제목 : halitosis
------------------------------------------------------------------------------ Halitosis; an etiologic classification, a treatment approach, and prevention Dominic P.Lu Ora surgery 1982:54: 521-526 Howe, 1874: Halitosis *Classification 1. halitosis due to local factors of the pathological pain 2. halitosis due to local factors of nonpathologic factors 3. halitosis due to systemic factors of pathologic origin 4. halitosis due to systemic factors of nonpathologic origin 5. halitosis due to systemic administration of drugs 6. halitosis due to xerostomia *Halitosis due to local factors of pathologic origin poor oral hygiene, extensive caries, gingivitis, periodontitis, open contacts a llowing food impaction, Vincent�s disease, hairy tongue, coated tongue, fissure d tongue, excessive smoking, healing extraction wound, necrotic tissue from ulc eration chronic periodontal disease-- periodontal pocket--hydrogen sulfides increase of gram-negative filamentous organisms, increase in PH to 7.2 and the formation of indoles and amines in the oral cavity dentigerous cyst with fistula chronic sinusitis with nasal polyp; lethal granuloma pharyngitis, tonsillitis, syphilitic ulcers cancrum oris, tumors of nose, abscess, ulcerogangrenous process, cancerous tumo rs of the trachea and bronchi, chronic fetid bronchitis infectious malignant neoplasm of oral and pharyngeal cavities *Halitosis due to local factors of nonpathologic origin Morning smell 1. stagnation of saliva associated with food debris 2. lack of movement of cheek and tongue 3. decrease of metabolic rate during sleep--reduction of sal ivary flow--- odor intensity of the breath increases with age. excessive smoking dentures--known as denture breath endodontics patient--leakage of eugenol and creosote young children aged 2 to 5 years; sweet fetid mouth odor due to their tonsil cr ypts lodging food and bacteria *Halitosis due to systemic factors of pathologic origin Diabetes--acetone, sweet, fruity odor --diabetic acidosis or impending hypergly cemic coma due to abnormal accumulation of kittens in the blood which are excre ted through the respiratory system Uremia and kidney failure; odor of ammonia and urine on the breath severe hepatic failure; fatter hepaticus--sweetish, feculent, amine odor resemb ling a fresh carver portocaval venous anastomosis; same as above acute rheumatic fever; acid sweet odor lung abscess or bronchiactasis a foul putrefactive breath(odorous rating meat) gangrene of lung and pulmonary tuberculosis toxemia, gastrointestinal disorders, hemorrhage at the level of gastrointestina l tract neuropsychiatric disease-- poor oral hygiene emotional upset nonlipid retoiculoendothelial disorders(eosinophilic granuloma, Letterer-Siwe disease, Hand-Schuller-Christian disease) acute and chronic scurvy due to vitamin C deficiency; typical breath with fusos pirochetal stomatitis macroglobulinemia,primary herpes simplex infection, hemophilia, Van Willebrand� s disease, cryoglobulinemia, aplastic anemia, polycythemia Vera, agranulocytosi s, leukemia, infectious mononucleosis, thrombocytopenic purpula, thrombocythemi a, noma *Halitosis due to systemic factors of nonpathologic origin metabolites from ingested foods that are excreted through the lungs fad diet result in acidosis or ketosis garlic onion, leeks, alcohol excessive alcohol intake---alteration of microbial flora--cause of proliferatio n of odorfermenting organisms uremia dysmenorrhea;mousy odor resembling decayed clotted blood hunger odor; putrefaction of pancreatic juices in stomach *Halitosis due to systemic administration of drugs antiAngina pectoris drug( isosorbide dinitrate) iodine or choral hydrate some antineoplastic drug, antihistamines, amphetamines, trnanqulizers, diuretic s, phenothiamines, atrophine like drug--diminish saliva production--decrease th e self-cleansing ability antineoplAstic drug--xerostomia, candidiasis, gingival bleeding, oral ulceratio n (.methotrexate,actinomycin d, fluorouracil, adrimycin, bleomycin)--leukemia patient taking antineoplastics; halitosis due to decomposed blood from gingival hemorrhage and plaque formation due to dehydration amylnitrate by inhalation phenothiazine--xerostomia, black or white hairy tongue dimethyl sulfoxide (for m.pain and interstitial cystitis)-- DMSO--it is metabolized and reduced to dimethyl sulfide(chemical essence of gar lic) isordil anginal therapy intrinsic, metabolic end product ethyl alcohol anginal, sedation breath via systemic route iodine함유약품 mucolytic expectorant amyl nitrate anginal antihistamines allergy,sedation antineoplastics cancer therapy diuretics antihypertensive antiedematic phenothiazine schizophrenia, antiemetic,psychosedation due to xerostomia by drug tranquilizer sedation amphetamine anorexant analeptic CNS stimulant dimethyl sulfoxide interstitial cystitis metabolized to dimethyl sulfide muscle pain *Halitosis due to xerostomia disease with high fever and dehydration, emotional disturbances, excessive use of condiments, poor oral hygiene *Treatment approach and prevention 숨으로 나오는 냄새는 사실상 허파와 구강내에서 날수 있으므로 구강인지 허파인지의 감별이 중요하다 방법으로는 환자가 입을 다문 후에 코로 숨을 쉬어보라고 환자에게 시킨다. 만약 냄새가 나면 전신적 요인이 작용한다고 생각... 구강내로 부터의 냄새를 알아내기 위하여 손으로 환자의 코를 잡도록 하고 입술을 다 물고 숨을 멈춘 후 잠시후 입을 벌리고 숨을 내뱉는다 냄새가 나면 oropharyngeal cavity내의 국소적요인이다. One should not solely rely on odors for diagnosis. a good medical history and lab. test dietary habit--drinking, smoking 국소적 원인을 제거하는 것이 구취처치의 첫번째 방법이다 대부분의 구취의 해결방법은 eradication of periodontal pockets improvement of oral hygiene restoration of carious lesion and open contacts between the teeth prophylaxis through thorough polishing and scaling extraction of unrestorable teeth correction of any other defects that could minimize the accumulation and putrefaction of food debris stagnation of saliva degradation of breakdown of protein byproducts .denture wearer should keep their dentures clean by brushing and soaking them i n cleansing and disinfecting solution . mint sucking---increase salivary flow--facilitate the removal of food ---reduce stagnation and putrefaction of saliva . gum chewing---aid in the removal and reduction of food debris---increase the cleansing function--하지만 근원적 방법은 될 수 없다. . commercial mouth rinse--자주 사용하면 구강내 건조를 유발한다 .구취의 처치를 위한 항생제의 국소도포에 대한 연구가 되고 있다--aureomycin and vanco mycin--reduce the inflammation of gingival tissue and offensive odor . prolonged use of vancomycin--hearing loss and kidney and liver impairment . prolonged use of aureomycin--candidiasis, glossitis, xerostomia, Fanconi-like syndrome . morning breath--because of offending odor of methylmercaptan(0.5mg이하) and h ydrogen sulfide(1.5mg이하) which have accumulated in the mouth--혀는 이러한 물� 珦� 축적되는 주 부위이다.--치솔질로 감소 시킬수 있다. . halitosis due to xerostomia;sodium carboxymethyl cellulose to moisten the ora l cavity without any untoward reactions *conclusion 제거시킬 수 있다. 하지만 임상의는 모든 요인 특히 전신적 요인 항상 고려하여야 한다
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