- Email: [email protected]
Analyzing bad breath
Clinical Significance.—Compared with patients aged 65 to 84 years, older patients had a statistically significant increase in the frequency of squamous cell carcinoma. Dental practitioners should ensure that older patients in their practices receive regular and routine oral health examinations and screening for this condition. It would be helpful to have noninvasive means for detecting oral lesions, and further development is needed in this area. All patients should be educated on the need for regular oral health screenings. Collaborative preventive efforts with allied health providers and geriatric patient populations are recommended.
Muzyka BC, Dehler KR, Brannon RB, et al: Characterization of oral biopsies from a geriatric population. Gen Dent 57:432-437, 2009 Reprints available from the Academy of General Dentistry. Fax your request to Jo Posselt (312/440-4261) or e-mail: [email protected]
Halitosis Analyzing bad breath Background.—Eighty to 90% of breath malodor, or halitosis, has oral causes, but nonoral causes include earnose-throat (ENT) infections; respiratory or gastrointestinal tract infections, ulcerations, or tumors; systemic diseases; metabolic disorders; and carcinomas. More than 2000 Caucasian patients with halitosis have been evaluated at the University Hospital, Leuven, Belgium. From the accumulated data, the etiology, characteristics, and any relationship between organoleptic ratings and portable bad breath device measurements were evaluated. Methods.—The patients ranged in age from 2 to 90 years, and 71.4% came to the facility on their own (Fig 1). All the patients completed a standardized questionnaire and underwent a clinical examination for their halitosis. Organoleptic scores were obtained by a trained, calibrated judge; a portable bad breath detector (Halimeter) was also used. The etiology, characteristics, and score correlations were then analyzed. Results.—In 75.8% of cases the cause of halitosis was oral. Tongue coating was the most frequent cause (43.4%), and a combination of tongue coating and gingivitis/periodontitis was next (18.2) (Table 1). Xerostomia was noted in 2.5% of cases. Nearly 2% of patients had ENT problems, such as tonsillitis. About 2% of patients had an extraoral cause, and no cause was found in 0.8% of cases. For
96
Dental Abstracts
15.7% of the patients, two thirds of whom were women, no objective signs of malodor were present. The organoleptic score was less than 3 for most patients. The scores for male patients were slightly higher than those for female patients. The portable bad breath detector score was less than 240 ppb and also showed this male-female trend (Fig 2). The organoleptic scores and portable detector results showed a significant correlation (Fig 3). There were significant differences between the portable detector scores and organoleptic scores of 0 to 1, 1 to 2, and 2 to 3. No significant differences were noted between the portable detector scores and organoleptic scores 3, 4, and 5. Significant correlations were also found between the organoleptic scores and tongue coating and pocket probing depth and between the portable detector scores and these two clinical findings. Discussion.—Halitosis was caused by intraoral factors in about 76% of the cases analyzed. Tongue coating was the most common etiologic factor. The combination of tongue coating and periodontal disease was associated with halitosis in almost 20% of cases. Few cases were caused by extraoral conditions. Some patients also demonstrated pseudo-halitosis, having no clinical signs of breath malodor but believing that they have bad breath. Organoleptic scores are subjected but showed a significant correlation with the objective findings of a portable bad breath detector.
35
Table 1.—Aetiology of Halitosis
30
Percentage
25
Female
Female
Male
n
%
n
%
Population %
452 46 62 184
41.9 4.3 5.8 17.1
416 29 86 179
45.1 3.1 9.3 19.4
43.4 3.8 7.4 18.2
26 2.4 24 2.6 2 0.2 5 0.5 2 0.2 2 0.2 71.8 80.4
2.5 0.4 0.2 75.8
20 15 10 5 0 < 15
a
15-25
26-35
36-45
46-55
56-65
> 65
Age (years)
Percentage
45 40
Female
35
Male
30
ENT Tonsillitis Rhinitis Sinusitis Nose obstruction
10 6 1 4
0.9 0.6 0.1 0.4 1.9
0.4 0.5 0.3 0.4 1.7
0.7 0.6 0.2 0.4 1.9
Extra-oral Gastro-intestinal Trimethylaminuria Other diseases Medication Hormonal Diet
16 1 1 2 2 7
1.5 10 1.1 0.1 0 0 0.1 4 0.4 0.2 0 0 0.2 0 0 0.6 2 0.2 2.7 1.7
1.3 0.1 0.3 0.1 0.1 0.5 2.3
25 20 15 10 5 0 <1
1-2
b
3-5
>5
Unknown
Duration (years) 80 Female
70
Combination Combination ENT/oral cause Combination GI/oral cause
Male
60
Percentage
Oral Tongue coating Gingivitis Periodontitis Combination (tongue coating/gingivitis/periodontitis) Xerostomia Teeth related Candida
Halitophobia, pseudo-halitosis Unknown
50 40 30
Male
4 5 3 4
18 1.7 24 16 1.5 17 3.2 211 19.6 102 9 0.8
2.6 1.8 4.4 11.1
2.1 1.7 3.8 15.7
6 0.7
0.8
(Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
20 10 0
c
Env
Env + Pat
Pat
Who is complaining
Fig 1.—General characteristics: Age of patients (A), duration of complaint (B), and who is complaining (C). Abbreviations: Env, Environment; Pat, patient himself. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009 Reprints available from M Quirynen, Dept of Periodontology, Catholic Univ of Leuven, Kapucijnenvoer 33, BE-3000 Leuven, Belgium; e-mail: [email protected]
Clinical Significance.—Because most halitosis has an oral cause, dentists will often be the healthcare professional consulted for this problem. A few patients will have extraoral causes and some will believe they have bad breath in the absence of any proof. To ensure that all cases are properly evaluated, the dentist should include ENT and other specialists’ contributions to the diagnostic process.
Volume 55
Issue 2
2010
97
Fig 3.—Halimeter values according to the organoleptic score. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Fig 2.—Organoleptic scores (while speaking) and volatile sulfur compounds levels (Halimeter) for male and female patients. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Occlusion Tooth wear Background.—Tooth wear is normal as a person ages, with tooth substance being lost as a result of erosion, attrition, and abrasion. The result can alter vertical dimension and induce parafunction. With younger patients showing tooth wear, factors other than age need to be explored. Methods.—A retrospective, cross-sectional design was used to determine if there are relationships between tooth wear and gender, orthodontic treatment, index of complexity, outcome, and need (Index of Complexity Outcome and Need [ICON]) score, and dietary factors. The ICON index was specifically formulated for dental study casts and was used to analyze tooth wear in 307 adults (133 men and 174 women) age 30 to 31 years.
98
Dental Abstracts
Results.—The whole-mouth mean tooth wear score was 2.77, with minimum and maximum scores of 1.78 and 4.09, respectively. Men had consistently higher mean tooth wear scores than women, with statistically significant differences between gender for total mean and mean incisor tooth wear scores. Molars and canines demonstrated more severe wear than other teeth. Subjects who received orthodontic treatment had slightly more tooth wear on the molars and a higher overall mean tooth wear score than subjects who had no orthodontic treatment. However, the mean tooth wear scores related to orthodontic treatment did not demonstrate a significant difference. ICON groups and low- and high-intake groups relative to acidic beverages and foods did not differ from one another in
Muzyka BC, Dehler KR, Brannon RB, et al: Characterization of oral biopsies from a geriatric population. Gen Dent 57:432-437, 2009 Reprints available from the Academy of General Dentistry. Fax your request to Jo Posselt (312/440-4261) or e-mail: [email protected]
Halitosis Analyzing bad breath Background.—Eighty to 90% of breath malodor, or halitosis, has oral causes, but nonoral causes include earnose-throat (ENT) infections; respiratory or gastrointestinal tract infections, ulcerations, or tumors; systemic diseases; metabolic disorders; and carcinomas. More than 2000 Caucasian patients with halitosis have been evaluated at the University Hospital, Leuven, Belgium. From the accumulated data, the etiology, characteristics, and any relationship between organoleptic ratings and portable bad breath device measurements were evaluated. Methods.—The patients ranged in age from 2 to 90 years, and 71.4% came to the facility on their own (Fig 1). All the patients completed a standardized questionnaire and underwent a clinical examination for their halitosis. Organoleptic scores were obtained by a trained, calibrated judge; a portable bad breath detector (Halimeter) was also used. The etiology, characteristics, and score correlations were then analyzed. Results.—In 75.8% of cases the cause of halitosis was oral. Tongue coating was the most frequent cause (43.4%), and a combination of tongue coating and gingivitis/periodontitis was next (18.2) (Table 1). Xerostomia was noted in 2.5% of cases. Nearly 2% of patients had ENT problems, such as tonsillitis. About 2% of patients had an extraoral cause, and no cause was found in 0.8% of cases. For
96
Dental Abstracts
15.7% of the patients, two thirds of whom were women, no objective signs of malodor were present. The organoleptic score was less than 3 for most patients. The scores for male patients were slightly higher than those for female patients. The portable bad breath detector score was less than 240 ppb and also showed this male-female trend (Fig 2). The organoleptic scores and portable detector results showed a significant correlation (Fig 3). There were significant differences between the portable detector scores and organoleptic scores of 0 to 1, 1 to 2, and 2 to 3. No significant differences were noted between the portable detector scores and organoleptic scores 3, 4, and 5. Significant correlations were also found between the organoleptic scores and tongue coating and pocket probing depth and between the portable detector scores and these two clinical findings. Discussion.—Halitosis was caused by intraoral factors in about 76% of the cases analyzed. Tongue coating was the most common etiologic factor. The combination of tongue coating and periodontal disease was associated with halitosis in almost 20% of cases. Few cases were caused by extraoral conditions. Some patients also demonstrated pseudo-halitosis, having no clinical signs of breath malodor but believing that they have bad breath. Organoleptic scores are subjected but showed a significant correlation with the objective findings of a portable bad breath detector.
35
Table 1.—Aetiology of Halitosis
30
Percentage
25
Female
Female
Male
n
%
n
%
Population %
452 46 62 184
41.9 4.3 5.8 17.1
416 29 86 179
45.1 3.1 9.3 19.4
43.4 3.8 7.4 18.2
26 2.4 24 2.6 2 0.2 5 0.5 2 0.2 2 0.2 71.8 80.4
2.5 0.4 0.2 75.8
20 15 10 5 0 < 15
a
15-25
26-35
36-45
46-55
56-65
> 65
Age (years)
Percentage
45 40
Female
35
Male
30
ENT Tonsillitis Rhinitis Sinusitis Nose obstruction
10 6 1 4
0.9 0.6 0.1 0.4 1.9
0.4 0.5 0.3 0.4 1.7
0.7 0.6 0.2 0.4 1.9
Extra-oral Gastro-intestinal Trimethylaminuria Other diseases Medication Hormonal Diet
16 1 1 2 2 7
1.5 10 1.1 0.1 0 0 0.1 4 0.4 0.2 0 0 0.2 0 0 0.6 2 0.2 2.7 1.7
1.3 0.1 0.3 0.1 0.1 0.5 2.3
25 20 15 10 5 0 <1
1-2
b
3-5
>5
Unknown
Duration (years) 80 Female
70
Combination Combination ENT/oral cause Combination GI/oral cause
Male
60
Percentage
Oral Tongue coating Gingivitis Periodontitis Combination (tongue coating/gingivitis/periodontitis) Xerostomia Teeth related Candida
Halitophobia, pseudo-halitosis Unknown
50 40 30
Male
4 5 3 4
18 1.7 24 16 1.5 17 3.2 211 19.6 102 9 0.8
2.6 1.8 4.4 11.1
2.1 1.7 3.8 15.7
6 0.7
0.8
(Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
20 10 0
c
Env
Env + Pat
Pat
Who is complaining
Fig 1.—General characteristics: Age of patients (A), duration of complaint (B), and who is complaining (C). Abbreviations: Env, Environment; Pat, patient himself. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009 Reprints available from M Quirynen, Dept of Periodontology, Catholic Univ of Leuven, Kapucijnenvoer 33, BE-3000 Leuven, Belgium; e-mail: [email protected]
Clinical Significance.—Because most halitosis has an oral cause, dentists will often be the healthcare professional consulted for this problem. A few patients will have extraoral causes and some will believe they have bad breath in the absence of any proof. To ensure that all cases are properly evaluated, the dentist should include ENT and other specialists’ contributions to the diagnostic process.
Volume 55
Issue 2
2010
97
Fig 3.—Halimeter values according to the organoleptic score. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Fig 2.—Organoleptic scores (while speaking) and volatile sulfur compounds levels (Halimeter) for male and female patients. (Courtesy of Quirynen M, Dadamio J, Van den Velde S, et al: Characteristics of 2000 patients who visited a halitosis clinic. J Clin Periodontol 36:970-975, 2009.)
Occlusion Tooth wear Background.—Tooth wear is normal as a person ages, with tooth substance being lost as a result of erosion, attrition, and abrasion. The result can alter vertical dimension and induce parafunction. With younger patients showing tooth wear, factors other than age need to be explored. Methods.—A retrospective, cross-sectional design was used to determine if there are relationships between tooth wear and gender, orthodontic treatment, index of complexity, outcome, and need (Index of Complexity Outcome and Need [ICON]) score, and dietary factors. The ICON index was specifically formulated for dental study casts and was used to analyze tooth wear in 307 adults (133 men and 174 women) age 30 to 31 years.
98
Dental Abstracts
Results.—The whole-mouth mean tooth wear score was 2.77, with minimum and maximum scores of 1.78 and 4.09, respectively. Men had consistently higher mean tooth wear scores than women, with statistically significant differences between gender for total mean and mean incisor tooth wear scores. Molars and canines demonstrated more severe wear than other teeth. Subjects who received orthodontic treatment had slightly more tooth wear on the molars and a higher overall mean tooth wear score than subjects who had no orthodontic treatment. However, the mean tooth wear scores related to orthodontic treatment did not demonstrate a significant difference. ICON groups and low- and high-intake groups relative to acidic beverages and foods did not differ from one another in