Diagnosis and treatment of physiologic halitosis: a case report

Soo-Ryeon Lee; Young-Soo Kim

doi:10.11149/jkaoh.2016.40.3.206

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Lee and Kim: Diagnosis and treatment of physiologic halitosis: a case report

Case Report

J Korean Acad Oral Health 2016;40(3):206-211.

Published online: 15 September 2016

DOI: https://doi.org/10.11149/jkaoh.2016.40.3.206

Diagnosis and treatment of physiologic halitosis: a case report

Soo-Ryeon Lee, Young-Soo Kim

Department of Preventive Dentistry, Korea University Guro Hospital, Seoul, Korea

Corresponding Author: Young-Soo Kim Department of Preventive Dentistry, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-1525 Fax: +82-2-837-6245 E-mail: youn5801@hanmail.net

Received 31 May 2016 Revised 22 June 2016 Accepted 18 July 2016

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We selected a patient with physiological bad breath from among the outpatients with bad breath that have visited the halitosis control clinic in KUMC. We identified the factors that were associated with the development of bad breath and assessed the occurrence of discomfort in the mouth; thereafter, we were able to prescribe a treatment method for the patient. We determined the daily routine of the patient through a questionnaire and a diary of dietary life. From these analyses, we deduced the factors associated with her physiologic halitosis. We combined this information with the results of analysis of her oral and exhaled gas measurements, nasal gas measurements by oral malodor measuring devices, and salivary measurements to develop a treatment method that we prescribed to the patient. We conclude that oral health education, including correction of the patient's mismanaged oral-care methods and routines, could act as an alternative treatment method for patients with physiologic halitosis in Korea.

Keywords: Oral health education, Physiologic halitosis, Salivary measurement

References

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Fig. 1.

Examination of tongue (Left: red and indented tongue, Right: normal tongue)^1,9,10).

Fig. 2.

Clinical photograph of throat area.

Fig. 3.

Flow diagram showing the effect of patient's anxiety and stress influence on oral malodor.

Fig. 4.

Flow diagram presenting the relationship among dietary habits, life habits and oral malodor.

Fig. 5.

Flow diagram representing the oral malodor caused by the inappropriate mucosal membrane management.

Fig. 6.

Flow diagram representing the oral malodor caused by the inappropriate tongue position and inadequate care of posterior part of a tongue and a throat hygiene.

Fig. 7.

Halitosis resulted by the strained state of tongue¹).

Fig. 8.

Example of deep breathing and pronunciation exercise for tension relieving^1,10).

Fig. 9.

Tongue and mouth movement to release tension of oral muscles^1,9).

Fig. 10.

Let dorsal surface of the tongue touch palatal area and move backward, and then proceed with right and left reciprocation. After reciprocation, gargle and swallow one cup of water over three times¹).

Fig. 11.

Smile method (Left: A state of tension Right: Through the smile face as shown on the right, the position of a tongue is corrected and the tension of the throat is relieved^1,10)).

Fig. 12.

Gum method^1,10.

Table 1.

Malodor measurement results

Measurement device		Malodor level			Threshold level＊
Measurement device		1^st	2^nd		Threshold level＊
BB checker^TM	Exhaled	71	77	BBV	50	BBV
	Oral	50	48	BBV
	Nasal	77 (Rt)	84 (Lt)	BBV
	Room^†	5		BBV
Halimeter^TM	VSCs^‡	116		ppb	100	ppb
TwinBreasorII^TM	H₂S	0.91	2.09	ng/10 ml	1.50	ng/10 mL
	CH₃SH	0.0	3.64	ng/10 ml	0.49	ng/10 mL

*When the measured level exceed the threshold level, people can detect oral malodor.

^† Measured level of malodor in the clinic room.

^‡ VSCs : volatile sulfide compounds.

Table 2.

Saliva test results

Saliva test	Result	Reference level＊
Unstimulated salivary flow rate	1.6 ml/3 min	3-5 ml/3 min
pH	6.5	7.2
Buffer capacity	5.3	≥5.5
Stimulated salivary flow rate	2.6 ml/3 min	3-5 ml/3 min
Precipitation rate^†	15.4% (0.4 ml/2.6 ml)	<10%
Malodor after incubation^‡	25 BBV

*Reference^1,9).

^† Precipitation rate=precipitate amount (ml) after settling more than 30 minutes/total stimulated saliva (ml).

^‡ Stimulated saliva was incubated in Attain

^TM Incubator mBA450 in 37

^o C, then malodor was measured by BB checker

^TM .

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