Oral Malodor 4 Classes

1
Oral Malodor 4 Classes. 3 Sub-types

• Above Carina (URTIs)- OZOSTOMIA
• Below Carina (LRTIs)- STOMATODYSODIA
• HALITOSIS
• i) Physiological
  ii)
  Pathological
  iii) Psychological
• FETOR EX ORE/ FETOR ORIS
  Oral Hygiene, Perio, and Decay

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OZOSTOMIA above carina

• Obstruction, Nasal- discharge, Tonsillitis,
  Tonsoliths, Laryngitis,
• Dysphagia, Voice problems
• Previous ENT pathology
• Sinusitis, Rhinitis, Pharyngitis, Foreign Bodies
• Stagnation and Infection
• Malignancies

3
STOMATODYSODIAbelow carina

• Tobacco Smokers
• Bronchitis
• Bronchiectasis
• Lung Abscess
• Pleuritis
• Pneumonia
• Blood
• Foreign Body
• Neoplasia, Mucous Stagnation/Infection

4
HALITOSIS physiological

• Poor hydration
• Menstruation
• Diet
• Constipation
• Starvation, Morning breath
• Habits (Mouth breathing, thumb sucking)

5
HALITOSIS pathological

• Lungs release blood-borne catabolic products
• Stomach--Gastritis, Liver hepatitis, Kidney
  nephritis
• Pancreas--Diabetes mellitus (Ketosis)
• Anorexia/Bulimia nervosa
• IgA deficiency
• Xerostomia (Sjogrens, Radiation therapy, Stress)

6
HALITOSIS psychological

• Halitophobia not very accurate term
• Delusional cacosmia
• Psychogenic dysosmia
• Symptomatic schizophrenia
• Temporal lobe epilepsy (Aura)
• Cerebral tumors

7
Fetor ex Ore/ Fetor Oris

• Faulty fillings, Overhangs
• Dental materials
• Cements Eugenol, Cajeput, Creosote, Kri3
• Fixed bridgework, Pontics
• Appliances Orthodontic, Prosthodontic
• Denture hygiene
• Oral medicine conditions
• Ulcerations, Abrasions, Wounds
• Neoplasias
• Hemorrhagic diatheses

• From Mouth GumsTeeth
• Gingivitis/Periodontitis
• Percoronitis/Peri-implantitis
• Dorsum of tongue
• Interdental areas
• ANUG/NUG
• Post-extraction, Dry socket
• Plaque Calculus Oral Hygiene, Stagnation areas
• Caries Tooth decay
• Brushing and Flossing
• Reduced salivary flow

8
Biological Sources of Oral Malodor

• BLOOD
• NECROSIS
• PUS
• MUCOUS
• BACTERIA

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Oral Malodor Volatile Sulfur Compounds

• VSC mainly responsible for stench
• Measure with the Halimeter
• VSCs include hydrogen sulfide, methyl mercaptan,
  and dimethyl sulfide

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Oral Malodor CLINICAL Management I

• Full comprehensive Oral Examination
• Detect, record all gingival problems
• Gingivitis and Periodontitis
• Scale and Polish Root Planing Pocket
  elimination
• Restore faulty restorations
• Oral Hygiene PIxlt10
• Recall re-measure VSCs
• Outcome analysis Results/Proof

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Oral Malodor CLINICAL Management II

• OHI Brushing, Flossing, Gargle, Rinse
• Teeth, Gums, Tongue, Tonsils, pharynx
• Prosthesis Hygiene, Repair, or Replace
• Remove all plaque

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Oral Malodor CLINICAL Management III

• Floss
• Anti-bacterial Paste
• Peroxide paste
• Bicarbonate of Soda Paste
• Tongue scraper --Commercial vs Spoon
• Pre-sleep Oral Hygiene

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Oral Malodor CLINICAL Management VI

• Rectify URT and LRT
• Treat systemic disease Diabetes, Hypertension,
  CCF
• Oral Health Teeth and Gum problems cause gt90
  cases of oral malodor
• Keep records
• Record on VAS scales
• Note measures of VSC
• Educate the patient

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OM CLINICAL Management VIIOral Irrigation A

• Medicinal Mouthwash
• Short-term for specific effect
• Associated risks
• Examples Peridex (Chlorhexidine gluconate)
  Phenol Based with oils (Listerine)
  Cetyl-pyridinium Cl (Cepacol) Chlorine dioxide,
  herbal remedies, etc.
• Side effects staining, taste changes, toxicity,
  overgrowth of bacteria, fungi etc.

• Physiological
• Daily use
• Long tem
• Minimal side effects if any
• Physiological substances Examples Salt,
  Bicarbonate of soda, Urea crystals
• Fluoride rinse correct physiological
  concentration 1ppm

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OM CLINICAL Management VIII Saline Mouthwash
Gargle

• PREPARATION
• NaCl common Table Salt
• Hypertonic solutions stir one teaspoonful of
  salt in about 300ml water.
• Salt should remain at base of glassSaturated
  solution?hypertonic
• Freshly prepared for each use.
• Not costly available

• MODE OF ACTION
• Hypertonicity dehydrates bacteria? bacteriostatic
  initial?then bacteriocidal
• Edema Swollen Cells are reduced
• Saline debridement of tonsillar crypts
• Washes and irrigates mucous membranes mucolytic
• Slows inflammation

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Oral Malodor Clinics

• Part of Practice NOT isolated
• Must have accurate clinical measuring
  devices--Halimeter (VSCs ppb)
• Must have ALL oral therapeutic back-up
• Refer and COMMUNICATE
• Clinical Protocol Quote fees
• Examinations, Radiographs, Bacteriology,
  Histopathology, Periodontics, Endodontics,
  Restorative, Prosthodontics, Otolaryngology,
  Psychological referrals
• Written Report Mandatory