Hands OnDiagnosing and treating bad breath
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Background
About half of the population adult population suffers from halitosis, or oral malodor. Multiple etiologies can produce halitosis, some of which are systemic medical conditions. However, 90% of cases are the result of oral conditions, including poor oral hygiene, deep caries lesions, periodontal disease, oral infections, peri-implant disease, pericoronitis, mucosal ulcerations, foods, impacted food, coated tongue, poor saliva flow, and improperly cleaned dentures. The chemical agents associated
Diagnosis
A thorough patient interview should identify any overall systemic health, dental habits, or diet that may be contributing to the problem. The patient should also be asked how long he or she has noticed the presence of the odor or has been told by others about it. No ideal standard test yet exists to measure halitosis, but the practitioner can directly sniff the patient's breath or plaque samples, or sulfur-containing substances can be detected using halimetry or gas chromatography (GC).
Etiologic Search
An in-depth oral and radiographic assessment can identify oral causes of halitosis. In addition, patients should be thoroughly evaluated by their medical practitioners if any systemic conditions are present or suspected. Psychopathologic symptoms may be referred to psychological professionals.
Dental etiologies include caries lesions, food impaction in fractured restorations or teeth, and necrotic pulp tissue. VSCs are usually associated with periodontal disease and/or tongue coating. Denture
Management
The treatment protocol is determined by the etiology of the halitosis. Dentists can advise patients about lifestyle changes and hygiene practices that will reduce the problem. Individualized treatment for patients combines professional care in the dental office and proper home care by the patient. Etiologies other than those related to dental or oral factors may require the involvement of medical practitioners or specialists.
For dental etiologies, the patient should undergo proper excavation,
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Froum SJ, Salaverry KR: The dentist's role in diagnosis and treatment of halitosis. Compend Contin Educ Dent 34:670-675, 2013
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