Introduction

The production of bad breath (oral malodor, halitosis) is multi-factorial and may involve both oral and non-oral sources.^1,2  Non-oral sources of breath odor are generally related to systemic problems and/or medications.  Conditions such as diabetes, liver and kidney disorders, and pulmonary disease may contribute to offensive breath odor.  This is also true of some medications, especially those that reduce salivary flow such as antidepressants, antipsychotics, narcotics, decongestants, antihistamines, and antihypertensives.  These non-oral sources of breath odor have been well reviewed in the literature.^2,3,4  However, while systemic conditions and medications can contribute to breath problems, most authorities seem to agree the majority of bad breath originates in the oral cavity.

Bacterial putrefaction^5,6,7 by gram-negative anaerobic bacteria, particularly those residing on the posterior dorsum of the tongue, utilize sulfur containing amino acids, primarily cysteine and methionine,^8,9,10 to produce volatile sulfur compounds (VSCs).¹¹  Although other organic components (e.g., organic acids, indole/skatole, putrescine, cadaverine) may be involved in the production of halitosis,¹² hydrogen sulfide (H₂S), methyl mercaptan (CH₃SH), and dimethyl sulfide [(CH₃)₂S] have been identified as the predominate VSCs responsible for oral malodor.^9,13,14  While the tongue is considered the primary source of VSC production, other dental problems can generate these offensive gases.

Dental conditions such as gingivitis, periodontal disease, gross carious lesions, and poor oral hygiene have been shown to contribute to bad breath.^5,10,15-19  However, when dental disease is the source of oral malodor, treatment of the condition will often eliminate the problem.^5,10,17,19  Likewise, transient breath problems from eating spicy foods, smoking, and drinking certain beverages will most often disappear shortly after their use is discontinued.^1,20  However, while eliminating these sources can successfully treat the majority of patients who suffer from bad breath, some individuals continue to have chronic breath problems.

It has been estimated that up to 25% of the population suffer from bad breath on a regular basis in spite of having good physical and oral health and after the elimination of offensive foods and beverages.^21,22,23  It is these patients that most need our expertise.  While there are many new products and emerging information regarding the treatment of oral malodor, the dental professional also needs to feel comfortable sharing this information and these products with their patients.

Click Here To Navigate Within Article >> Abstract Introduction Self-Consciousness: A Barrier to Communication Preparation for Interviewing and Counseling Patients The Dental Professional's Responsibility A Conceptual Scheme for Counseling Patients With Oral Malodor: The P-LI-SS-IT System Application of the First Level of Treatment: Permission Application of the Second Level of Treatment: Limited Information Application of the Third Level of Treatment: Specific Suggestions Application of the Fourth Level of Treatment: Intensive Therapy Summary References About the Authors
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Citation Number: Vol. 2, No. 2, Page 047