Article in March 2005 Orthodontic Cyberjournal about halitosis

Some extracts from an article in the Orthodontic Cyberjournal dated March 2005

Evaluation of expired air:

According to Delanghe et al.,87% of malodor originates from the mouth(9). The simplest way to distinguish oral from non-oral sources of maloder is to compare the smell coming from the mouth with that exiting the nose(5). Any potential nasal source of malodor is differentially diagnosed by directing the subject to seal the mouth and exhale only through the nose. A potential oral source of malodor is detected by directing the patient to pinch the nose closed and exhale through the mouth(10).

Pungent odor from the expired air can indicate lesions or disease of the nasopharynx, nose or sinuses. The nasopharynx is a common site of bacterial colonization contributing to bad breath. Any condition that alters the mucous membrane of the nose including atrophic rhinitis or rhinitis medicametosa can contribute to bacterial overgrowth and malodor. Chronic sinusitis, unilateral choanal atresia and nasal foreign bodies also cause halitosis(10).

If the same malodour is detected from both nasally and orally expired air, a systemic or respiratory tract source should be suspected(10). Malodor can be an early symptom of nasal tumors. Referral to an otolaryngologist is indicated if infection, foreign body or neoplasm of these structures is suspected.

A more noxious odour found in the orally expired air than air expired nasally can indicate an oral, oropharyngeal, hypopharyngeal or, rarely, a gastric source (10).

The results of a study by Tonzetich, Peti and Huggins (1978) provided a satisfactory explanation of this phenomenon when they reported finding distinct variations of hydrogen sulfide, methyl mercaptan and dimethyl sulfide in mouth air during different stages of the menstrual cycle.Menstruation:

It has been reported that during menstruation or certain menstrual cycles(Massler, Emslie and Bolden, 1951), some women have bad breath. This is most likely secondary to hormonal changes. The results of a study by Tonzetich, Peti and Huggins (1978) provided a satisfactory explanation of this phenomenon when they reported finding distinct variations of hydrogen sulfide, methyl mercaptan and dimethyl sulfide in mouth air during different stages of the menstrual cycle.

Pathologic causes of halitosis
Non-oral(Systemic) causes of halitosis:

Odors can be derived from the mouth, the lungs, and the nasal passages. Any putrefaction in the lungs or in the nasal passages would also give off odiferous substances during the flow of air in the process of breathing...

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Full article:
http://www.oc-j.com/mar05/Halitosis-Part_1.htm