ORAL MALODORPALAK VORA 4TH B.D.S.

WHAT IA BREATH ODOR???IT IS DEFINED AS THE SUBJECTIVE

PERCEPTION AFTER SMELLING SOMEONES BREATH. IT CAN BE PLEASANT,UNPLEASANT OR EVEN DISTURBING IF NOT REPULSIVE. IF UNPLEASANT,THE TERM BREATH MALODOR,HALITOSIS OR BAD BREATH CAN BE APPLIED.

THEN WHAT IS ORAL MALODOR???IT HAS ITS NOT ORIGIN FROM ORALCAVITY

ONLY. THIS IS NOT ALWAYS THE CASE FOR ALL BREATH MALODOR. SO ITS TOO RESTRICTIVE.

WHAT IS HALITOPHOBIA???IN A SPECISL PATIENT CATEGORY,SUBJECTS

IMAGINE THEY HAVE BREATH MALODOR,THIS IS CALLED IMAGINARY BREATH ODOR OR HALITOPHOBIA. IT IS ASSOCIATED WITH OBSESSIVECOMPULSIVE DISODOR AND HYPOCHONDRIA.

WHO IS RESPONSIBLE???ITS MAINLY ORIGINATES FROM VOLATILE

SULFIDE COMPOUNDS(VSCs),ESPECIALLY HYDROGEN SULFIDE(H2S),METHYIMERCAPTAN(CH3SH),DI METHYISULFIDE[(CH3)2S] OTERS ARE DIAMINES,INDOL,SKATOLE,BUTYRIC ACID,PROPIONIC ACID.

THIS RESULT TROM THE PROTEOLYTIC

DEGRADATION BY ORAL MICROORGANISMS OF PEPTIDES PRESENT IN SALIVA,SHED EPITHELIUM,FOOD DEBRIS,GINGIVAL CREVICULAR FLUID. MAINLY GRAM-VE AMAEROBIC BACTERIA POSSESS SUCH PROTEOLYTIC ACTIVITY. SO,COMMON CAUSE IS TISSUE DISTRUCTION AND PUTREFACTION OF AMINO ACIDS BY BACTERIAS.

WHATS THE CAUSE???IT CAN BE INTAORAL OR EXTRAORAL. INTRAORAL---

GINGIVITIS,PERIODONTITIS,TONGUE COATING ETC. EXTRAORAL---ENT PATHOLOGY,DIABETES,HORMONEA PROBLEMS,HEPATIC OR RENAL INSUFFIENCY,BRONCIAL CARCINOMA OR GASTROENTROLOGI PATHOLOGY .

INTRAORAL DENTITIONDEEP CARIOUS LESIONS WITH FOOD

IMPACTION AND PUTRIFICATION,EXTRACTION WOUND FILLED WITH BLOOD CLOT,PURULENT DISCHARGE,INTERDENTAL FOOD IMPACTION,ACRYLIC DENTURE WHEN KEPT IN THE MOUTH AT NIGHT OR NOT REGULARLY CLEANED.

BACTERIAS ASSOCIATED WITH GINGIVITIS AND

PERIODONTITIS ALMOST ALL ARE GRAM-VE AND ARE KNOWN TO PRODUSE VSCs. THIS ARE MAINLY PORPHYROMONAS

GINGIVALIS,PREVOTELLA INTERMEDIA,ACTINOBACILLUS ACTINOMYCETUMCOMIYANS ETC.

THE LOW TENTION IN DEEP PERIODOTAL POCKETS ALSO RESUTS IN A LOW PH AN ACTIVATION OF THE DECARBOXYLATION

VSCc THEMSELVES AGGRAVATE THE

PERIODONTITIS PROCESS;THEY INCREASES THE PERMIABILITY OF THE PERIODINYAL AND MUCOSAL EPTHELIUN AND THEREFORE EXPOSE THE UNDERLYING CONNECTIVR TISSUE TO BACTERIAL METABOLITES. VSCs ARE ALSO KNOWN TO IMPED WOUND HEALING,THUS PERIODONTAL SURGRY IS PLANNED CLINITIAN SHOULD RECOGNIGE THIS PATHOLOGIC ROLL OF VSCs.

DRY MOUTHPATIENT WITH XEROSTOMIA OFTEN PRESENT

WITH LARGE AMOUNT OF PLAQUE ON THE TEETH,PROSTESES,TOUGUE DORSUM. THUS INCREASED MICRORIAL LOAD AND THE ESCAPE OF VSCs AS GASES WHEN SALIVA IS DRYING UP EXPLAIN THE STRONG BREATH MALODOR.

TONGUE COATINGTHE DORSUM OF THE TONGUE WITH THE AREA

OF 25CM2 SHOWS VERY IRREGULAR SURFACE TOPOGRAPHY . THE POSTERIOR PART EXHIBITS A NUMBER OF ORAL CRYPTOLYMPHATIC UNITS,WHICH ROUGHEN THE SURFACE OF THIS AREA. THE ANTERIOR PART IS EVEN ROUGHER BECAUSE OF HIGH NUMBER OF PAPILLA.

THIS DEPRESSIONS IN THE TONGUE SURFACE

ARE IDEAL NICHES FOR BACTERIAL ADHRSION AND GROWTH. A FISSURATED TONGUE AND A HAIRY TONGUE HAVE SN EVEN ROUGHER SURFACE. SO ,THE DORSUM PF THE TONGUE IS THE PRIMSRY SOURSE FOR ORAL MALODOR.

ENTTHIS INCLUDE---ACUTE PHARINGITIS,PURULENT

SINUSITIS,POST NASAL DRIP,REGURGITATION ESOPHAGITIS,OZENA,TONSILITIS,TONSILLOLIT HS,FOREIGN BODY IN NASAL OR SINUS CAVITY.

BRONCHI AND LUNGSTHIS INCLUDE CHRONIC

BRONCHITIS,BRONCHIECTESIS,BRONCHIAL CARSINOMA ETC.

GITZENKERS DIVERTICULUM,GASTRIC

HERNIA,REGURGITATION ESOPHAGITIS,INTESTINAL GAS PRODUCTION.

KIDNEY,LIVERCHONIC GLOMRRULONEPHRITIS WILL LEAD TO

INCREASED URIC ACID LEVEL IN THE BLOOD WHICH IS EXPRESSED IN THE EXPIRED AIR WITH A TYPICAL AMMONIUM-LIKE BREATH. IN CIRROSIS AMMONIUM WILL ACCUMULATE IN THE BLOOD AND WILL BE EXHALED.

SYSTEMIC METABOLIC DISODORSTYPE 1 DIABETES CAN RESULT IN THE

PROGESTERON LEVEL DURING ACCUMULATION OF KETONS LIKE ACETOACETATE,HYDRXYBUTYRATE.

HORMONALDURING MENSTRUATION CYCLE TYPICAL ODOR CAN BE DEVELOPED.

WITH INCRASED LEVEL OF PROGESTERON

MEDICATIONMETRONIDAZOLE,EUCALYPTUS CONTAINING

DRUS,ARSENIC SMELLS OF ROTTER ONIONS.

PHYSIOLOGYTHIS INCLUDE---OLFACTORY RESPONSE,ODOR

POWER,VOLATILITY,THRESOLD CONCENTRATION.

DIAGNOSISMEDICAL,DENTAL,PERSONAL HISTORY--LISTEN TO THE PATIENT AND THE PATIENT

WILL TELL YOU THE DIAGNOSIS THIS INCLUDE FREQUENCY,TIME OF APPEARANCE,WHETHER OTHERS HAVE IDENTIFIED THE PROBLEM,MEDICATION,DRYNESS ETC.

CLINICAL EXAMINATION1)INTRAORAL-TONGUE COATING,EVIDENCE OF

MOUTH BREATHING,XEROSTOMIA,ETC. 2)COMPLETE PERIODONTAL EXAMINATIONGENERAL PERSONAL CARE,STATE OF ORAL HYGIENE,PROBING FOR ATTACHMENT LEVELS,EVIDENCE OF NEGLETE,PAST HISTORY OF DENTAL HYGIENE CARE,ETC.

SELF EXAMINATIONSMELLING A METALLIC OR NONODOUROUS

SPOON AFTER SCRAPING THE BACK OF THE TONGUE. SMELLING A TOOTHPICK AFTER INTRODUCING IN THE INTERDENTAL AREAS SMELLING SALIVA SPIT IN A SMSLL CUP OR SPOON AFTER DRYING UP. LICKING THE WRIST AND ALLOWING IT TO DRY .

ORGANOLEPTIC RATINGIT IS THE GOLD STANDARD IN THE

EXAMINATION OF BREATH MALODOR. 0=NO ODOR PRESENT 1=BARELY NOTICIBLE ODOR 2=SLIGHT BUT CLEARLY NOTICIBLE ODOR 3=MODERATE ODOR 4=STRONG OFFENSIVE ODOR 5=EXTREMELY FOUL ODOR.

SPECIFIC CHARACTERROTTEN EGGS=VSCs SWEET ODOR=DEAD MICE=LIVER

INSUFFINCIENCY ROTTEN APPLE=UNBALANCED INSULIN DEPENDANT DIABETES. FISH ODOR=KIDNEY INSUFFIENCY .

LAB EXAMINATIONGAS CHROMATOGRAPHY DARK FIELD OR PHASE CONTRAST

MICROSCOPY. SALOVA INCUBATION TEST. ELECTRIC NOSE. HELIMETERS. BANA TEST. CHEMILUMINESCENCE.

TREATMENTIT IS MAINLY CAUSE RELATED. GENERAL TREATMENT STRATEGIES 1)MECHANICAL REDUCTION OF INTRAORAL

NUTRIENTS AND MOCROORGANISMS. CLEANSING OF THE TONGUE CAN BE CARRIED OUT WITH A NORMAL TOOTH BRUSH,BUT PREFERABLY WITH A TONGUE SCRAPER AS FAR BACKWARD AS POSSIBLE BUT SHOULD BE GENTLE TO PREVENT SOFT TISSUE DAMAGE.

IT CAN BE CARRIEDOUT WITH GAUSE PAD

ALSO IT ALSO IMPROVE TASTE SENSATION. INTERDENTAL CLEANING AND TOOTHBRUSHING ARE ASSENTIAL MECHANICAL MEANS OF DENTAL PLAQUE CONTROL.

IT REMOVES FOOD PARTICLES AND ORGANISMS

THAT CAUSES PUTREFACTION. CHEWINGTE GUM MAY CONTROL BAD BREATH TEMPORARILY BECAUSE IT CAN STIMULATE SALIVARY FLOW.

2)CHEMICAL CONTROL1)CHLORHEXIDINE-IT IS THE MOST EFFECTIVE

ANTIPLAQUE AND ANTIGINGIVITIS AGENT. ITS ANTIBACTERIAL ACTION CAN BE EXPLAINED BY DISRUPTION OF BACTERIAL CELL MEMBRANE BY CHLORHEXIDINE MOLECULE,INCREASES ITS PERMIABILITY AND RESULTING IN CELL LYSIS AND DEATH.

HALITAIT CONTAINS 0.05%CHLORHEXIDINE,0.14%ZINC

LACTATE,0.05%CPC,NO ALCOHOL ITS MORE EFFECTIVE THAN CHLORHEXIDINE.

2)ESSENTIAL OIL-LISTERINE RINSE HAS SHORT

TERM(3 HOURS)EFFECT. LISTERINE WAS FOUND TO BE ONLY RELATIVELY EFFECTIVE AGAINST ORAL MALODOR AND CAUSES SUSTAIN REDUCTION IN THE LEVEL OF ODORIGENIC BACTERIAS.

3)CHLORINE DIOXIDE-CLO2-ITS A POWERFUL

OXIDATING AGENT THAT CAN ELIMINATE BAD BREATH BY OXIDATION OF HYDROEN SULFIDE,METHYLEMERCAPTAN AND OTHER AMINO ACIDS. 4)TWO PHASE OIL WATER RINSE-IT CONTAIN CPC WHICH HAS DAYLONG REDUCTION IN ORAL MALODOR.

THE EFFICACY OF OIL WATER CPC

FORMULATION IS TJOUGHT TO RESULT FROM THE ADHESION OF HIGH PROPORTION OF ORAL MICROORGANISMS TO THE OIL DROPLETS,WHICH IS FURTHER ENHANCED BY CPC. ITS COMPARABLE TOCHLORHRXIDINE,SUPERIOR TO LISTERINE AND PLACEBO.

5)TRICLOSAN-ITS A BROAD SPECTRUM

ANTIBACTERIAL AGENT FOUND TO BE EFFECTIVE AGAINST MOST ORAL BACTERIAS. 6)AMINO/STANNOUS FLOURIDE-IT REDUSES THE MORNING BREATH ODOR. 7)HYDROGEN PEROXIDE-3%H2O2 REDUSES SULFER GASES THAT PERSISTED FOR 8 HOURS. 8)OXIDIZING LOZENGES-REDUSES TONGUE DORSUM MALODOR FOR 3 HOURS.

3)CONVERSION OF VOLATILE S COM.1)METAL SALT SOLUTIONS-METAL IONS WITH

AFFINITY FOR SULFUR ARE RATHER EFFECTIVE IN CAPTURING THE SULFER CONTAINING GASES. ZINC IS AN ION WITH TWO +VE CHARGES WHICH WILL BIND TWO THE TWICE VELY LOADED SULFER RADICALES AND REDUSES THE EXPRESSION OF VSCs SAME IS APPLIED FOR MERCURY AND COPPER.

2)TOOTH PASTE-BAKING SODA CONTAINING

DENTIFRICES HAVE TO BE EFFECTIVE FOR 3 HOURS. 3)CHEWING GUM-IT CAN BE FORMULATED WITH ANTIBACTERIAL AGENTS SUCH AS FLUORIDE AND CHLORHEXIDINE. SO,IT HAS BOTH MECHANICAL AND CHEMICAL APPROACHES. IT CONTAINS TEA EXTRACTION EPIGALLOCATCHINE FOR ITS DEODORIZING AGENT. IT HAS EMMEDIATE REDUCTION IN VSCs LEVEL.

4)MASKING THE MALODORIT INCLUDE RINSES,MOUTH SPRAYS,MINT CONTAINING

LOZENGES,LOW THE PH OF SALIVA,INCREASES THE SECRETION OF SALIVA BY USING CHEWING GUM,ORANCE JUICE.