Categorizing types of halitosis.
Before a dental professional begins treatment, the type of halitosis the patient has must first be identified.
When a dental professional initiates the treatment of a patient's breath problem, they must first make an assessment so to categorize the type of bad breath condition they are dealing with. The three major classifications that are used to categorize a patient's breath malodor problem are "genuine halitosis," "pseudo-halitosis" and "halitophobia."
As you read through the definitions of each of these classifications, it should become obvious to you that this classification step is important because the type of remedy that is need for each category can be quite varied.
A) Genuine Halitosis
This category refers to bad breath that can be readily detected by organoleptic testing (smelling the person's breath) or by the use of a scientific testing apparatus designed to detect the compounds typically associated with bad breath (volatile sulfur compounds).
This classification refers to a situation where an oral malodor problem does not exist (cannot be detected by smell or scientific apparatus testing) but the patient still feels that they have bad breath. Since no real breath problem exists, treatment consists of counseling the patient about their misconception.
A situation where a patient's perception of a breath problem continues to exist despite the successful treatment of their genuine halitosis condition or, in the case of pseudo-halitosis, after receiving counseling. At this point, treatment for the patient's condition needs to be referred to a medical professional who can provide appropriate psychological counseling.
The subcategories of Genuine Halitosis.
Breath treatment professionals will subdivide the genuine halitosis category into two further classifications, "physiologic" and "pathologic" halitosis.
1) Pathologic Halitosis
This classification recognizes a person's bad breath as being a symptom of a disease, or other pathologic condition, or aggravated by it.
2) Physiologic Halitosis
This category refers to those situations where the person's malodor is attributable to (the somewhat typical) putrefactive processes taking place in the oral cavity. Usually these processes are taking place within the white-colored coating found on the posterior portion of the tongue. In most cases the person's breath problems can be resolved simply by improving their oral home care, especially their tongue cleaning habits.
This classification of bad breath is considered to be transient, in the sense that its presence comes and goes (as determined by temporary localized conditions in the mouth) and that it can be easily resolved. Examples include "morning breath" and bad breath associated with speaking. (The bad breath experienced in both of these situations is caused by the dry oral conditions that develop during sleep or when we speak for extended periods of time)
The subcategories of Pathologic Halitosis.
The "pathologic" halitosis category is further subdivided into subcategories based on the location of the disease process that is associated with the breath problem.
1) Oral Pathologic Halitosis
This category includes breath problems that are caused or aggravated by disease or other pathologic condition associated with the tissues of the mouth. As an example, problems with bad breath are often caused by the presence of periodontal disease (gum disease). The dental professional treating this type of case will need to provide the patient with instructions outlining proper oral hygiene, especially tongue cleaning. They will also need to provide treatment for the diseased oral tissues. In most cases this will start with a thorough professional dental cleaning.
2) Extraoral Pathologic Halitosis
With this classification, the person's breath malodor originates from a disease or a pathologic condition involving body tissues other than in the mouth. The odor may originate from:
- The nasal or laryngeal areas (upper respiratory tract).
- The lower respiratory tract (lungs) or upper digestive tract.
- Disorders anywhere else in the body. In these cases, compounds produced by the disease process are blood borne and a state of breath malodor is created when they are exhaled from the lungs. These disorders can include diabetes, liver cirrhosis, uremia and internal bleeding.
The dental professional addressing these types of cases will need to provide the patient with instructions regarding proper oral hygiene. Definitively, however, the dentist will need to refer the patient to a physician or medical specialist for treatment.