Detection
While most of the population has transient halitosis, chronic malodor is less common. Regardless of the type of halitosis, proper diagnosis is important. The difficulty in determining whether an individual has halitosis and its possible cause(s) arises because there are no convenient methods to measure this condition. Some self-monitoring tests and in-office tests are available to aid in the diagnosis, although they are either awkward or still need research to ensure their viability.
Self-monitoring tests generally involve obtaining feedback from a spouse or friend (an odor judge). Individuals may have difficulty detecting halitosis themselves because the brain has the ability to suppress odors stemming from ourselves. While procuring an odor judge may be embarrassing, it is the best method for at-home breath testing. If the odor judge does not wish to smell the patient's breath directly, the patient can scrape the posterior region of the tongue with a spoon or place saliva on the wrist by licking it. The spoon or wrist can then be smelled and assessed by the odor judge. The spoon test is better in case the saliva is not a good carrier of the potential odorant. There is also a home microbial test which is comprised of cotton-tipped applicators and test tubes containing a specific medium. After the applicators are placed on the tongue, they are inserted in the test tubes. If the color in the test tube changes within a certain time period, this is an indication that you have chronic bad breath.
In-office testing can include odor judge testing, microbial and fungal testing, the salivary incubation test, volatile sulfur detection testing, and, in the future, artificial noses. Among other problems, the current tests lack specificity, i.e. it is difficult to determine either the existence or the cause of chronic halitosis. The most recent machine on the market for detecting halitosis, a portable sulfide monitor, also has its proponents and critics. The machine is designed to measure sulfur content in the breath, but it can be inaccurate. At this point, the machine is better for monitoring a patient's progress than in obtaining an initial diagnosis. Most dental offices do not have the capability yet to perform these tests.
Treatments
One of the easiest and most efficient treatments for halitosis is mechanical debridement. This means thorough, regular flossing and brushing of your teeth and your tongue. A tongue scraper can be very helpful as well. When using a tongue scraper, it is best to clean as far back on the tongue as possible, starting from the back and moving toward the front. This scraping motion is done several times in row. Other management tools include antibiotics, nasal mucous control methods, avoidance of certain foods and medications, salivary substitutes, and management of systemic diseases. One of the most potentially promising and lucrative areas of bad breath control is the development of various oral rinses.
Effective oral rinses must eliminate the problematic bacteria while maintaining the balance of normal bacteria in the oral environment. The assorted types of rinses being developed and marketed contain quaternary ammonium, zinc, chlorhexidine (already in use to help treat periodontitis), chlorine dioxide, or triclosan. Chlorhexidine and chlorine dioxide rinses have received the most press lately. Because chlorhexidine is such a strong antimicrobial rinse, it is advised to only use this type of rinse as a short-term adjunct for treatment. At present, chlorine dioxide can be used on a long-term basis, although some researchers do question its safety. In lab experiments, chlorine dioxide has been shown to be effective by breaking the sulfide bonds in VSCs, but this finding has not yet been substantiated using live subjects.
Currently, many of these rinses provide limited effectiveness in the treatment of chronic halitosis. Regular dental care and proper oral hygiene including tongue cleaning are the most effective. The detection and treatment of halitosis is a relatively new aspect of dentistry. The future is sure to bring better diagnostic techniques and treatments.
Facts
Did you know:
An estimated sixty-five percent of Americans are estimated to have bad breath. Over 40 million Americans have "chronic halitosis", bad breath that never quite goes away. Ninety percent of all halitosis is of oral, not systemic, orgin. More than a billion dollars a year is spent on over the counter halitosis products that often merely mask bad breath odors.Bad breath emanates from the lungs when certain foods are digested. Small odor molecules from onions, garlic and peppers enter the bloodstream with some making their way into the lungs. Halitosis or Oral Malodor is an offensive odor coming from the mouth, nose or sinuses. It can be split into two categories.
Physiological
Pathological
Morning breath
Mouth
Hunger breath
Nose/Sinuses
Menstrual breath
Tonsils/Pharynx
Food/Drugs
Digestive Organs
No systemic illnesses
Systemic illnesses
Less intense
More intense
Generally responds to oral hygiene
Requires treatment of underlying cause
Drugs That Cause Dryness Of The Mouth Contribute to Halitosis
Central Nervous System Agents
Others
Antiparkinson drugs
Antihistimines/decongestants
Antipsychotics
Anticholinergics
Narcotics
Antihypertensives
Antidepressants
Oral Conditions Causing Halitosis
Periodontitis
Gingivitis
Apthous ulcers (canker sores)
Traumatic ulcers
Dental abscesses
Herpetic infections (viral)
Candidiasis (fungal infection)
Oral cancer
Xerostomia (dry mouth)
Poor oral hygiene
Non-Oral Sources Causing Halitosis
Nose/Sinuses
Pulmonary (lungs)
Tonsils/Pharnyx
Systemic Illnesses
Digestive Organs
Systemic Illnesses
Diabetic Ketoacidosis
Schizophrenia
Liver Failure
Olfactory reference syndrome
Renal Failure
Disease
Odor Characteristics
Diabetes
Acetone, fruity
Liver failure
Sweetish, musty
Acute rheumatic fever
Acid, sweet
Lung abscess
Foul, putrefactive
Blood dyscrasias
Resembling decomposed blood
Liver cirrhosis
Resembling decayed blood
Uremia
Ammonia or urine
Toxemia, gastrointestinal disorder, neuropsychiatric
Varies, poor oral hygiene intensifies the odor
Fever, dehydration, macroglobulinemia
Odor due to xerostomia with poor oral hygiene and toxic waste products accumulated
Sjorgen's syndrome
Fetid
Eosinophilic granuloma, Letter-Siwe disease, Hand-Schuller-Chrisitan disease
Fetid breath and unpleasant taste
Scurvy
Foul breath from stomach inflammation
Wegner's granulomatosis
Necrotic, putrefactive
Kidney failure
Ammonia or urine
Diptheria, dysentery, measles, pneumonia, scarlet fever, tuberculosis
Extremely foul, fetid odor
Syphilis
Fetid
Phsiological Halitosis or Oral Malodor is generally caused by volatile sulfur compounds. It responds to treatment with Zytex, a combination of zinc chloride, thymol and eucalyptus oil. It neutralizes the sulfur compounds and kills the bacteria that causes them.
The Problem
Everybody worries about this one. The scenario goes something like this: You’re talking to a friend when you suddenly notice that he is recoiling, his nostrils are flaring, and he is beginning to back off. Puzzled, you move closer to continue the conversation when it hits you that the reason for your friend’s reverse gear is that you have a garbage bin in your mouth; a major social problem called bad breath.
Of all of the non-fatal maladies that afflict the human body, fear of bad breath may be one of the most common and embarrassing. Bad breath is democratic, affecting male and female, the rich and poor, the young and old of all races. It is demoralizing, for it can strike at anytime without warning; early in the day with morning mouth, at noon after a power lunch, during a stressful business presentation, or in the evening to cloud the emergence of social possibilities. It is so traumatic that many people hesitate to mention it to their physicians and dentists. It fuels the 1 billion a year mouthwash industry.
Basic Causes of Bad Breath
At least ninety percent of bad breath is of oral origin, that is, it comes from the odor caused by bacterial decay of food particles and other debris in your mouth. The cleanest human mouth harbors millions of potentially pathogenic bacteria, and given the right set of circumstances these bacteria decompose food particles left in the mouth. The odor-causing decay products have technical and imaginative names: Hydrogen sulfide, methyl mercaptan, dimethyl disulfide, putrescence, cadaverine, skatole, and indole.
Poor hygiene also contributes to bad breath when bacteria putrefy blood that oozes from periodontally diseased gum tissues, creating a particularly revolting and easily identifiable stench. Unclean dentures of any kind can cause bad breath in two ways, first by absorbing odor themselves and by helping to retain food particles.
Just as smelly substances are produced in stagnant water, offensive mouth odors result when the saliva becomes stagnant or diminishes . This is the basic cause of morning mouth, that noxious aroma that is observed upon wakening. During the night, salivary glands have slowed their functioning, and fresh saliva is meager, allowing the bacteria in the mouth to overgrow. Morning mouth tends to be most potent among those who snore or breathe through their mouths. Morning mouth disappears when you have rinsed your mouth or eaten something such as an apple or a slice of bread.
Morning mouth is also associated with hunger odor. This is a distinctive odor that accompanies the sensation of hunger. There is some evidence that hunger breath may arise from the putrefaction of pancreatic juices which pass into the stomach during the fasting state. Hunger breath is very apparent if the morning meal is omitted, even after tooth brushing.
Common Myths about Halitosis
1. Halitosis comes from the stomach. (Only rarely does this ever occur.)
2. Halitosis comes from the lungs. (Only rarely does this occur and can be a manifestation of a serious disease.)
3. Halitosis is a hereditary problem. (This is absolutely not true.)
4. Mouth washes and breath mints can help a breath problem. (This is not true. They only mask the problem for a few short minutes at best. Alcohol based mouthwashes in fact will worsen the problem because they dry out the mouth thus increasing the volatilization of breath odors.)
5. Internal breath fresheners can help my problem. (These do absolutely nothing for a chronic halitosis condition.)
6. There is no treatment for halitosis. (There now is a highly effective treatment for this problem at The Center For Breath Treatment.)
7. Brushing my teeth more will help eliminate my breath condition. (This is also not true. Excessive brushing can dry one’s mouth, thus increasing the halitosis problem. Excessive brushing can also damage the teeth and gums over time. It is very difficult to remove the specific odor causing bacteria with brushing and flossing alone, and most patients we see at our center tend to have very good oral hygiene.
8. Halitosis is caused by foods. (Foods such as onions, garlic, or cauliflower can induce certain odors but these are only transitory, and can be easily eliminated by avoiding that particular food. The odors they produce also are not of the “sulfur” type commonly seen in true halitosis conditions, and generally are not as offensive.
Checklist for Halitosis Control
Below is a little list which summarizes the methods of treating bad breath. It’s easy to print out, clip and put in your wallet or purse for a quick reference.
1.Meticulous oral hygiene is essential. Brush floss, clean the tongue after each meal.
2.Increase saliva production by chewing Sugarless gum or sugarless candy mints.
3.Make sure mouth is moist by drinking adequate water. Hold water in mouth for as long as possible, swishing it vigorously.
4.Recognize the effect of stress on bad breath and be able to detect a state of stress in yourself and take appropriate action.
5.Rinse mouth with 50/50 solution of hydrogen peroxide and warm water for one minute.
6.Baking soda toothpaste and Vitamin C help.
7.Use a portable battery-powered Water Pik or other oral irrigation device.
Risk Factors for Bad Breath
A person with bad breath is rarely aware of his offense. He cannot detect his own mouth odor even when he exhales against his hand, or licks it to test the quality of the odor--both methods are unreliable. He usually only becomes aware that he has it when he notices (as in the example) that people are avoiding him or when someone tells him. All of us are more or less vulnerable at one time or another. Bad breath can come when you least expect it, and it tends to get worse and more frequent as you get older. The intensity of the odor is variable, but researchers usually record the aroma as mild, moderate, pungent, objectionable and very objectionable. I leave it to your imagination to select appropriate examples of this classification.
Halitosis, the technical term for bad breath, or malodor or Fetor ex Oris, as dentists sometimes call it, can curse those which consume those foods or substances which often cause bad breath: garlic, raw onions, cabbage, horse radish, eggs, broccoli, Brussels sprouts, fish, red meat, peppers, cigarettes, alcohol and coffee, but bad breath can occur even if your diet does not include the above named foods, for the basic causes are always present in the human mouth: when bacteria in your mouth decompose food, evil smelling putrefaction products result.
Medical risks for bad breath include bronchial and lung infections, chronic sinusitis, post-nasal drip, tonsillitis. The mucous discharge which comes during cold or flu can create bad breath. Also implicated are untreated nasal polyps, diabetes, syphilis, diseases of the stomach and lungs, liver, kidneys, and there is a type of halitosis which is caused by a gallbladder dysfunction. Altering the diet to reduce the amount of fat intake will often eliminate this type of “pungent” heavy odor. There is a fetid and “fishy” odor associated with chronic renal or kidney failure. Some medications can cause or exacerbate bad breath. Various carcinomas can cause malodor. You should consult your physician if bad breath becomes chronic and the simple treatments detailed in this report don’t work. However, these problems taken altogether affect a very small percentage of people.
Stress or nervous tension is a major enhancer of bad breath. In fact, there seems to be a stress component to most bad breath. One major effect of stress is drying of the mouth, but stress also aggravates the fulsome odor in other subtle ways. If you have lived through a stressful or unpleasant experience you may have noticed that a case of bad breath also went along with the ordeal. One person developed bad breath during airplane trips. The halitosis promptly went away after a safe arrival. A woman developed bad breath when a man she was dating made advances. Having to give a speech or take an examination or endure some other stress inducing situation may also bring out a malady, so monitor your emotional state for cues.
Some women have a distinctive and mousy odor associated with the onset of menstruation. This particularly common in the women who suffer from dysmenorrhea or painful menstruation. The cause is thought to be caused by the rise in estrogen which triggers sloughing of the body’s lining tissues, including those of the mouth. More sloughed tissue means more food for bacteria. Usually the woman is unaware of the odor, but is readily apparent to her spouse.
Be aware of the fact that some people don’t have bad breath at all, but merely think they do. That is, they imagine that their oral aroma is more intense and offensive than it really is. Such cases of “imaginary” bad breath are sometimes associated with psychological problems. These sufferers may withdraw from society, develop anti-social behavior, and may even contemplate suicide.
Treating Bad Breath
First of all, thorough brushing to remove food particles is a daily necessity. Regular check-ups to correct problem areas: gum disease, carious teeth, faulty restorations, overhanging fillings, leaking crowns, all of which cause food traps, is a must. For those over thirty, the odor of periodontal disease is a particularly common cause of halitosis and one which is easily treated.
Having made certain that your physical oral condition is as pristine as possible by brushing and flossing and proper diet and all the other good things, your method of attack is as follows.
1.Chew sugarless gum or suck on sugarless lozenges to increase saliva flow. Saliva is the mouth’s natural mouthwash; it has antibiotic elements in it which reduce the numbers of bacteria in the mouth. Sugarless gum or candy is an absolute must. I’ve seen horrible cases of decay and gum disease arise from the habit of frequently eating sugar containing foods. Some people learn how to milk the salivary glands by sucking on the cheeks or tongue.
2.When saliva production diminishes, keep the mouth wet with a liberal intake of water. Experts advise drinking eight glasses of water a day for basic metabolic function, and it seems that keeping the mouth moist is a good way of keeping the bacterial flora of the mouth under control. Hold the water in the mouth as long as possible-minimum of twenty seconds, and swish it around to loosen food particles and other bits of debris that bacteria feed upon. The longer the water remains in the mouth the better.
3.Snack on carrots, celery, or other vegetables to keep plaque from forming.
4.Vitamin C deficiency may be a cofactor-factor on bad breath. Smokers, especially should take regular supplements of vitamin C since the nicotine in the cigarettes destroys vitamin C. A better tactic is to stop smoking all together, but if you’re still puffing after hearing all the evidence, the fact that your own halitosis is polluting the air probably isn’t going to change you much.
5.What works in the refrigerator may work in the mouth. Consider brushing your teeth and tongue with baking soda. This is admittedly kind of gross. Any of several brands of toothpaste containing baking soda can be used instead and are more palatable.
6.A handy portable, battery powered version of the water Pik is available. It can be easily transported in a purse or brief case and is one of the most powerful and certain ways of preventing bad breath; it really knocks the food particles out from between the teeth.
7.Consider any of the over-the-counter mouthwashes which do the same thing as rinsing the mouth with water, but also add a bit of odor neutralizing substances such as cetylpyridinium chloride (CPC), zinc chloride (more about zinc in a bit.), or chlorhexidine. Look for products containing these compounds. Buying the mouthwash also makes the buyers a little wealthier, stimulates the economy, and maybe provides a sense of security. There is a prescription mouthwash called Peridex which seems to be a little more effective than the over-the- counter brands although its taste leaves something to be desired.
8.Before the big date, the business presentation, or the stress encounter consider rinsing the mouth with a 50/50 solution of hydrogen peroxide and water. A teaspoon of each is swished in the mouth for one full minute. Hydrogen peroxide releases free oxygen which is poisonous to many of the bacteria that cause bad breath. If things are really going to be tense, Maybe a tranquilizer or two might help also. (See your health care provider for advice on this)
9.Zinc and compounds of this metal have complex effects on the plaque forming process, and one researcher has suggested that zinc salts combined with ionone, an ingredient of tomato juice, appear to produce a much longer anti-plaque and anti-odor effect than either alone. Maybe those who favor bloody Mary’s, virgin or real, in the morning, have hit upon the definitive cure for the jungle mouth.
10.In those cases where hunger odor is present, the way of correcting the problem is simple: just have a bit to eat.
The good news is that this scourge of humanity is not as much of a problem as its victims fear. Researches in the field find that at any one time only about one percent of the population has it, so many more people worry about bad breath than are actually afflicted. As a practicing dentist, I’m regularly asked about this phenomenon, and while gentle questioning of my patients indicates that almost everyone worries about bad breath, I find that I’m unable to detect it in most patients on examination. The conclusion, reinforced by many years of practical experience, is that bad breath isn’t all that common. If however you have the risk factors given above, and if bad breath strikes you, the incidence is one hundred percent and the malady is real.
Commonly asked question about halitosis treatment
Q: How long does it take to treat, and once treated will my breath problem return?
A: It typically takes about 3 appointments to eliminate a person’s halitosis condition. At the completion of treatment we will recommend a program that will prevent the reoccurrence of your halitosis. If the program is followed your breath problem will not return.
Q: Will my insurance cover any of the treatment?
A: If you have dental insurance you will be able to get partial benefits for the treatment. Because the treatment is so new, insurance companies have not yet developed the new insurance codes necessary for processing the treatments.
Q: Do you prescribe antibiotics for the treatment?
A: No. Antibiotics are not able to effectively reach the specific bacteria that cause halitosis. In some instances we do utilize specialized antibacterial rinses in conjunction with our treatment.
Q: What is the success rate for the treatment?
A: We’re proud to say that we have a 99% success rate.
Q: What happens if it is determined that my problem is of a medical origin.
A: In the rare instance that this occurs we will refer you to the appropriate physician.
Q: Does the procedure hurt in any way, or are needles involved?
A: There is absolutely no discomfort involved in any treatment we provide. It is a noninvasive procedure that requires no anesthesia or injections of any kind.
Q: Can any of the treatment you perform for the treatment of a breath problem causea person any harm?
A: No. In no way can our treatment cause any harm or complications with a patient. It is a noninvasive treatment and the worse thing possible that can happen is for the procedure to be unsuccessful.
Q: Once treated, will my breath problem return?
A: At the completion of your treatment we will develop an individualized maintenance regimen for you which will prevent the reoccurrence of your old halitosis condition.
What is Halitosis and What are the Causes
Have you experienced any of the following?
1. You frequently have a bad taste in your mouth.
2. Your breath is interfering with your social or professional success.
3. Somebody has commented on your bad breath, or offered you mints or chewing gum.
4. You feel embarrassed by your breath .
5. You find yourself using either breath mints, mouthwashes, chewing gum, or internal breath fresheners.
6. People step back from you when you are talking to them, or they avoid direct contact with you.
7. You experience a dry mouth or thick saliva on a regular basis and can’t seem to improve the condition.
If you answered yes to any of the above you likely have a breath problem. The good news is that at the Center for Breath Treatment we have a highly effective treatment that has had a 99% success rate.
What is halitosis?
Chronic halitosis is a condition in which a person produces an offensive odor from their oral or nasal regions and they’re unable to eliminate it through normal oral hygiene techniques, such as flossing or brushing. The occasional “morning breath” most people experience at one time or another is not really true halitosis. Halitosis knows no boundaries when it comes to age, sex, race, or socioeconomic levels. Furthermore, it can be truly demoralizing, and it negatively impacts the lives of as many as 50-80 million individuals in the United States alone. Because it’s such an embarrassing problem we have found that many patients are reluctant to even mention their problem to either their physician or dentist. Another unfortunate fact is that most halitosis sufferers have no idea that they have a breath problem unless somebody directly informs them. People suffering from halitosis have been known to become withdrawn and avoid social situations. There unfortunately have even been documented cases of suicide stemming from a halitosis problem.
What causes a halitosis condition?
There are a number of possible causes of halitosis. Below we have listed some possible causes and have separated them into medical and dental causes.
Medical
1. Sinus infections & abnormal sinus anatomies
2. Tonsilar infections or tonsiloliths
3. Lung diseases
4. Kidney diseases
5. Liver diseases
6. Blood disorders
7. Diabetes
8. Gallbladder dysfunction
9. Menstruation
10. Carcinomas
11. Certain foods
Dental
1. Extensive dental decay
2. Periodontal (gum) disease
3. Oral infections or abscesses
4. Oral cancers
5. Xerostomia (dry mouth condition). Many medications can contribute to a condition of xerostomia.
6. Oral conditions resulting from post-nasal drips or discharges
7. Allergy conditions
8. A proliferation of specific types of gram negative anaerobic bacteria.
90% of breath problems are caused from a proliferation of specific types of gram negative anaerobic bacteria in the mouth. This has also been supported by extensive research in the field of halitosis. This proliferation is often a result of conditions such as allergies, sinus congestion or post-nasal drips, nasal polyps, and xerostomia which is a dry mouth condition. A common area where the bacteria congregates can actually be on the tongue itself. Because we rarely find halitosis resulting from a medical condition, we suggest that the first approach in eliminating the problem should be an oral approach. This approach is more economical, noninvasive, and it has a higher probability of success. We do recommend that all patients maintain their dental health by seeing their dentist regularly. Should a halitosis condition persist, despite the simple and noninvasive oral treatments that we offer, then we suggest that those patients should see their physician. Usually from the differential diagnosis that we perform at the first appointment, we can determine whether a halitosis problem is of a medical or dental origin.
Infection of the Pulp
Gingivitis
Normal Tooth
My Mom's (3rd from left)
Putri, Om Kiki selalu teringat. Baik-baik sekolah ya. Jangan nakal dengan adiknya. I miss you. Salam untuk Papa dan Mama. Insya Allah, kita bisa berjumpa lagi.
Pekerjaan yang sangat menantang adalah Penyuluhan Kesehatan dalam hal mengubah perilaku masyarakat menjadi perilaku hidup bersih dan sehat. Sangat sulit melakukannya, tapi begitu mengasyikkan. Sambutan hangat dari warga desa membuat tugas ini menjadi lebih menyenangkan. Gambar ini menunjukkan saat Penyuluhan Kesehatan di Kantor Pangulu Nagori Naga Dolok, Kecamatan Tapian Dolok, Kabupaten Simalungun.
Saya alumni SD Negeri 001 Cinta Raja Kecamatan Sail, Pekanbaru. Gambar ini adalah sewaktu perpisahan SD tahun 1991. Terlihat teman-teman dahulu Hudri Akbar, Suryanedi, Gracea Timotella, Kardonal, Toni Sabila, Irfan Zora, Arfan Suheri, Marwan Setiadi dkk. Saya ingin mengetahui kabar mereka lebih lanjut. Kalau diantara pembaca yang mengetahui mereka, Please, kirim e-mail ke saya. hargo_b@plasa.com. Terima kasih.
