Halitosis en otorrinolaringología: una revisión de la literatura / Halitosis in otolaryngology: a review of the literature

RESUMEN La halitosis es un motivo de consulta frecuente y que puede repercutir de gran manera en la calidad de vida de quien la presenta. Puede dividirse en halitosis genuina, pseudohalitosis y halitofobia. De las halitosis genuinas, cerca del 90% son secundarias a patología de la cavidad oral. En otorrinolaringología, las principales causas responden a tonsilolitiasis, patología rinosinusal y cuerpos extraños nasales. Existen distintos métodos diagnósticos que permiten medir e identificar la halitosis, con sus beneficios y desventajas. Las medidas generales de higiene oral, así como intervenciones específicas deben estar basadas en la evidencia a cargo de un equipo multidisciplinario que permita garantizar mejores resultados.

ABSTRACT Halitosis is a frequent health problem, that can have a huge impact in the quality of life of those affected. It can be classified as genuine halitosis, pseudohalitosis and halitophobia. Of genuine halitosis, approximately 90% is originated from the oral cavity. In otorhinolaryngology, most frequent causes are tonsiloliths, rhinosinusitis and nasal foreign bodies. There are different diagnostic methods, each one with its benefits and disadvantages. General measures of oral hygiene, as specific interventions must be evidence-based in charge of a multidisciplinary team that guarantees better results.

Prevalence of self-reported halitosis and associated factors in adolescents from Southern Brazil

The aim of this study was to assess the prevalence of selfreportedhalitosis and associated factors in adolescents fromPasso Fundo, Brazil. Additionally, we studied adolescents’concern with their own breath and whether anyone hadever told them that they had halitosis...

O objetivo do presente estudo foi verificar a prevalência de halitose autorreportada e fatores associados em adolescentes de Passo Fundo, Brasil. Além disso, foram verificados a preocupação dos adolescentes com o seu próprio hálito e se eles já foram avisados por alguém sobre essa condição em qualquer momento de suas vidas...

Self-reported halitosis and associated demographic and behavioral factors

Abstract Halitosis is still poorly studied in young adults. The aim of this study was to evaluate the occurrence of self-reported halitosis and associate it with demographic and behavioral factors in young adult dental students. This cross-sectional study was designed as a census of students enrolled in three initial and three final semesters of a dental course in a Brazilian public university. Of 284 eligible students, 257 (90.5%) completed a self-administered questionnaire. Self-reported halitosis was the primary study outcome, and was assessed with the question "do you feel you have bad breath?". Data on age, gender, frequency of tooth brushing and interproximal cleaning, tongue cleaning, mouth rinse use and dry mouth were collected using the questionnaire, and were considered independent variables. Of the students surveyed, 26.5% reported as never, 51.7% as rarely, 21.4% as sometimes, and 0.4% as always feeling they had halitosis. Morning halitosis was reported by 90.6% of those who reported halitosis. In the final multiple model, last semester students had a 55% lower chance of reporting halitosis, compared with students from the first semesters [odds ratio (OR) 0.46; 95%CI 0.24-0.89]. Women had a 2.57fold higher chance of reporting halitosis (OR = 2.57; 95%CI 1.12-5.93). Dry mouth increased the chance of self-reported halitosis 3.95-fold, compared with absence of dry mouth (OR = 3.95; 95%CI 2.03-7.68). It can be concluded that self-reports of halitosis were low among dental students, but may represent an important complaint. Gender, dry mouth and level of college education of the dentist were factors significantly associated with self-reported halitosis.

Emotional impact of halitosis / O impacto emocional da halitose

Objective: To evaluate the emotional impact of halitosis on 18-year-old men using a self-reported questionnaire. Method: A total of 2,224 participants underwent dental and medical examinations in the army medical services in the city of Pelotas, southern Brazil, in July 2008. Results: In this sample, 12% of respondents expressed concern about their oral malodor, which had a strong emotional impact on their quality of life. Conclusions: The individuals reporting halitosis showed a higher degree of concern with their oral malodor. Low educational level and low income were associated with psychological impact and halitosis in this population (AU)

Objetivo: Avaliar o impacto da halitose em uma amostra de homens de 18 anos usando um questionário autoaplicável. Métodos: Um total de 2.224 indivíduos foram submetidos a exames dentários e médicos no serviço médico do Exército na cidade de Pelotas, no sul do Brasil, em julho de 2008. Resultados: Nessa amostra, 12% dos respondentes expressaram sua preocupação quanto ao mau hálito, com forte impacto emocional em sua qualidade de vida. Conclusões: Os indivíduos que relataram halitose apresentavam maior grau de preocupação com mau hálito. Nível educacional baixo e baixa renda estiveram associados ao impacto psicológico e à halitose nesta população (AU)

Halitosis: an overview of epidemiology, etiology and clinical management

Halitosis is an unpleasant condition that causes social restraint. Studies worldwide indicate a high prevalence of moderate halitosis, whereas severe cases are restricted to around 5 percent of the populations. The etiological chain of halitosis relates to the presence of odoriferous substances in exhaled air, especially the volatile sulphur compounds (VSC) produced by bacteria. The organoleptic diagnosis is the gold standard and clinical management includes oral approaches, especially periodontal treatment and oral hygiene instructions, including the tongue. When oral strategies are not successful, referral to physicians is warranted.

Autopercepção da halitose / Halitosis auto-perception

Objective: the aim of this study was to assess the self-perception of halitosis and to identify predisposing factors to the disease in individuals seeking dental treatment at public and private services in Recife (Pernambuco), Brazil. Materials and Methods - This cross-sectional study was carried out in Recife (Pernambuco/Brazil), which is divided into six geographical districts for health assistance. Public and private services units were randomly selected and questionnaires were used to collectdata from the service users. Results - The sample consisted of 416 randomly selected individuals aged 14-91 years old, of whom 74% were female and 26% male. The mean age was 37.49 years. The study found that 6.97% of subjects reported having bad breath and 39.9% moderate halitosis. There was no difference between genders and type of care (public/private) regarding the halitosis auto-perception. Despite the existence of risk factors for halitosis such as low consumption of water,smoking, alcohol use, and poor hygiene practices, the studied individuals reported no self-awareness.Conclusions - Therefore it is important to check the self-perception of halitosis and spread the knowledge about the disease and its etiology, because identification of the disease’s risk factors is important for its prevention and treatment.

Objetivo: o objetivo deste estudo foi o de verificar a autopercepção de halitose bem como identificar a presença de fatores predisponentes à doença em indivíduos que procuram tratamento odontológico nos serviços públicos e privados do Recife(PE) - Brasil. Material e Métodos - Foi realizado estudo transversal em Recife (Pernambuco/Brasil), que obedece à divisão geográfica dos seis Distritos Sanitários da cidade, sendo selecionados, aleatoriamente, os serviços públicos e privados para visitação e aplicação de questionário. Resultados - A amostra foi constituída de 416 indivíduos selecionados aleatoriamente, com idade entre 14-91 anos.. A idade média foi de 37,49 anos, sendo 74% do sexo feminino e 26% do sexo masculino. 6,97% dos indivíduos revelaram ter mau hálito, e 39,9% halitose moderada. Não houve diferença entre sexo e local de atendimento (público/privado) em relação à autopercepção do mau hálito. Apesar da existência de fatores de risco para a halitose como o baixo consumo de água, fumo, álcool, má higiene oral, os indivíduos da amostra não relataram a autopercepção. Conclusões - Assim, é importante verificar a autopercepção da halitose bem como socializar o conhecimento sobre as formas da doença e etiologia, porque a identificação da presença de fatores de risco para o desenvolvimento da doença aumenta, consideravelmente,a prevenção e tratamento.

Association between halitosis and mouth breathing in children

OBJECTIVE: To determine whether there is a correlation between halitosis and mouth breathing in children. STUDY DESIGN: Fifty-five children between 3 and 14 years of age were divided into two groups (nasal and mouth breathing) for the assessment of halitosis. A descriptive analysis was conducted on the degree of halitosis in each group. The chi-square test was used for comparison between groups, with a 5 percent level of significance. RESULTS: There was a significantly greater number of boys with the mouth-breathing pattern than girls. A total of 23.6 percent of the participants had no mouth odor, 12.7 percent had mild odor, 12.7 percent had moderate odor and 50.9 percent had strong odor. There was a statistically significant association between halitosis and mouth breathing. CONCLUSIONS: The occurrence of halitosis was high among the children evaluated, and there was a statistically significant association between halitosis and mouth breathing.

Aspectos epidemiológicos e etiológicos da halitose: considerações recentes / Epidemiological and etiological aspects of halitosis: recent consideratios

A halitose constitui um problema de saúde... A halitose constitui um problema de saúde relevante, que acomete indivíduos de ambos os sexos e em todas as faixas etárias. Representa uma queixa comum, principalmente entre os adultos, de ocorrência mundial, que atinge, aproximadamente, 30% da população brasileira. Diversas são as etiologias atribuídas à halitose, sendo que, na maioria dos casos (90%), as alterações odoríferas apresentam origem estomatológica, ou seja, iniciam-se na boca, especialmente em virtude de uma higiene oral deficiente. O objetivo deste trabalho consiste em realizar uma ampla abordagem literária acerca da halitose, com ênfase em seus aspectos epidemiológicos e etiológicos. Com base na pesquisa realizada podemos concluir que é um problema de saúde bucal de alcance mundial.

[Halitosis]

Oral malodor also called halitosis is an unpleasant odor excelled from the nose or mouth by expiration. The prevalence of halitosis is reported up to 50% and the first healthcare workers who help this kind of patients are dental practitioners. Halitosis is a multifactorial disease divided to genuine halitosis, pseudohalitosis, and halitophobia. The most common cause of halitosis is oral cavity [80-90%]. The oral etiologies of halitosis are xerostomia, periodontal diseases, mucosal ulcers, tongue coating, dental implants, and oral infections.If the patient believes to have halitosis, it is called pseudohalitosis, and if the treatment for genuine or pseudohalitosis is accomplished but the patient insists to have it, it is called halitophobia. The anaerobic gram-negative bacteria are the major factor of halitosis. The most appropriate methods to detect and measure oral malodor are organoleptic based on the examiner's perception of mouth odor, gas chromatography, and sulphide monitoring. Mechanical oral hygiene techniques such as proper use of mouth brushes, dental flosses and tongue brushes should be instructed to patients. They should rather to put fibrous foods in their daily diet and drink large amounts of water and keep their dentures clean. Antiseptic mouth washes are considered as a supplementary method to decrease oral malodor, and chlorhexidine is the most effective one

Oral health in Brazilian patients with chronic renal disease / Salud oral en pacientes brasileños con insuficiencia renal crónica

Background: Poor oral health status mayhave an impact on the health status of patients with chronic renal failure. Aim: To describe the oral health status of a group of Brazilian patients with chronic renal failure. Material and methods: Retrospective review of the medical records of patients with chronic renal failure, ofwhom 13 (4.5 percent) werein apre dialysis stage, 158 (55 percent) were on hemodialysis, 23 (8.4 percent) were on peritoneal dialysis and 92 (32.1 percent) were transplanted. General oral health, presence of dental calculus, and halitosis were recorded. The number of decayed, missed and filled teeth was analyzed by means of DMF-T (Decayed, Missed and Filled Teeth) índex. Resulte: The sample was composed of 152 men (53 percent) and 134 women (47 percent), aged 42±13 years. Oral health status was considered defective in most patients (83 percent). Eighty-seven percent had dental calculus and 55 percent had halitosis. Transplant patients reponed significantly less halitosis (40.2 percent) than the rest of the groups. The DMF-T for the whole population was 20.6 and had a positive correlation with age. Conclusions: This group of patients with chronic renal failure presented a poor oral health status. Dental treatment programs for these patients should be implemented to avoid the exposure to dental pathogens.

Introducción: Las alteraciones de la cavidad oral pueden tener impacto en la salud de pacientes con insuficiencia renal crónica. Objetivo: Describir la salud oral de pacientes brasileños con insuficiencia renal crónica. Material y métodos: Revisión retrospectiva de las fichas dentales de pacientes con insuficiencia renal crónica, de los cuales 13 (4,5 por ciento) estaban en etapa prediálisis, 158 (55 por ciento) estaban en hemodiálisis, 23 (8,4 por ciento) estaban en peritoneodiálisis y 92 (32,1 por ciento) habían sido trasplantados. Se registró la salud oral general, la presencia de tártaro y halitosis. El número de piezas faltantes y obturadas fue analizado utilizando el índice DMF-T (Decayed, Missed and Filled Teeth o dientes con cañes, faltantes y obturados). Resultados: La muestra estaba constituida por 152 hombres y 134 mujeres con una edad promedio de 42±13 años. La salud dental general era deficitaria en 83 por ciento y 87 por ciento tenía tártaro. El 55 por ciento tenía halitosis y ¡os pacientes trasplantados tenían este problema con una frecuencia significativamente menor que el resto de ¡os grupos. El índice DMF-T global fue 20,6 y tuvo una correlación positiva con la edad. Conclusiones: La salud oral de estos pacientes con insuficiencia renal crónica es mala. Es importante implementar programas de tratamiento dental para estos pacientes para evitarla exposición a patógenos que pueden causar complicaciones sistémicas.

Halitosis: a review of associated factors and therapeutic approach

Halitosis or bad breath is an oral health condition characterized by unpleasant odors emanating consistently from the oral cavity. The origin of halitosis may be related both to systemic and oral conditions, but a large percentage of cases, about 85 percent, are generally related to an oral cause. Causes include certain foods, poor oral health care, improper cleaning of dentures, dry mouth, tobacco products and medical conditions. Oral causes are related to deep carious lesions, periodontal disease, oral infections, peri-implant disease, pericoronitis, mucosal ulcerations, impacted food or debris and, mainly, tongue coating. Thus, the aim of the present review was to describe the etiological factors, prevalence data and the therapeutic mechanical and chemical approaches related to halitosis. In general, halitosis most often results from the microbial degradation of oral organic substrates including volatile sulfur compounds (VSC). So far, there are few studies evaluating the prevalence of oral malodor in the world population. These studies reported rates ranging from 22 percent to more than 50 percent. The mechanical and chemical treatment of halitosis has been addressed by several studies in the past four decades. Many authors agree that the solution of halitosis problems must include the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This could be achieved by therapy procedures that reduce the amount of microorganisms and substrates, especially on the tongue.

Impact of socio-demographic variables, oral hygiene practices and oral habits on periodontal health status of Indian elderly: a community-based study.

Periodontal disease is the most common cause of tooth loss. It is has insidious onset, chronic course, and commonly result due to cumulative effect of dietary habits, oral hygiene methods and oral habits practiced over the years. This study was planned to evaluate the periodontal health status of elderly population (above 60 years) in the community, using CPITN index, gingival recession, mobility of teeth and halitosis, using modified WHO Oral Health Survey Proforma. In addition, impact of several socio-demographic variables, oral hygiene practices, oral habits, chronic systemic diseases, dietary preferences and body mass index (BMI) on periodontal health status was also studied. It was found that prevalence of periodontal diseases in the elderly was high. Step-wise multivariate logistic regression analysis showed that periodontal diseases were directly correlated with age, oral hygiene practices and presence of cardiac diseases.

L'halitose d'origine intra-orale et son traitement en parodontologie

L'halitose correspond à l'odeur offensive en provenance de la cavité buccale (mauvaise haleine). Sa prévalence est variable mais reste relativement élevée, elle constitue ainsi un problème majeur et un handicap à l'intégration sociale.L'halitose est d'origine intra-orale dans 85 à 90% des cas. Les maladies parodontales et l'enduit lingual sont les principales causes orales responsables.D'un point de vue étiopathogénique, l'halitose provient des composés chimiques désodorants produits par le processus de dégradation et putréfaction bactérienne des protéines contenues dans les débris alimentaires et cellulaires, le sang et le fluide gingival.Le traitement de l'halitose est principalement étiologique. Il fait appel à une réduction mécanique des micro-organismes et de leurs substrats, par le traitement des maladies parodontales et la maitrise de l'hygiène bucco-dentaire et surtout linguale.Secondairement une approche chimique sera préconisée, elle permettra la réduction de la charge bactérienne, la diminution de l'expression des composés des gaz désodorants volatiles et leur conversion en non volatiles, ceci à l'aide d'agents antibactériens et d'agents neutralisants actifs