Halitosis or foul breath odour is a common problem in the population. It may be a reflection of a local disease or organ system dysfunction by various mechanisms leads to the appearance of odoriferous substances in the breath of the person.
In most cases the cause is intraoral, but can also be the manifestation of a systemic problem and be the first symptom leading to the diagnosis of previously undetected disease.
90% of cases of halitosis originate in the mouth by bacterial decomposition of food particles, cells, blood, and certain components of saliva. Proteins and other chemicals of these materials will break down into simpler compounds such as amino acids and peptides. During many volatile sulphur compounds are those that produce odour occur.
Oral hygiene Inadequate results in inflammation of the gums and the possible formation of periodontal pockets with proliferation of bacteria able to produce volatile sulphur compounds with the substrate adequate. This has obvious effects on the breath, but in addition, these compounds increase the permeability of the mucosa, accelerate collagen breakdown, delayed healing and affect the functions of gingival cells causing further degradation of the health of the gums, inflammation etc.. .
Situations that cause halitosis are: gingivitis, periodontitis, extensive decay, lack of oral hygiene, xerostomia (dry mouth) and benign or malignant oral ulcerations.
Halitosis of extra oral origin
Halitosis should not be considered in isolation, but rather as one element of which is probably a constellation of medical conditions.
Possible causes of halitosis can set different groups:
- Respiratory causes: chronic sinusitis, lung carcinoma, oropharyngeal carcinoma, mucus, polyps, cleft palate, etc..
- Gastrointestinal causes: colonogastrica fistula, aortoenteric fistula, bleeding in the digestive system, reflux, pyloric stenosis, hiatal hernia, etc..
- Metabolic causes: diabetes, TMAU or fish odour syndrome (which results from the body’s inability to metabolize the hill), uraemia of renal impairment causes bad breath urea excretion through the oral cavity. Liver and bile problems cause a smell in the breath quite characteristic.
- Drugs: There are several medications that cause changes in the breath.
Diagnosis of Halitosis
Of all the diagnostic procedures proper and detailed medical history is the first step. You have to collect as much information as possible about the frequency and duration of halitosis and patient habits (diet, intake of drugs, alcohol and snuff, etc..)
The first thing to determine is the intraoral or extra oral source halitosis. The assessment of air must be breathed by a trained professional who can direct or indirect use various techniques to evaluate the intensity of bad breath (smell directly breathed air, gas chromatography, osmoscopia, etc..)
Clinical examination of the oral situation dental, periodontal and prosthetic patient is essential. We must put emphasis on language and its alterations as they may cause an excessive accumulation of desquamated cells, food debris and bacteria.
Treatment of halitosis
Control of systemic disease
If we face an extra oral halitosis of origin have to diagnose the source of the problem and refer the patient to the most appropriate specialist for a multidisciplinary treatment.
It will be necessary to change the habits of diet, smoking and intake of certain beverages like coffee, tea and alcohol. It is advisable to eat more often, leaving shorter spaces between meals. Ingestion of problematic foods should be avoided, we recommend a low in fat and rich in fresh fruits and vegetables diet. The poor in fat and vegetarian diets (but including fruits and vegetables) decrease the chances of halitosis.
Treatment of diseases of the mouth
You should always perform the treatment of oral diseases present as caries, gingivitis and periodontitis. It should also review the status of restorative treatments (fracture fillings, old or poorly fitted dentures, etc.).
Xerostomia, dryness of the mouth by malfunctioning salivary glands should be treated by techniques increase salivary flow or using salivary substitutes in severe cases.
Lingual and oral hygiene
In the treatment of halitosis, and lingual oral hygiene is a priority. It is important to learn how to clean tee the fictively and pay special attention to cleanliness of the dorsal and posterior portion of the tongue that is the location where there is increased bacterial load.
Effect of brushing on the back of the tongue is short duration must be extended with the use of toothpastes and mouthwashes especially will tell the dentist.
Most commercially available mouthwashes only mask the odour (even if they contain antiseptic substances). The effects are not long and some of them also contain ethanol can produce side effects on the mucosa of the mouth that may even aggravate the problem.
Therefore appropriate antiseptic should be indicated by the dentist and must meet a number of features between. Those included have low toxicity if swallowed and have few side .
Currently the most used products for the treatment of halitosis are: zinc chloride, cetylpyridinium chloride, benzethonium chloride, phenolic compounds, chlorhexidine, chlorine dioxide, clindamycin, etc..