The term halitosis, more commonly known as bad breath, generally indicates the unpleasant or disturbing smell of the air emitted from the oral cavity.
Halitosis is a condition that can affect individuals of any sex or age and can be transient or persistent and / or pathological, caused by oral or systemic diseases.
The origins of the bad breath smell can be multiple and related to different physiological and pathological conditions, oral and non-oral.
The most common is found precisely in the oral cavity, where local physiological or pathological events of strictly oral origin confer a bad smell to the air exhaled in transit from the mouth.
The disturbance is in fact caused in most cases by the presence of volatile compounds, mainly sulfides (hydrogen sulfide ), produced in the oral cavity by micro-organisms capable of metabolizing food and cellular residues, generating bad odour.
Oral causes, which represent 90% of cases, are represented by:
- Bacterial lingual patina
- Insufficient oral hygiene
- Gingivitis or periodontitis
- Untreated carious lesions
- Oral infections
- Ulcerative stomatitis
- Oral cancer.
The epidemiological contribution of systemic or non-oral diseases and pathological conditions is extremely low and cannot be considered in the case of halitosis without other specific extra-oral or systemic symptoms or signs.
the most frequent among the non-oral causes of halitosis are:
infectious / inflammatory diseases of ENT interest, mainly acute and chronic sinusitis, acute and chronic tonsillitis with purulent exudate in tonsillary or tonsillite crypts, the presence of abnormally deep tonsillary crypts and nasal respiratory obstruction due to the altered dynamics of air flow.
diabetes mellitus, chronic renal failure and severe liver disease which need a specialist to solve the problem (less frequent).
The clinical odontostomatological assessment of the patient who reports halitosis problems begins with a thorough anamnestic interview aimed at clarifying the characteristics of halitosis in the specific case and any correlations with lifestyle or habits of life and with oral, extra-oral or systemic anomalies or diseases in progress.
The oral clinical examination must necessarily include the clinical examination of the soft tissues and oral mucous membranes, carried out by means of the inspection and palpation of all the mucous membranes, as well as the teeth.
The patient must necessarily be examined in standard conditions, that is preferably in the morning, after having abstained from taking any food or drink and without having performed oral hygiene maneuvers or used chewing-gum or candies or smoked in the previous three hours.
The dentist and dental hygienist will carry out organoleptic tests and use innovative technological tools to recognizing the volatile sulfur compounds present (hydrogen sulphide, methyl mercaptan and dimethylsulphide) and measure their concentration. This is indispensable to identifying the type of halitosis.
The method we use provides important support for diagnosis, directing the patient towards a treatment aimed at definitively removing the causes; after all, halitosis is only a symptom.