2. • The term halitosis is a general term used to describe any disagreeable
odor of expired air, regardless of its origin.
• Halitus: Breath Osis: Disease
• In a study done in the United States,
the prevalence of halitosis was found
to be 10% to 30%.
• Further, it was noted that around 87% of cases with
halitosis had oral causes associated with the condition
INTRODUCTION
4. DEFINITION:-
• Halitosis is also termed as fetor ex ore or fetor oris. It is a foul
or offensive odor emanating from the oral cavity.
- Carranza's clinical periodontology 10th edition
11. SOME DRUGS THAT CAUSE HALITOSIS
• Chloral hydrate
• Nitrites and nitrates
• Dimethyl sulfoxide
• Disulfiram
• Cytotoxic agents
• Phenothiazines
• Amphetamines
12. DIAGNOSIS
Self-Assesment test Objective tests
• Organoleptic measurement
• Gas chromatography (GC)
• Sulphide monitoring
• Electronic nose
• BANA test
• Tongue coating index
• Dark Field or Phase Contrast
Microscopy
• Saliva Incubation Test
• Whole mouth malodor
• Wrist lick test
• Spoon Test
• Dental floss test
13. WHOLE MOUTH MALODOR
The subjects are instructed to smell the odor emanating from
their entire mouth by cupping their hands over their mouth
and breathing through the nose. The presence or absence of
malodor can be evaluated by the patient himself/herself.
14. WRIST LICK TEST
Subjects are asked to extend their tongue and lick
their wrist in a perpendicular fashion. The presence of
odor is judged by smelling the wrist after 5 seconds at
a distance of about 3 cm.
15. SPOON TEST
Spoon test is used to scrape and scoop material from
the back region of the tongue. The odor is judged by
smelling the spoon after 5 seconds at a distance of
about 5 cm organoleptically.
17. ORGANOLEPTIC MEASUREMENT
Rosenberg and McCulloch (1992) *GOLD STANDARD
It is a subjective test scored on the basis of the examiner’s perception
of a subject’s oral malodor. The organoleptic measurement can be
carried out by sniffing the patient’s breath and grading the level of
halitosis.
PATIENT
• Refrain from using deodorants or
fragrances six hours prior to the visit to
the clinic.
• At least 12 h before the consultation, teeth
should not be cleaned or rinsed.
• Smoking should be stopped at least 24
hour before any examination
EXAMINER
• Should have a normal sense of smell.
• He/she should avoid drinking coffee,
tea or alcohol, abstain from smoking
and the use of perfumes and scented
cosmetics should be strictly avoided.
• While doing this test, different samples
are analyzed from each patient.
18. Organoleptic rating:
1) Spoon test
2) Tongue coating test
3) Interdental ‘floss’
test
4) Nasal odor test
5) Prosthesis odor test
Test:
19. GAS CHROMATOGRAPHY
Measurement of VSC’s is done on samples of
saliva, tongue coating or expired breath.
Oral Chroma
• Plastic syringe which is placed deep in the
oral cavity and patient is asked to make a
tight lip seal around the syringe.
• The plunger is gently pulled and then pushed
back. The procedure is repeated again and
the syringe is taken out of the mouth.
• The needle is dried and the gaseous contents
of the syringe are injected into the inlet of
the main unit of the Oral Chroma.
20. VOLATILE SULFIDE MONITOR
• Portable chair side equipment used to assess
oral malodor.
• Cost effective and easy to use.
• The monitor is equipped with a transparent tube that
carries the exhaled breath of the patient to a suction
pump which in turn carries the air to the monitor.
• The machine then analyses the sulfur content in the air.
21. ELECTRONIC NOSE
Automated detection and classification of odors, vapors,
and gasses. The system is a hand-held device that rapidly
classifies the chemicals in the unidentified vapor.
22. BANA TEST
• Benzoyl-DL-arginine-2 naphthylamide
• Bacterial culture and smear
• Samples taken from oral cavity are
cultured and the bacterial species present
in the sample are identified.
• Bacterial species which can produce VSC’s
can be identified by this method.
• T. denticola, B. forsythus and P.
gingivalis
23. MANAGEMENT
Mechanical reduction of intraoral nutrients and micro-
organisms.
Chemical reduction of oral microbial load
Rendering malodorous gases nonvolatile
Masking the malodor
24. Mechanical reduction of intraoral nutrients and micro-organisms.
• Tongue cleaning
• Tooth brush
• Inter-dental cleaning
• Professional periodontal therapy
• Dietary Recommendation
