Halitosis, and the treatment of this problem, is quickly becoming the growth area of the 90's in dental practices throughout North America. Oral malodor is a very pervasive problem, and can be simply an embarassment to some, or the sign of potentially serious systemic problems for others. Most of us as dental professionals have received little, if any, formal training in the management of this problem.
Professionals are being drawn to establish this treatment service within their offices for several reasons. Perhaps the primary reason is the power of this concept as a marketing tool. It is an excellent way of attracting new patients, particularly those who are not regular users of dental services. The treatment of halitosis is often viewed as a "non-dental" procedure by the public, and so does not carry the psychological impact of other dental treatment. This allows us to get these people comfortable with the dental environment in a non-threatening fashion. Amongst our existing patients it is a strong motivator for the acceptance of dental treatment, particularly in the area of periodontal disease, which is known to be a major source of halitosis. Finally, we now have available the means to quantify this problem, and some definitive means to treat the problem, once properly diagnosed.
It is generally known and agreed that VSC's(Volatile Sulfur Compounds) are responsible for the odor, and that 80-90% of these come from oral sources. VSC's are produced by bacterial and cellular degradation, and include hydrogen sulphide, methyl mercaptan, and dimethyl sulphide. The fact that oral odors can originate from sources other than the oral cavity, demands that a proper diagnosis be done, requiring a thorough exam and history. It is known that systemic disorders, medications, and ENT problems can all contribute to halitosis.
The successful implementation of any halitosis treatment program requires two crucial ingredients. You need a way to quantify the level of VSC's and you need a treatment that will effectively neutralize the VSC's. The Halimeter, a gas analysis sensor, similar to a breathalyzer in design, can detect and measure the level of VSC's. This gives us an indication of the severity of the problem, its primary source, and allows us to monitor improvement. Once identified the VSC's can be neutralized with a product containing a stabilized form of Chlorine dioxide. These products are available in mouthrinses, toothpastes, and gels which are pleasant for the patient to use and non-irritating to oral tissues. Combining these products with other standard oral hygiene regimens, and promoting the use of tongue scrapers and the use of the new hydromagnetic irrigators, will effectively handle the worst of problems. There is also growing evidence that VSC's increase the permeability of the periodontal membrane to bacteria, and may play a role in the its destructive process. With a decreased level of VSC's, as seen with the use of Chlorine dioxide products, we see the opposite effect - decreased membrane permeability. It is quite often the case that as we treat the patient for a primary complaint of halitosis, we see a significant improvement to the periodontal condition.
There are several programs available to assist individuals in implementing this innovative approach in their offices. The amount of time, money, and physical resources required to get started are surprisingly small. The public is becoming very aware of the advances in this area, and may soon be demanding it of you. These programs offer incredible potential, and are definitely worth investigating.
1.Yaegaki,K.,Sanada,K.;Volatile Sulphur Compounds in Mouth Air from Clinically Healthy Subjects and Patients with Periodontal Disease; Journal of Periodontal Research 1992;Vol 27: pgs233-8.
2.Kutchner,M.;Diagnosis and Treatment;The California Dental Institute for Continuing Education;1994;Vol. 49: pgs3-13.
3.McDowell,J.,Kssebaum,D.;Diagnosis and Treating Halitosis;JADA, July 1993;Vol.24:pgs55-64.
4.Tonzentich,J.;Sources,Measurements and Implications of Oral Malodor; Abstract.JADR Symposium;Acapulco,Mexico;1991 Apr.
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