Diagnosis of Halitosis

The most reliable and practical procedure for evaluating a patient's level of oral malodour is still a thorough organoleptic assessment by a trained clinician.  Nevertheless, the use of a portable sulphide monitor is of interest, since we can quantify the changes and the patients are able to monitor their evolution through therapy.  This is an important factor, especially in those patients with pseudohalitosis or halitophobia.

Apart from the mentioned methods to assess the level of oral malodour, there are other clinical variables that we must evaluate as these data can be useful to design the individual treatment needs and to objectively evaluate the changes in the follow up visits.  Among these clinical variables are the patient's periodontal status including oral hygiene levels and the status of tongue coating.  Since different indexes and methods have been reported in the literature to evaluate tongue coating, it is recommended that one index be used that allows us to quantify changes in the amount of coating. (Tables 3, 4, and 5)

Table 3.  Tongue Coating Index

0- no tongue coating 1- thin coating over 1/3 of the tongue dorsum. 2- thin coating over 2/3 or thick over 1/3. 3- thick coating over 2/3.
Taken from 2 Delanghe G, Ghyselen J, Bollen C, et. al.  An inventory of patients' response to treatment at a multidisciplinary breath odor clinic.  Quintessence Int.  1999 May;30(5):307-10.

Table 4.  Tongue Coating Index:  (Winkel E.G. 1998 (personal communication))

W.T.C. INDEX = A+B +C+D+E+F   0 = no coating   1 = light coating   2 = heavy coating

Table 5. Tongue Coating Wet Weight: (Yaegaki K. 1998)

Remove the entire tongue coating and measure its wet weight

Therapeutic Approaches to the Treatment of Halitosis

Treatment needs (TN) for halitosis in the dental practice have been categorized into 5 classes in order to provide guidelines for clinicians in treating halitosis patients. (Table 6)  These guidelines are directly related to a thorough diagnosis of the origin of halitosis.¹⁶  Treatment of physiologic halitosis (TN-1), oral pathologic halitosis (TN-1 and TN-2), and pseudo-halitosis (TN-1 and TN-4) should be the responsibility of a dentist, however, treatment of extra-oral pathologic halitosis (TN-3) or halitophobia (TN-5) should be undertaken by a physician or medical specialist such as a psychiatrist or psychologist.

Table 6.  Treatment Needs (TN) for Halitosis

In physiologic halitosis (TN-1), management should be focused on patient self-care.  It is important to make the patient aware of his/her halitosis, instruct him/her on the appropriate cleaning of the dorsum of the tongue (Figure 3), as well as on the use of adequate interdental oral hygiene measures.  In most of the patients, self-performed oral hygiene should be reinforced with an adequate chemical plaque control approach consisting of the use of mouthrinses or dentifrices with proven antibacterial efficacy

In oral pathologic halitosis (TN-2), patients should carry out the same regime as in TN-1, but the dentist should take care of the underlying oral pathology, especially the treatment of periodontal diseases or any dental therapy needed to treat caries or faulty restorations.

In TN-3, patients exhibit oral malodour but no oral origin can be demonstrated.  These patients should be referred to an appropriate medical specialist.

In TN-4, patients need to be counselled by educating them that their problem is psychological through an explanation of their results of diagnostic assessment.  For this purpose, the portable sulphide monitors are very useful.  Some patients are convinced of not having halitosis after they can see the lack of objective signs of malodour for themselves (pseudo-halitosis), whereas, others remain completely obsessed about their perceived problem in spite of any counselling (halitophobia).  In these (TN-5) situations, patients would need assistance from a psychological specialist.  Furthermore, patients with genuine halitosis who undergo successful reduction of halitosis by TN-2 or TN-3 and still believe they have the condition should also be referred to a psychological specialist.

Click Here To Navigate Within Article >> Abstract Introduction Prevalence and Social Importance of Halitosis Classification of Halitosis Etiology of Halitosis Factors Involved In The Etiology of Halitosis The Role of Bacteria In Oral Halitosis The Role of Physical and Chemical Conditions of the Oral Cavity The Role of Substrates The Role of the Dorsum of the Tongue Association Between Halitosis and Periodontal Disease Diagnosis of Halitosis References About the Authors
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Citation Number: Vol. 2, No. 4, Page 015