Causes, diagnosis and treatment of halitosis. CDA 2003 ( 9/2003 )
People have been concerned about ?bad breath,? or halitosis, for a long time. More than 2,000 years ago, Hippocrates suggested a rinse using herbs and wine be used to sweeten the unpleasant odors of the breath.1 While up to half of the adult population is estimated to be affected by real or perceived halitosis at some time or another,2,3 one-quarter may have this problem chronically to the extent that others have ?trouble enjoying their company.?3,4 These estimates are difficult to validate, however, as many who readily admit breath malodor have none, while those who deny experiencing any significant breath problems are actually suffering from it5 We?ve all known the latter type, and putting oneself in the place of one who unknowingly inflicts others feeds our social paranoia. Thus it is no surprise that over the decades, the public?s concerns over their own potential oral odors have not decreased, even while dental health has improved. These concerns continue to spawn ingenuity in the breath-freshening industry. For example, in 2002, Time magazine hailed Listerine?s PocketPaks?the first breath strips that dissolved on the tongue?as one of their ?Products of the Year,? along with breakthroughs such as the birth-control patch.6 Meanwhile, diagnostic devices, usually used in dental offices and research studies, are available to measure odor-producing chemical compounds in the breath. In the United States, estimates are that we spend $1 to $3 billion a year for gum, mints, and breath fresheners,7,8 and there?s no sign of the popularity of these products dissipating any time soon. The joke is on the consumer, however, when a product (e.g., Altoids, etc.) contains sugar, as this feeds bacteria, furthering odor-production just as the mintiness dissipates. Also, alcohol-containing rinses can dry out the mouth, re-establishing an odor problem soon after their fragrance is gone. One report claims that even sugarless gum has been shown to slightly increase the production of methyl mercaptan (smells of feces).9 So when over-the-counter (OTC) fresheners fail, it is not uncommon for some to consult with or at least mention it to a doctor of dental medicine or surgery. Dentists get lots of education about treating teeth, but could probably learn more about malodor. In 2001 one dental conference established some best practices regarding oral malodor evaluation.3 A few years later, the ADA Council on Scientific Affairs released its 2003 ADA Seal Acceptance Program Guidelines for Products Used in the Management of Oral Malodors, in which an example of a scale for odor assessment is found.10 These guidelines will protect the public by assuring that ADA Seal products that make malodor control claims will meet strict criteria by mid-2005. Yet, some dentists still complain that the profession has yet to agree upon a standard assessment of halitosis.11 Before the dust settles on assessment protocols or the which products will end up bearing the ADA Seal, diagnostic and treatment products will continue to make their way into dental offices and the Home Shopping Channel. Halitosis is on the American consumer?s radar so fluorimetric sensor-based instruments?among other types of clinical gizmos?may be at a dental office near you, or in your own, for volatile sulfur compound (VSC) diagnostic assistance.12 This review article summarizes some of the current literature on halitosis to provide an overview of etiology and treatment. Suggestions for management and prevention are provided, along with research frontiers in halitosis.