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 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ © 2019 Philips North America 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 __________________________________ © 2019 Philips North America 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. __________________________________ __________________________________ __________________________________ __________________________________ © 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 __________________________________ __________________________________