Smell It Like It Is: Addressing Halitosis

Tracey Jacobs, BSDH, RDH Manager, Professional Education South [email protected]

Tracey is a graduate of the University of Alabama School of Dentistry with a Bachelor’s of Science in Den-

tal Hygiene. She is a member of the American Dental Education Association, American Dental Hygienists’ Association and American Academy for Oral Systemic Health. Having served several leadership positions including President of the Florida Dental Hygiene Association, she is most noted for her dedicated service as the FDHA Addressing The Elephant In The Room Event Planner and awarded the FDHA Distinguished Service Award.  50-80% adults experience halitosis Tracey manages the South region for Philips and pre-  Ancient Egyptians used herbs and spices sents a variety of educational programs nationwide. With over 25 years of clinical experience  Jewish text, Talmud granted rights for divorce over bad breath

Notes:______Halitosis ______ Most common dental concern ______ 90% originates from oral cavity ______ 13% results from gingivitis or periodontitis ______ 10% systemic ______ 5% sinus ______ 5% other etiologies ______Old Paradigm ______

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Physiologic <—> Pathologic Relativity Notes:______ Subject to variations ______ May fluctuate within hours ______

 Multi-factorial ______

______Classifications ______1) Oral Halitosis ______ Tongue ______ Periodontal Pockets >4mm ______

______2) Airway Halitosis ______ Respiratory Tract ______ Rhinosinusitis ______ Tonsillitis ______ Pharyngitis ______ Laryngitis ______ Bronchitis ______ Pneumonia ______ Post Nasal Drip ______ Rhinorrhea ______ Tonsils ______ Tonsilloliths aka Tonsil Stones ______3) Gastroesophageal Halitosis ______ Odor from stomach leakage ______ Gastric reflux: reflux of gastric juice, bacteria and ______digested food into pharynx ______ Some studies reveal a correlation btw H. pylori ______and halitosis ______4) Blood borne Halitosis: volatile chemicals in systemic ______circulation transfer to exhaled breath ______ Systemic Diseases ______ Lung Diseases: Lung Carcinoma, Chronic Ob- ______structive Pulmonary Disorder ______ Sickle Cell Anemia ______ Sleep Apnea ______ Cirrhosis ______ Kidney Disease & Failure ______ Some Cancers i.e. Breast Cancer ______

4) Blood borne Halitosis: volatile chemicals in systemic Notes:______circulation transfer to exhaled breath ______II. Metabolic Disorders ______ Diabetes ______ Trimethylaminuria TMAU: body is unable to ______break down TMAU, a compound derived from ______diet that has a strong odor of rotting fish. ______III. Food ______ Temporary Halitosis: spicy foods, garlic, onions, ______coffee, alcohol ______ Crash Diets or Fasting ______ Protein Digestion ______IV. Medications ______ Antibiotics ______ Anti-depressants ______ Anti-Hypertensives ______ Anti-Allergic ______ Sedatives/Hypnotics ______ Alcohol/Tobacco ______ Recreational Drugs (Amphetamines) ______5) Subjective Halitosis: complaint without an objective ______confirmation by someone else or a halimeter. ______ Psychologic—Obsessive Compulsive Disorder ______ Neurologic-Side effects of medications, hypothy- ______roidism, hyposalivation, nutrient deficiency, trau- ______ma or tumors of brain, nerve damage, neuro- ______degenerative diseases, environmental pollutants, ______drug abuse, diabetes, GERD, blood-borne stimula- ______tion of taste and smell receptors in blood circula- ______tion. ______Call to Action: ______Update health ques- ______tionnaire to inquire ______about halitosis con- ______cerns. ______

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© 2019 Philips North America Notes:______www.beathalitosis.com ______Volatile Sulfur Compounds (VSC) ______ Gases produced from gram (—) bacteria on tongue ______surface ______ Responsible for 80-90% of oral malodor ______ Primary Gases: ______ Hydrogen Sulfide (HS) = Rotten Egg Smell ______ Methyl Mercaptan (MM) = Feces Smell ______ Dimethyl Sulfide (DS) = Cabbage/Gas Smell ______Did you know methyl mercaptan is associated with the ______smell of periodontal disease? ______

______Subjective Diagnosis Method ______1)Organoleptic (Human Nose) ______2)Spoon Test ______Rosenberg Scale ______3)Floss Test ______Objective Diagnosis Method ______Instrumental Assessment ______1) Gas Chromatography ______ Measures all gases ______ Highly sensitive ______ Large equipment ______ Expensive ______

Objective Diagnosis Methods Notes:______Instrumental Assessment Continued ______2) Sulfide Monitors ______ OralChroma™ ______ Detects/differentiates primary VSCs ______ Highly sensitive to VSCs ______ Halimeter® - Not sensitive to VSCs ______ Breathtron®- Detects total VSCs ______Disadvantages ______ Cost $2,400—$5,000 ______ Needs routine calibration ______ Sensors need replacement every 2 years ______Chemical Sensors-Electronic Nose ______ VSCs generate electrochemical voltage ______ Voltage is measured by electronic unit ______ Measures all VSCs separately ______Saliva Test ______ BANA-detects treponema denticola, P. gingivalis, ______and T. forsynthensis ______ Amine-detects protein breakdown ______ Beta-galactosidase-detects glycoproteins ______ Saliva Incubation-organoleptic measures are per- ______formed after incubation ______Advantages: inexpensive, can detect perio patho- ______gens and/or halitosis ______Disadvantage: pathogens mainly linked to periodonti- ______tis, not all who have periodontal disease suffer from ______halitosis and vice versa. ______Hiding Behind The Mask ______ $2 billion/year for short-term effects ______ 49% rinse with mouthwash ______ 70% chew gum ______ 75% brush teeth ______

Treatment Regimen Notes:______TN—1: Explanation of halitosis and OHI ______TN—2: Prophylaxis, SRP, necessary dental tx ______TN—3: Referral to physician and/or specialist ______TN—4: Halitosis education, instructions, and reassurance ______TN—5: Referral to psychologist or psychiatrist ______Treatment Solutions ______

______Homeopathic ______ Herbs-mint, parsley, fennel seed, cinnamon ______ Zinc-lozenges to neutralize VSCs ______ Oil Pulling-lauric acid in coconut oil has antimicrobial ______properties ______ Probiotics-studies show helpful to reduce oral malodor ______Chemical Solutions ______ Prescription Rx ______ Chlorhexidine Gluconate ______ OTC ______ VSC Neutralizers: Zinc, Chlorine Dioxide ______ Antibacterial Agents: CPC, Essential Oils, Triclosan ______Mechanical Solutions ______ Tongue coating = 80-90% halitosis ______ Tongue brushing and cleaning lowers VSC levels ______Most Effective System: Brush —> Scrape —>Rinse ______Call to Action: ______Incorporate A Breath ______Management System © 2019 Philips North America

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