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HALITOSIS [BAD BREATH / MALODOR]

Halitosis is an important social problem and standard management and dental treatments recommended provide temporary relief.
Almost 2.4% of the population face the problem of bad breath at some point of their life.
Studies show that 85% of  bad breath arises from the oral cavity
If we reflect back the problem of halitosis has been haunting us since thousands of years, and many guidelines have been placed on the emphasis of good oral hygiene on social and even religious front, islam stresses the importance of good oral hygiene and fresh breath .
Oral malodor is a result of microbial metabolism,the oral cavity houses hundreds of bacteria, and these organisms digest proteins and give rise to several fetid substances giving rise to bad breath,also overgrowth of gram-ve anaerobic and proteolytic  bacteria on the dorsum of the tongue give rise to malodor.
The role of volatile sulphur compounds [VSC]produced by bacteria colonizing on the tongue was recently understood as the main cause of halitosis.
A simple way to distinguish oral and non-oral etiologies is to compare the smell coming from the patients mouth and that exiting from the nose
Patients with a good oral hygiene  habits, healthy periodontium and teeth may complain from halitosis,which  is mainly from the back of the tongue, people with deep furrows nad grooves on the tongue tend to accumulate more white coating than with people with smoother tongues, coating of 0.1 -0.2mm is sufficient to deplete oxygen which creates an anaerobic enviornment where bacteria can thrive.
Dentures also play a vital role in causing bad breath if they are worn overnite.
Saliva also play an important role in elimination of bad breath, it is inversely proportional to halitosis, during nights at sleep, during fasting when the body is dehydrated, the flushing action of saliva is low so there is an increase in bad breath, like wise during mastication saliva flushes and concommitantly cleans the oral cavity and decreases malodor.
The most common bacteria found in patients with fresh breath is streptococcus salivarius.
The role of tonsils in chronic bad breath is still unclear.
Non oral etiology of halitosis is most predominantely from the nasal passage. Nasal odor maybe indicative of nasal infections,or problems with the airflow associated with thick mucous secretions. Persons with chronic sinus problems usually have a post nasal drip that makes them prone to bad breath
Amongst the other non oral cause of halitosis are bronchial infections, lung infections,kidney failures, carcinomas,metabolic dysfuntions,biochemical disorders, but the just attribute to a small percentage in the general population. Contrary to the thinking that halitosis from the gasteriointestinal tract is quiet rare because the oesophagus normally is collapsed and closed,the occassional blech that may carry odour from the stomach, or the gasterointestinal reflux escaping from the nose or mouth is still rare.
There are certain methods to measure halitosis by the use of Rosenberg scale  that uses one's nose to measure the amount of malodor, however these tend to be uncomfortable both for the patient and the operator.
Instrumental analysis can be made by monitors such as Halimeter that measure the level of volatile sulphur componds in the oral cavity.
Despite all these tests the clinician must rely on their nose to diagnose or distinguish bad breath from periodontal pockets or interdental spaces, from the posterior aspect of the dorsum of the tongue,denture malodour and nasal odour and with practise theseodors becomedistinct and recognizable.
Treatment of bad breath is to instill good oral hygiene practices, dental flossing,scraping the tongue regularly, and also using chewing gums.
Subjects must be encouraged to maintain good hydration because bad breath tends to be worse when the mouth dries.
Inspite of all these rigorous oral hygiene methods some people persist to have bad breath, in these cases mouth washes are advised, mouth washes are best used during night time wen the residue of the mouth wash stays in the mouth and can exert their antibacterial activity especially wen the action of saliva is low during sleep and bacterial activity is high
Other means to reduce malodor is by modifying the diet by consuming a high protein diet, also preventing dehydration of the oral mucosa so as to inhibit bacterial activity.
In short a number of remedies are available to prevent bad breath and it entirely depends on each individual and the most important of them is to practice good oral hygiene methods
 
 
 

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