Tracey Jacobs, BSDH, RDH Manager, Professional Education South

tracey.jacobs@philips.com

Tracey is a graduate of the University of Alabama

School of Dentistry with a Bachelor’s of Science in Den-

tal Hygiene.

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 pre-

sents a variety of educational programs nationwide.

With over 25 years of clinical experience

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Smell It Like It Is: Addressing Halitosis

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

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 Ob-structive Pulmonary Disorder

Sickle Cell Anemia

Sleep Apnea

Cirrhosis

Kidney Disease & Failure

Some Cancers i.e. Breast Cancer

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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, hypothy-roidism, hyposalivation, nutrient deficiency, trau-ma or tumors of brain, nerve damage, neuro-degenerative diseases, environmental pollutants, drug abuse, diabetes, GERD, blood-borne stimula-tion of taste and smell receptors in blood circula-tion.

Call to Action:

Update health ques-tionnaire to inquire about halitosis con-cerns.

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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

3)Floss Test

Objective Diagnosis Method

Instrumental Assessment

1) Gas Chromatography

Measures all gases

Highly sensitive

Large equipment

Expensive

www.beathalitosis.com

Rosenberg Scale

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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 per-formed after incubation

Advantages: inexpensive, can detect perio patho-gens and/or halitosis

Disadvantage: pathogens mainly linked to periodonti-tis, 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

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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

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