Smell It Like It Is: Addressing Halitosis

Transcription

1 Smell It Like It Is: Addressing Halitosis Tracey Jacobs, BSDH, RDH Manager, Professional Education South Tracey is a graduate of the University of Alabama School of Dentistry with a Bachelor s of Science in Dental Hygiene. Addressing The Elephant In The Room 50-80% adults experience halitosis Ancient Egyptians used herbs and spices Jewish text, Talmud granted rights for divorce over bad breath Halitosis Most common dental concern 90% originates from oral cavity 13% results from gingivitis or periodontitis 10% systemic 5% sinus 5% other etiologies Old Paradigm She is a member of the American Dental Education Association, American Dental Hygienists Association and American Academy for Oral Systemic Health. Having served several leadership positions including President of the Florida Dental Hygiene Association, she is most noted for her dedicated service as the FDHA Event Planner and awarded the FDHA Distinguished Service Award. Tracey manages the South region for Philips and presents a variety of educational programs nationwide. With over 25 years of clinical experience _

2 Physiologic < > Pathologic Relativity Subject to variations May fluctuate within hours Multi-factorial Classifications 1) Oral Halitosis Tongue Periodontal Pockets >4mm 2) Airway Halitosis Respiratory Tract Rhinosinusitis Tonsillitis Pharyngitis Laryngitis Bronchitis Pneumonia Post Nasal Drip Rhinorrhea Tonsils Tonsilloliths aka Tonsil Stones 3) Gastroesophageal Halitosis Odor from stomach leakage Gastric reflux: reflux of gastric juice, bacteria and digested food into pharynx Some studies reveal a correlation btw H. pylori and halitosis 4) Blood borne Halitosis: volatile chemicals in systemic circulation transfer to exhaled breath Systemic Diseases Lung Diseases: Lung Carcinoma, Chronic Obstructive Pulmonary Disorder Sickle Cell Anemia Sleep Apnea Cirrhosis Kidney Disease & Failure Some Cancers i.e. Breast Cancer

3 4) Blood borne Halitosis: volatile chemicals in systemic circulation transfer to exhaled breath II. Metabolic Disorders Diabetes Trimethylaminuria TMAU: body is unable to break down TMAU, a compound derived from diet that has a strong odor of rotting fish. III. Food Temporary Halitosis: spicy foods, garlic, onions, coffee, alcohol Crash Diets or Fasting Protein Digestion IV. Medications Antibiotics Anti-depressants Anti-Hypertensives Anti-Allergic Sedatives/Hypnotics Alcohol/Tobacco Recreational Drugs (Amphetamines) 5) Subjective Halitosis: complaint without an objective confirmation by someone else or a halimeter. Psychologic Obsessive Compulsive Disorder Neurologic-Side effects of medications, hypothyroidism, hyposalivation, nutrient deficiency, trauma or tumors of brain, nerve damage, neurodegenerative diseases, environmental pollutants, drug abuse, diabetes, GERD, blood-borne stimulation of taste and smell receptors in blood circulation. Call to Action: Update health questionnaire to inquire about halitosis concerns.

4 Volatile Sulfur Compounds (VSC) Gases produced from gram ( ) bacteria on tongue surface Responsible for 80-90% of oral malodor Primary Gases: Hydrogen Sulfide (HS) = Rotten Egg Smell Methyl Mercaptan (MM) = Feces Smell Dimethyl Sulfide (DS) = Cabbage/Gas Smell Did you know methyl mercaptan is associated with the smell of periodontal disease? Subjective Diagnosis Method 1)Organoleptic (Human Nose) 2)Spoon Test Rosenberg Scale 3)Floss Test Objective Diagnosis Method Instrumental Assessment 1) Gas Chromatography Measures all gases Highly sensitive Large equipment Expensive

5 Objective Diagnosis Methods Instrumental Assessment Continued 2) Sulfide Monitors OralChroma Detects/differentiates primary VSCs Highly sensitive to VSCs Halimeter - Not sensitive to VSCs Breathtron - Detects total VSCs Disadvantages Cost $2,400 $5,000 Needs routine calibration Sensors need replacement every 2 years Chemical Sensors-Electronic Nose VSCs generate electrochemical voltage Voltage is measured by electronic unit Measures all VSCs separately Saliva Test BANA-detects treponema denticola, P. gingivalis, and T. forsynthensis Amine-detects protein breakdown Beta-galactosidase-detects glycoproteins Saliva Incubation-organoleptic measures are performed after incubation Advantages: inexpensive, can detect perio pathogens and/or halitosis Disadvantage: pathogens mainly linked to periodontitis, not all who have periodontal disease suffer from halitosis and vice versa. Hiding Behind The Mask $2 billion/year for short-term effects 49% rinse with mouthwash 70% chew gum 75% brush teeth

6 Treatment Regimen TN 1: Explanation of halitosis and OHI TN 2: Prophylaxis, SRP, necessary dental tx TN 3: Referral to physician and/or specialist TN 4: Halitosis education, instructions, and reassurance TN 5: Referral to psychologist or psychiatrist Treatment Solutions Homeopathic Herbs-mint, parsley, fennel seed, cinnamon Zinc-lozenges to neutralize VSCs Oil Pulling-lauric acid in coconut oil has antimicrobial properties Probiotics-studies show helpful to reduce oral malodor Chemical Solutions Prescription Rx Chlorhexidine Gluconate OTC VSC Neutralizers: Zinc, Chlorine Dioxide Antibacterial Agents: CPC, Essential Oils, Triclosan Mechanical Solutions Tongue coating = 80-90% halitosis Tongue brushing and cleaning lowers VSC levels Most Effective System: Brush > Scrape >Rinse Call to Action: Incorporate A Breath Management System

7 Resources 1. Rayman S, Almas K. Halitosis among racially diverse populations: An update. Int J Dent Hyg 2008;6: Aydin, Murat, and C. N. Harvey-Woodworth. "Halitosis: a new definition and classification." British Dental Journal (2014): E1-E1. 3. Soares, L. G., and E. M. B. Tinoco. "Prevalence and related parameters of halitosis in general population and periodontal patients." OA Dent 2 (2014): Nunes, Jonas Cameira, et al. "Halitosis: Are dentists being prepared for this challenge? A questionnaire survey in a dental school." Revista Portuguesa de Estomatología, Medicina Dentária e Cirugia Maxilofacial 52.3 (2011): Rosenberg M. The science of bad breath. Scientific American. 4: Scully G et al: Breath odor: etiopathogenesis, assessment and management, Euro J Oral Sci 105: , Porter SR, Scully C. Clinical review on oral malodor (Halitosis). BMJ 333(7569): Azodo CC, Osazuwa-Peter, N., Omili, M. Psychological and social impacts of halitosis: A review. J Soc Psychol Sci. 3: IPSOS, Philips Oral Health Care U & A Study, Dec J Nat Sci Biol Med Jan-Jun; 4(1): Quirynen M, Dadamio J, Van den Velde S, De Smit M, Dekeyser C, Van Tornout M and Vanderkerckhove B 2009 Characteristics of 2000 patients who visited a halitosis clinic J. Clin. Periodontol. 14.Zalewska A, Zatoñski M, Jabłonka-Strom A, Paradowska A, Kawala B, Litwin A. Halitosis--a common medical and social problem. A review on pathology, diagnosis and treatment. Acta Gastroenterol Belg. 2012;75: Miyazaki H, et al. "[Tentative classification of halitosis and its treatment needs] (Japanese)". Niigata Dental Journal 1999;32: Tangerman A, Winkel EG. Extra-oral halitosis: an overview. J Breath Res Mar;4 (1): Panicker K, Devi R, Honibald EN, Prasad AK. Oral malodor: A review. J Indian Acad Dent Spec Res (2015);2: Danser, MM et al. Tongue coating and tongue brushing: a literature review. International Journal of Dental Hygiene (Landmark study references by many others) 19. Pratibha, PK. Oral Malodor: A Review of the Literature. Journal of Dental Hygiene, Vol. 80, No. 3, July Suzuki, N. et al. Evidence-Based Control of Oral Malodor. Emerging Trends in Oral Health Sciences and Dentistry. Chapter Yaegaki K, Sanada K. Volatile sulfur compounds in mouth air from clinically healthy subjects and patients with peri odontal disease. J Periodontol Res Jul;27(4 Pt 1): M. Ferguson, M. Aydin. and J. Mickel. Halitosis and the Tonsils: A Review of Management. Otolaryngology Head and Neck Surgery 2014, Vol. 151(4) American Academy of Otolaryngology Head and Neck Surgery Foundation Bernie, KM. Oral Malodor and Diagnosis and Management. Mosby, Chapter 38. pp Kopoor, Anoop et al. Halitosis Revisited. Indian Journal of Dental Sciences. December 2011 Issue:5, Vol.:3

8 Resources Continued 26. Salvatore Corrao. Halitosis: new insight into a millennial old problem. Intern Emerg Med (2011) 6: DOI /s Received: 3 January 27. Porter, Stephen R. "Diet and halitosis." Current Opinion in Clinical Nutrition & Metabolic Care 14.5 (2011): Motta LJ, Bachiega JC, Guedes CC, Laranja LT, Bussadori SK. Association between halitosis and mouth breathing in children. Clinics. 2011;66(6): doi: /s Aylıkcı, Bahadır Uğur, and Hakan Çolak. Halitosis: From Diagnosis to Management. Journal of Natural Science, Biology, and Medicine 4.1 (2013): PMC. Web. 3 Aug McNamara TF, Alexander JF, Lee M. The role of microorganisms in the production of oral malodor. Oral Surg Oral Med Oral Pathol 1972;34: Ratcliff Pa, Johnson PW. The relationship between oral malodor, gingivitis, and periodontitis. A review. J Periodontol 1999;70: Kotti, Subramanyam. Oral Malodor: A Review of Etiology and Pathogenesis. Journal of Dr. NTR University of Health Sciences 2015;4(1) Laleman, Isabelle, et al. "Instrumental assessment of halitosis for the general dental practitioner." Journal of breath research 8.1 (2014): Bosy, A., Kulkarni, G. V., Rosenberg, M., & McCulloch, C. A. G. (1994). Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations. Journal of periodontology, 65(1), Bartold, M. Simple Solutions for Breath Malodor : Dimensions of Dental Hygiene. January 2015;13(1):56 58, Suzuki, Nao, Masahiro Yoneda, and Takao Hirofuji. "Evidence-based control of oral malodor." Emerging Trends in Oral Health Sciences and Dentistry. InTech, Singh, Abhinav, and Bharathi Purohit. "Tooth brushing, oil pulling and tissue regeneration: A review of holistic approaches to oral health." Journal of Ayurveda and integrative medicine 2. (2011): Young, Alix, Grazyna Jonski, and Gunnar Rölla. "Inhibition of orally produced volatile sulfur compounds by zinc, chlorhexidine or cetylpyridinium chloride effect of concentration." European journal of oral sciences (2003): Aung, Ei Ei, et al. "Effectiveness of three oral hygiene regimens on oral malodor reduction: a randomized clinical trial." Trials 16.1 (2015): Seemann, Rainer, et al. "Halitosis management by the general dental practitioner results of an international consensus workshop." Journal of breath research 8.1 (2014): Kuo, Ya-Wen, et al. "Toothbrushing versus toothbrushing plus tongue cleaning in reducing halitosis and tongue coating: a systematic review and meta-analysis." Nursing research 62.6 (2013): Pedrazzi, Vinícius, et al. "Tongue-cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper." Journal of periodontology 75.7 (2004): Nachnani, Sushma. "Oral malodor: Causes, assessment, and treatment." Compend Contin Educ Dent 32.1 (2011): Cleaing_Methods_A_Comparative_Clinical_Trial_Employing_a_Toothbrush_and_a_Tongue _Scraper/links/ f0cf26ff55f7fcba5.pdf 45. Saad, Saliha, et al. "Daily reduction of oral malodor with the use of a sonic tongue brush combined with an antibacterial tongue spray in a randomized cross-over clinical investigation." Journal of breath research 10.1 (2016):