| Diagnosis and Treatment of
Halitosis
Jon L. Richter, DMD, Ph.d
Excerpted and edited by the author from his article of the same title
published in Compendium, April 1996.
Introduction
Most adults and many children suffer from bad breath (halitosis)
occasionally, chronically or regularly at specific times of the day.
Public awareness and concern for this phenomenon is evidenced by the
support of an $850 million mouthwash industry in the United States
despite wide agreement that commercially available products have no
significant effect on halitosis.1
Physicians and dentists are generally poorly informed about the
causes and treatments for halitosis. It is the purpose of this paper
to review briefly our current understanding of the etiologies of
halitosis and current developments in its diagnosis and treatment.
The clinical techniques and strategies for diagnosis and treatment
that are described below have been drawn from the research methods and
results of Tonzetich2, Preti3, Rosenberg4, Yaegaki5 and Bosy6 as
well as my own experience in treating over 600 hundred patients
presenting with a chief complaint of "bad breath."
Research reports about the etiologies of breath malodor agree that
the vast majority of halitosis originates with the anaerobic bacterial
degradation of sulfur containing amino acids within the oral cavity
resulting in the emission of hydrogen sulfide (H2S), methyl mercaptan
(CH3SH) and dimethyl sulfide (CH3SCH3), collectively referred to as
volatile sulfur compounds (VSC)2-5,7. Therefore, it is most reasonably
the responsibility of dentists to diagnose and manage breath malodor.
When systemic or other non-oral etiologies are suspected, dentists
must be prepared to prescribe the appropriate medical referrals.
While there are many common non-oral diseases cited in the
literature10, for which halitosis can be a symptom, halitosis
typically occurs late in the pathogeneses of these diseases when other
more obvious or more urgent symptoms are present7.11.12. Rapid onset
and progressively intensifying breath malodor is suggestive of an
infective process, possibly secondary to carcinomas or other localized
pathologies in the airway8,11. However, patients with a sole, chief
complaint of long-standing, chronic halitosis have, almost without
exception, either an oral etiology for halitosis or no halitosis at all.
Imaginary Halitosis
In dealing with patients seeking professional care for halitosis, one
must be prepared to differentiate between those patients who emit
above average malodor, those who emit average or near average malodor
but are more sensitive to it, and those who emit below average or no
odor but believe that their breath is offensive despite objective
evidence to the contrary. In the former two cases treatment for
malodor is warranted; in the latter it is not.
There are many patients who complain of chronic bad breath for whom no
objective evidence of breath malodor can be identified8,13-17,
Olfactory reference syndrome is a recognized psychiatric condition in
which there occurs a somatization of some distress resulting in a
belief on the part of the patient that an offensive odor emanates from . . . More on Halitosis
Chlorine Dioxide Mouthwash | Jon L. Richter, DMD, Ph.D
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