Halitosis

Dermatol Clin 21 (2003) 147 – 155

Halitosis
Diana V. Messadi, DDS, MMSc, DMSc*, Fariba S. Younai, DDS
Section of Oral Medicine, Division of Oral Biology and Medicine, School of Dentistry, University of California Los Angeles, CHS 63-019, 10833 LeConte Avenue, Los Angeles, CA 90095, USA

Halitosis, also known as bad breath or oral malodor, is defined as offensive odors emanating from themouth or air-filled cavities, such as nose, sinuses, and pharynx [1]. The cause of halitosis has been localized to the oral cavity in up to 85% of people suffering from bad breath; most frequently it is produced in the mouth by the action of gram-negative anaerobic bacteria on sulfur-containing proteinaceous substrates in the saliva, such as debris and plaque. The primary molecules responsible fororal malodor are volatile sulfur compounds (VSC), such as hydrogen sulfide and methylmercaptan. Any intraoral site where food is trapped and stagnates can produce oral malodor. The most common sites include the dorsum of the tongue, interdental, and subgingival area [2,3].

What is halitosis Halitosis, fetor ex ore, fetor oris, and oral malodor or bad breath are terms that have frequently beenused to describe unpleasant or offensive odors emitted in the expired air. The term fetor ex ore has long been used to depict malodors that arise from conditions within the mouth and associated sinuses. Halitosis is from the Latin halitus meaning breath and osis is condition. It is bad breath stemming from systemic conditions, such as respiratory conditions, gastrointestinal tract, and kidney (Table1). It has been suggested that another term, oral malodor, be used to describe offensive odors originating from the mouth [4].

Halitosis can be either physiologic (nonpathologic) or pathologic. Physiologic halitosis is of temporary nature and occurs when volatile odoriferous hematologically borne substances are liberated into the lungs from food, such as herbs; spices; and some vegetables,such as onion and garlic. These odors are mostly reversible, transient, and generally responsive to traditional oral hygiene practices. Hunger or morning breath also causes temporary halitosis, the result of stagnation of epithelial and food debris because of decreased salivary flow and decreased activity of tongue and cheek muscles during sleep [1]. Pathologic halitosis is more intense and is noteasily reversible. It arises by practically the same mechanism as the physiologic type, also by pulmonary release of blood-borne substances. This type of malodor originates from regional or systemic pathosis, such as diabetic ketosis, gastritis, gastric ulcer, esophagitis, pyloric stenosis, or hepatitis. These odors are distinct in quality, persistent, and require treatment of the underlying disease[5].

Sources of oral malodor Oral sources Tongue The most common source of bad breath in individuals with good oral hygiene and healthy periodontal tissues is from the posterior dorsum of the tongue. Several review articles have shown that the oral cavity is the main contributor to bad breath in 85% of patients with halitosis [4 – 6]. Scientific analysis of odors using chemical andorganoleptic analysis demonstrated that the major elements in the

* Corresponding author. E-mail address: dmessadi@dent.ucla.edu (D.V. Messadi).

0733-8635/03/$ – see front matter D 2003, Elsevier Science (USA). All rights reserved. PII: S 0 7 3 3 - 8 6 3 5 ( 0 2 ) 0 0 0 6 0 - 8

148

D.V. Messadi, F.S. Younai / Dermatol Clin 21 (2003) 147–155

Table 1 Role of systemic diseases in halitosisSystemic diseases Liver diseases Kidney diseases Diabetes mellitus Description Cirrhosis and hepatic failure have been linked to bad breath displaying rotten egg smell or sulfur odor. Uremia associated with kidney failure gives a distinct ammonia smell. Early dialysis also gives a fishy odor. Produces ketoacidosis, xerostomia secondary to dehydration, increases susceptibility to oral infections....