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Oral Malodor 4 Classes…. 3 Sub-types

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

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Oral Malodor 4 Classes…. 3 Sub-types

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  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. 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 Fetor ex Ore/ Fetor Oris

  8. Biological Sources of Oral Malodor • BLOOD • NECROSIS • PUS • MUCOUS • BACTERIA

  9. Oral MalodorVolatile 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. 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 OM CLINICAL Management VIIOral Irrigation A

  15. 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 OM CLINICAL Management VIII Saline Mouthwash & Gargle

  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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