Halitosis: Cure Your Chronic Bad Breath Today!
Diagnosis and Treatment of Halitosis Jon L. Richter, DMD, Ph.d
Excerpted and edited by the author from his article of the same title published in Compendium, April 1996.
Introduction Most adults and many children suffer from bad breath (halitosis) occasionally, chronically or regularly at specific times of the day. Public awareness and concern for this phenomenon is evidenced by the support of an $850 million mouthwash industry in the United States despite wide agreement that commercially available products have no significant effect on halitosis.1
Physicians and dentists are generally poorly informed about the causes and treatments for halitosis. It is the purpose of this paper to review briefly our current understanding of the etiologies of halitosis and current developments in its diagnosis and treatment. The clinical techniques and strategies for diagnosis and treatment that are described below have been drawn from the research methods and results of Tonzetich2, Preti3, Rosenberg4, Yaegaki5 and Bosy6 as well as my own experience in treating over 600 hundred patients presenting with a chief complaint of “bad breath.”
Research reports about the etiologies of breath malodor agree that the vast majority of halitosis originates with the anaerobic bacterial degradation of sulfur containing amino acids within the oral cavity resulting in the emission of hydrogen sulfide (H2S), methyl mercaptan (CH3SH) and dimethyl sulfide (CH3SCH3), collectively referred to as volatile sulfur compounds (VSC)2-5,7. Therefore, it is most reasonably the responsibility of dentists to diagnose and manage breath malodor. When systemic or other non-oral etiologies are suspected, dentists must be prepared to prescribe the appropriate medical referrals. While there are many common non-oral diseases cited in the literature10, for which halitosis can be a symptom, halitosis typically occurs late in the pathogeneses of these diseases when other more obvious or more urgent symptoms are present7.11.12. Rapid onset and progressively intensifying breath malodor is suggestive of an infective process, possibly secondary to carcinomas or other localized pathologies in the airway8,11. However, patients with a sole, chief complaint of long-standing, chronic halitosis have, almost without exception, either an oral etiology for halitosis or no halitosis at all.
Imaginary Halitosis In dealing with patients seeking professional care for halitosis, one must be prepared to differentiate between those patients who emit above average malodor, those who emit average or near average malodor but are more sensitive to it, and those who emit below average or no odor but believe that their breath is offensive despite objective evidence to the contrary. In the former two cases treatment for malodor is warranted; in the latter it is not.
There are many patients who complain of chronic bad breath for whom no objective evidence of breath malodor can be identified8,13-17, Olfactory reference syndrome is a recognized psychiatric condition in which there occurs a somatization of some distress resulting in a belief on the part of the patient that an offensive odor emanates from . . . More on Halitosis
Chlorine Dioxide Mouthwash | Jon L. Richter, DMD, Ph.D
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