanone and 1-propanol may appear in both mouth and alveolar (lung) air, with indole and dimethyl selenide in alveolar air.
Assessment of halitosis is usually based upon organoleptic assessment of exhaled air - the clinician sniffs air exhaled from the mouth and nose – most apparently objective measurements of halitosis are expensive and time-consuming. Oral and extraoral causes of malodour must be identified and treated.
Smoking, drugs, and foods that might be responsible for malodour should be avoided. Regular meals are important. Current treatment is directed towards reducing accumulation of food debris and malodour-producing oral bacteria, achieved by treating oral/dental diseases, improving oral hygiene - tooth cleaning (brushing and interdental flossing) and use of antimicrobial toothpastes and/or mouthwashes (chlorhexidine, ceptylpyridinium, zinc, stannous or triclosan products may be beneficial), by stimulating salivation (chewing gum), and reducing the tongue coating by brushing/scraping. Emerging strategies are mainly directed against the bacteria, their metabolism, or their odiferous products. |
