Halitosis: condition of foul breath; by Dr Anthony Uloko

 I am Dr. Uloko Anthony and would be giving a lecture on Halitosis

Halitosis simply means BAD BREATH

It is said that Prophet Mohammed(SAW) once sent a congregant from the mosque for having the smell of garlic in his breath.

Imagine a course mate with constant bad breath

Imagine your seat mate with constant bad breath

Imagine your girlfriend or boyfriend with bad breath

Breath malodor should not be confused with the momentarily disturbing odor caused by food intake (e.g., garlic, onions, and certain spices), smoking, or medication (e.g., metronidazole) because these odors do not reveal a health problem.

The same is true for “morning” bad breath, as habitually experienced on awakening.

Well, let me give a classification to aid us

CLASSIFICATION

There are three main categories of halitosis: 

Genuine halitosis.

Pseudo-halitosis, and 

Halitophobia.

Genuine halitosis: is the term that is used when the breath malodor really exists and can be diagnosed.

If you have a boyfriend or girlfriend that has this persistent malodor that she complains about and that you can perceive or those around her can, we call that Genuine Halitosis.

Pseudo-halitosis:

When an obvious breath malodor cannot be perceived, but the patient is convinced that he or she suffers from it.

Pseudo Halitosis no be small thing o

I have had many patients who have cried in my presence because of pseudo Halitosis

Imagine telling people your mouth is smelling but they cannot perceive it. It's psychologically draining

Some have gone for deliverance after blaming witches.

But deliverance no work o.

Halitophobia: If the patient still believes that there is bad breath after treatment of genuine halitosis or diagnosis of pseudohalitosis.

This is a recognized psychiatric condition.

Let's look at the Etiology ( causes) of Halitosis

Before I continue, let's not forget that *Atleast 90% of all malodor originates from the oral cavity. The remaining 10% has systemic or ExtraOral cause.

 It could be 

 Physiological(Normal causes outside disease)

 Pathological (As a result of a disease process)

What normally causes Halitosis even though we are not sick( knowingly or unknowingly)

Physiologic

Food containing lactose (dairy products like milk, cheese, yoghurt, ice-cream).

Food containing sulphur (onion, garlic).

Lack of salivary flow during sleep.

Smoking and alcoholic drinks.

Of course, after smoking or drinking alcohol, our mouths become dry. Saliva has a washing(cleansing) effect on the mouth and if it's not available, bad breath.

Moreover the alcohol and cigar can cause bad breath itself.

When we wake up after sleep, our mouth is closed and there is generally decrease salivary flow.

For Pathological causes of Halitosis, it could be

Intra oral(from the mouth)

ExtraOral (outside the mouth)

 Imagine what can cause bad breath from the mouth

 Intra Oral(from the mouth or oral cavity)

Poor oral hygiene.

Dental caries. Popularly called ‘holes’ that lead to the accumulation of food material.

Of course, when you don't take care of your mouth well(poor oral hygiene), halitosis (persistent bad breath) can occur. No be village People cause am. Na you.

When you have a hole in your tooth that accomodates food debris always, the food would definitely undergo decay. You already know the result

Other causes of introral oral causes of Halitosis

Dental plaque: The public general call this ‘dirt’ in the mouth.

Gingivitis: Infection of the gum

Periodontitis.

Oral carcinoma(cancers)

Let's look at the ExtraOral pathologic causes of Halitosis We just finished with the intraoral

I just hope the lecture thus far is simplified

 Extra Oral(occurring from outside the mouth)

Disorders of the upper respiratory tract: Mouth breathing due to upper respiratory tract blockade, chronic sinusitis, foreign bodies.

Disorders of the lower respiratory tract: Pulmonary abscess, bronchiectasis, pulmonary tuberculosis, carcinoma of the lung, necrotizing pneumonitis and empyema.

Gastrointestinal conditions: Salivary gland dysfunction, peritonsillar abscess etc.

Disorders of lower gastrointestinal tract: Gastric carcinoma, hiatus hernia.

Imagine a blocked respiratory tract🤔

 Imagine someone that usually has catarrh as it's popular called for days and find it difficult to breath. There will definitely be some level of bad breath

Let's quickly look at how this halitosis occurs

PATHOGENESIS

 Bacteria plays a role

Saliva plays a role

For the bacteria. I will name a couple just for the purpose of the lecture

Role of bacteria: The common microorganisms involved are anaerobic Streptococci, Peptostreptcoccus, Bacteriodes, Fusobacterium, Veillonella, Eubacterium, Enterococci, Pseudomonas, Campylobacter, Actinomyces, Enterobacter, Klebsiella and Aggregatibacter aaacactinomycetemcomitans

Their(Bacteria) main nutrient sources are proteins, peptides, or amino acids which are degraded to volatile sulfur compounds and other odoriferous substances.

The most common intraoral sites of malodor production is tongue. 

Others are interdental and subgingival areas, denture, overhanging restorations, leaking crowns, large carious lesions, sites of food impaction .

For the role of Saliva

Role of saliva: Saliva has dual action of inhibiting and favoring malodour formation. 

When the salivary flow rates is slow and oxygen availability is low, saliva favors the malodor formation and when the flow of saliva is rapid and there is greater availability of oxygen, the inhibitory property of saliva dominates.

There is something very important y'all should note.

Role of Volatile organic compounds:

Halitosis is due to the presence of odorous gases in the air expelled from the oral cavity. For the compound to be odoriferous it must be volatile. 

Volatile sulfur compounds are mainly produced through putrefactive activities of bacteria present on the tongue surfaces, in the saliva, gingival sulcus and other areas.

A quick look at the treatment strategies

TREATMENT STRATEGIES TO CONTROL HALITOSIS

Scaling(popularly called, mouth cleaning) and root planing is done and oral hygiene instructions are given to the patient.

For you wey no get Halitosis, have you ever gone for scaling and polishing?

I just dey look you🌚

Another important strategy is

Tongue cleaning: is done by either a brush or a tongue scraper. Rinse and clean the tongue scraper well after each use.

Let's not forget the highlighted statement. So tongue scraper is important

Other strategies include:

Chemical reduction of oral microorganisms: Chlorhexidine, Listerine, Cetylpyridium chloride and Zinc chloride are common mouthwashes used in cases of halitosis.

Masking the malodor: Using lozenges.

Consultation of physician by the dentist: Bad breath may indicate the presence of an underlying systemic condition.

Therefore, whenever local measures prove ineffective, the consultation of physician is indicated for systemic cause. 

Pseudo-halitosis almost always requires referral to clinical psychologist for management.

Even though you don't have Halitosis, there are basic things a normal human should do. These include:

Visiting a Dentist Regularly

 Brushing twice daily. Last thing at night and after meal in the morning

With appropriate brushing techniques for At least 2 to 3 mins

Flossing after brushing or between major meals to remove food particles stuck between teeth

Limit intake of spices

Limit sugar and caffeine intake

Drink plenty of liquid

IN CONCLUSION

Halitosis is a common complaint that affects lots of persons

When halitosis(persistent bad breath) is noticed by any individual, it can be a result of Oral or systemic causes.

So it's good to visit the hospital for consultation and possibly treatment

THANK YOU

Question and answer segment:

What can u say about eating before brushing the teeth

Question:

What can you say about brushing without rinsing your mouth?

Question: 

What type of spices please?

Also, how far should one go when washing the tongue?

Question:

Is scaling a painful procedure?.

Question:

Kissing a girl with this condition, how appropriate could it be?

Question:

All those local herbal dental powders for brushing ... Are they safe and efficacious? Would u advice it usage?

 Dr Uloko: 

When you brush last thing at night, you remove relatively all the food particles in your mouth. Don't forget to brush your tongue.

This means that your mouth is fresh.

Remember that bacteria act on food debris. So you have deprived them.

In the morning, you will even notice your mouth is fresh. So just rinse your mouth and eat. Then brush to remove food debris.

People who brush then eat usually, before mid day, they notice badbreath.

But if you do as I have stated, brushing last thing at night and after eating in the morning, your fresh breath stays with you relatively through the day

 Dr Uloko: 

Things like ginger, garlic,

Even onions can cause bad breath.

Dr Uloko: 

I am not in that school of thought.

If you brush and you don't rinse your mouth, what you brushed out(food particles, coatings on tongue), where does it go to?

Dr Uloko: 

Lolx...

Counsel her.

If you can stand it or the bad breath makes her attractive to you, continue!

But it's not appropriate because you won't feel comfortable.

Question:

So fluorine is quite necessary in the prevention of cavities

Bhur more than average amount of fluorine causes teeth coloration..

Is brushing twice a day consistently sine qua non in this regard?

 Dr Uloko: 

Usually, it's not.

But it can if you are traumatized during the procedure or during cleaning, the person goes deep down between your gums and teeths.

Usually, your tiny blood vessels on your gums bleeds easily especially with great dirts.

Question:

How far should one go when washing the tongue?

Dr Uloko: No!

As a professional, I don't.

Many people who use them end up coming to see us in the hospital.

 Dr Uloko: 

Flourish is present in water, salt, milk etc.

As you brush or as the toothpaste containing flouride comes in contact with your teeth, your saliva absorbs some. There is a reaction between the flouride and your teeth.

Rinse off excess.

Don't forget Flouride toxity exists and Flourosis can happen with time.

 Dr Uloko: 

Brushing twice a day is important.

The flouride in milk, water, salt etc are well measured for human requirements to avoid excess.

If you are a swimmer, take the necessary protective devices

 Dr Uloko: 

Brushing twice a day is important.

The flouride in milk, water, salt etc are well measured for human requirements to avoid excess.

If you are a swimmer, take the necessary protective devices

 Dr Uloko: 

This is based in research.

If you feel comfortable, you can spit it out or rinse out later later. To give enough time for the flouride

 Dr Uloko: 

But there are other sources of flouride and usually, the flouride has combined with saliva and the teeth must have absorbed the needful for that moment.

 Dr Uloko: 

I guess I have answered. Choose the one that  best suites you. Although research has shown it's more beneficial not to rinse. Just spit.

But will you feel comfortable?

Are there no other sources of flouride?

The time it takes for the flouride to be in your mouth, isn't it enough for the time being?

 Dr Uloko: 

As far back as you can reach. Not hard. Gently! You are not washing a sack.

Guess I have answered all the questions

Thank You all.