Dr. Dt. Murat Aydın

IF ORAL MALODOR DOES NOT HEAL?

Given that the most ambitious oral malodor occurs in the cleanest mouths, it is doubtless that we have not discovered or understood the mechanism of certain types of oral malodor. 3 out of every 4 persons complain about bad breath or oral malodor but this is not tackled adequately. Tartar and plaques are cleaned in patients with oral malodor, antiseptic mouthwash is prescribed and it is hoped that it will heal. But it is obvious that it does not heal in that way.

Odorous gas concentration is < 0.00027 in gingival pockets while it is ~6000 ppb in dorsum lingua. Thus, dirtiness of dorsum lingua should be suspected before periodontal diseases. Tartar cleaning has a poor positive impact on the prevention of bad breath (16-26%), tongue cleaning has a greater effect (42-88%). The only reason of oral malodor is not just periodontal disease. To the contrary, oral malodor may be a cause of periodontal disease. Probably most of the oral malodor cases associated with oral hygiene could heal if patients are taught to clean their tongues only and if soft brush and tongue scraping is abandoned.

Some of the oral malodor cases that do not heal despite all efforts are neurological (chemosensor dysfunction, retronasal ofaction, hematogenous olfaction, taste-scent confusion etc.) while some others are psychiatric disorders (obsession, dysmorphism, fobia and delusion). This group of patients are higher than we think (%12-17).

In this study, types of bad breath and oral malodor were elaborated in a comprehensive manner. It explains that tonsils should not be removed to treat oral malodor, likelihood of malodor from stomach is little if any and even it is not likely to find gastric malodor in a patient admitted to an outpatient clinic, there is no need to evaluate reflux gastritis and Helicobacter pylori gastritis, association between candida yeast fungi and oral malodor is not definitive.

Since the dentists are inadequate on this matter, physicians from other disciplines have to be involved in the process. It is even striking that the number of charlatans and hokeypokey people called halito-mafia increased.