This document discusses oral malodour (bad breath). It begins by defining oral malodour and noting its various synonyms. It then classifies oral malodour into genuine, physiological, pathological, pseudo, and halitophobia categories. The document outlines intraoral and extraoral causes of oral malodour and describes methods for diagnosis, including medical history, examination, and laboratory tests. Key diagnostic tests mentioned are organoleptic rating, portable sulfide monitors, and BANA testing. The document concludes by discussing treatments for oral malodour which include mechanical reduction of substrates, chemical reduction of microorganisms, conversion of volatile sulfur compounds, and masking of malodour.

1. ORAL MALODOR
Presented by
Dr. Bibina George

2. CONTENTS
Introduction
Classification
Etiology
Intraoral causes
Extraoral causes
Diagnosis and assessment of oral malodor
Clinical and laboratory examination:
Direct & Indirect methods
Treatment of oral malodor
Summary

3. Introduction
• Breath odor can be defined as the subjective perception after smelling someone’s breath.
It can be pleasant, unpleasant or even disturbing, if not repulsive.
• Synonyms:
• breath malodor
• halitosis
• bad breath,
• fetor ex ore; stomato dysodynia
Halitosis is foul or offensive odor emanating from the oral cavity.
Carranza (9th edition)

4. Classification:
• Genuine halitosis
• Physiologic halitosis
• Pathologic halitosis
• Pseudo halitosis
• Halitophobia.
Yaegaki K, Coil J (2000)

5. Etiopathogenesis:
• 2 pathways for bad breath:
a) Increase of certain metabolites
in blood circulation escaping
via lungs while breathing.
b) Increase in bacterial load /
amount of substrate for these
bacteria at the lining surfaces---
• Volatile sulfur compounds
• Hydrogen Sulfide
• Methyl mercaptan
• Dimethyl sulfide
Tonzettich (1977)

6. Intraoral Causes

7. Extraoral causes
SMELL ORIGIN
Sulfur Intraoral
Sulfur + Sweet odor Liver disease
Rotten apples Unbalanced insulin dependent
diabetes
Fish Odor Kidney insufficiency
Trimethylaminuria

8. Diagnosis:
• Medical History
• Clinical and Laboratory Examination
• Self examination
• Oropharyngeal examination

9. Organoleptic Rating

10. Portable sulfide monitor Electronic nose
Portable Gas
Chromatography

11. BANA test
• It is a test strip which composed of benzoyl - DL arginine-a-naphthylamide and
detects short-chain fatty acids and proteolytic obligate gram-negative anaerobes,
which hydrolyze the synthetic trypsin substrate and cause halitosis.
• It detects especially Treponema denticola, P. gingivalis, and T. forsythensis that
associated with periodontal disease.
• By using the BANA test, we can detect not only halitosis, but also periodontal risk
assessment.

13. Treatment of Oral Malodor
• Mechanical reduction of intraoral nutrients (substrates) and microorganisms
• Chemical reduction of oral microbial load
• Rendering malodorous gases nonvolatile
• Masking the malodor

14. Mechanical

15. Chemical
CHX
Triclosan
Essential Oils

16. Conversion of volatile sulfur compounds
• Metal salt solutions
• Toothpastes
• Chewing gum

17. Masking

18. Conclusion:
• Breath malodor has important socio-economic consequences.
• A proper diagnosis and determination of the etiology allows the proper
etiological treatment to be instituted quickly.
• Although gingivitis, periodontitis and tongue coating are by far the most
common causes, other more challenging diseases should not be overlooked.
• This can be dealt with either by a trial therapy to deal quickly with intra-oral
causes or by a multidisciplinary consultation.

19. References:
• Carranza 12th
edition
• Tonzetich J. Production and origin of oral malodor: a review of mechanisms and
methods of analysis. J Periodontol 1977;48:13-20.
• Association report: JADA, Vol. 134, February 2003;209-214
• Rosenberg M. Clinical assessment of bad breath: current concepts;JADA
1996;127:475-82.

20. Thank YouThank You