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Oral Malodor 4 Classes…. 3 Sub-types Above Carina (URTI’s)- OZOSTOMIA Below Carina (LRTI’s)- STOMATODYSODIA HALITOSIS: i) Physiological ii) Pathological.

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Presentation on theme: "Oral Malodor 4 Classes…. 3 Sub-types Above Carina (URTI’s)- OZOSTOMIA Below Carina (LRTI’s)- STOMATODYSODIA HALITOSIS: i) Physiological ii) Pathological."— Presentation transcript:

1 Oral Malodor 4 Classes…. 3 Sub-types Above Carina (URTI’s)- OZOSTOMIA Below Carina (LRTI’s)- STOMATODYSODIA HALITOSIS: i) Physiological ii) Pathological iii) Psychological FETOR EX ORE/ FETOR ORIS: Oral Hygiene, Perio, and Decay

2 OZOSTOMIA… above carina Obstruction, Nasal- discharge, Tonsillitis, Tonsoliths, Laryngitis, Dysphagia, Voice problems Previous ENT pathology Sinusitis, Rhinitis, Pharyngitis, Foreign Bodies Stagnation and Infection Malignancies

3 STOMATODYSODIA …below carina Tobacco Smokers Bronchitis Bronchiectasis Lung Abscess Pleuritis Pneumonia Blood Foreign Body Neoplasia, Mucous Stagnation/Infection

4 HALITOSIS physiological Poor hydration Menstruation Diet Constipation Starvation, Morning breath Habits (Mouth breathing, thumb sucking)

5 HALITOSIS pathological Lungs release blood-borne catabolic products Stomach--Gastritis, Liver hepatitis, Kidney nephritis Pancreas--Diabetes mellitus (Ketosis) Anorexia/Bulimia nervosa IgA deficiency Xerostomia (Sjogrens, Radiation therapy, Stress)

6 HALITOSIS psychological “Halitophobia” not very accurate term Delusional cacosmia Psychogenic dysosmia Symptomatic schizophrenia Temporal lobe epilepsy (Aura) Cerebral tumors

7 Fetor ex Ore/ Fetor Oris From Mouth: Gums&Teeth Gingivitis/Periodontitis Percoronitis/Peri-implantitis Dorsum of tongue Interdental areas ANUG/NUG Post-extraction, Dry socket Plaque & Calculus Oral Hygiene, Stagnation areas Caries: Tooth decay Brushing and Flossing Reduced salivary flow Faulty fillings, Overhangs Dental materials Cements: Eugenol, Cajeput, Creosote, Kri3 Fixed bridgework, Pontics Appliances– Orthodontic, Prosthodontic Denture hygiene Oral medicine conditions Ulcerations, Abrasions, Wounds Neoplasias Hemorrhagic diatheses

8 Biological Sources of Oral Malodor BLOOD NECROSIS PUS MUCOUS BACTERIA

9 Oral Malodor Volatile Sulfur Compounds VSC mainly responsible for stench Measure with the Halimeter ® VSC’s include hydrogen sulfide, methyl mercaptan, and dimethyl sulfide

10 Oral Malodor CLINICAL Management I Full comprehensive Oral Examination Detect, record all gingival problems Gingivitis and Periodontitis Scale and Polish: Root Planing; Pocket elimination Restore faulty restorations Oral Hygiene PIx<10% Recall: re-measure VSC’s Outcome analysis: Results/Proof

11 Oral Malodor CLINICAL Management II OHI: Brushing, Flossing, Gargle, Rinse Teeth, Gums, Tongue, Tonsils, pharynx Prosthesis: Hygiene, Repair, or Replace Remove all plaque

12 Oral Malodor CLINICAL Management III Floss Anti-bacterial Paste Peroxide paste Bicarbonate of Soda Paste Tongue scraper -- Commercial vs Spoon Pre-sleep Oral Hygiene

13 Oral Malodor CLINICAL Management VI Rectify URT and LRT Treat systemic disease Diabetes, Hypertension, CCF Oral Health: Teeth and Gum problems cause >90% cases of oral malodor Keep records Record on VAS scales Note measures of VSC Educate the patient

14 OM CLINICAL Management VII Oral Irrigation A Medicinal Mouthwash Short-term for specific effect Associated risks Examples: Peridex (Chlorhexidine gluconate); Phenol Based with oils (Listerine); Cetyl-pyridinium Cl (Cepacol) Chlorine dioxide, herbal remedies, etc. Side effects: staining, taste changes, toxicity, overgrowth of bacteria, fungi etc. Physiological Daily use Long tem Minimal side effects if any Physiological substances: Examples: Salt, Bicarbonate of soda, Urea crystals Fluoride rinse: correct physiological concentration 1ppm

15 OM CLINICAL Management VIII Saline Mouthwash & Gargle PREPARATION: NaCl common Table Salt Hypertonic solutions: stir one teaspoonful of salt in about 300ml water. Salt should remain at base of glass=Saturated solution  hypertonic Freshly prepared for each use. Not costly; available MODE OF ACTION Hypertonicity dehydrates bacteria  bacteriostatic initial  then bacteriocidal Edema: Swollen Cells are reduced Saline debridement of tonsillar crypts Washes and irrigates mucous membranes; mucolytic Slows inflammation

16 Oral Malodor Clinics Part of Practice: NOT isolated Must have accurate clinical measuring devices-- Halimeter ® (VSC’s ppb) Must have ALL oral therapeutic back-up Refer and COMMUNICATE Clinical Protocol: Quote fees Examinations, Radiographs, Bacteriology, Histopathology, Periodontics, Endodontics, Restorative, Prosthodontics, Otolaryngology, Psychological referrals Written Report Mandatory


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