SUMMARY: Dental professionals should make recommendations to treat oral malodor based on their patients' individual condition. Xylitol-containing products provide a host of benefits when incorporated into a dental hygiene treatment regimen.
 
  Bosy, A. (2006): "Managing Oral Malodor", Journal of Practical Hygiene, July/August 2006

SUMMARY:  Probable causes and various factors affecting offensive breath are discussed.  New approaches for assessment and treatment of oral malodour are explored in this article.
 
  Bosy, A. (1997): "Oral Malodour: New Directions", The Colgate Oral Care Report 7 (2) 10-12)

SUMMARY: Associations between oral malodour, measures of periodontal disease and trypsin-like activity of periodontal pathogens on teeth and tongue were examined in 127 subjects.  The volatile sulphur compounds present in mouth air were measured by halimeter and by organoleptic methods.  The study showed that there was a significant contribution to oral malodour by the tongue surface.  Subjects were treated with chlorhexidine gluconate to study the effect of reducing microbial colonization on oral malodour.  Reductions of volatile sulphur compound levels were significant.  Oral malodour in subjects with and without periodontitis was measured and the two groups were compared.  The average volatile sulphur compound measurement in the 37 subjects with periodontitis was only slightly higher than the average measurement of the 90 healthy subjects.  The data in this study indicate that a large proportion of individuals with oral malodour are periodontally healthy and that the surface of the tongue is a major site of oral malodour production.
 
  Bosy, A.; Kulkarni, G.V.; Rosenberg, M. and McCulloch, C.A.G. (1994): "Relationship of Oral Malodour to Periodontitis: Evidence of Independence in Discrete Sub-Populations", Journal of Periodontology 65(1):37-46

ABSTRACT: Although oral malodor or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort. At least 50 per cent of the population suffer from chronic oral malodor, however, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment. The mouth air of chronic malodor sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to the people in their vicinity. Sufferers often make desperate attempts to mask their oral malodor with mints and chewing gum, compulsive brushing and repeatedly rinsing with commercial mouthwashes. While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor. Proteolytic activity by ;microorganisms residing on the tongue and teeth results in foul-smelling compounds, and is the most common cause of oral malodor. A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air. Many of the manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodor over long periods of time. None, however, effectively eliminate the problem. Interest in oral malodor research and clinical treatment has increased in the last few years, and this distressing problem is finally getting the attention it deserves.
 
  Bosy, A. (1997): "Oral Malodour: Philosophical and Practical Aspects", J. Canadian Dental Association, March 1997, 63 (3) 196-201

ABSTRACT:  Oral malodour can be either a short-term, transient problem that includes morning breath or food odors or it can be a long-term, chronic problem.  Commercial products support the short-term problem, but the duration of relief varies with the active ingredient.  Long term, chronic problems are difficult to eliminate and require a more aggressive treatment with antimicrobial rinses such as chlorhexidine.
 
 Bosy, A. (2002) "A Review of Oral Products for the Treatment of Oral Malodour", The Journal of Practical Hygiene July/August 2002.  Supplement.

ABSTRACT:  Casey M., a 48 year old woman was first seen 3 years ago with the complaint of oral malodour.  A nonsmoker with good oral hygiene, she saw her dentist routinely and had a dental examination and cleaning 3 weeks before the initial visit for breath odor.
 
Her concern was the bitter and very unpleasant taste that persisted though out the day.  She had experienced this taste for the last 20 years and associated it with bad breath.  She felt very embarrassed about her breath and kept a safe distance from her co-workers and friends.  However, she did not feel that this interfered with work or relationships.  If the situation required close contact, gum and mints were used to decrease the possibility of the odor being noticed.
 
Assessment of the complaint included odor analysis, oral examination and microbial reports.  Treatment consisted of rinsing with 5 cc. of 0.2% chlorhexidine twice daily.  At the end of a two week period a considerable reduction in all measurements was noted.  No odor was detected on the breath, tongue base and dorsum.  A very slight and fleeting odor was noted in between the teeth.  Casey felt comfortable using the chlorhexidine rinse and was to continue rinsing, decreasing to once a day and to return for observation.  At the one year re-evaluation the mouth air was normal but there were slight odors in between the teeth and on the tongue as well as some probing.  The microbial report showed an increase in gram-negative bacteria and spirochetes.  Feedback from her family indicated that if she stopped using chlorhexidine for more than two days at a time, the breath odor became noticeable.  Casey elected to continue with chlorhexidine rinsing once a day to see if she could improve this condition.  At the two year evaluation the mouth odors were definitely noticeable.  At this time, the rinsing with chlorhexidine was increased to twice a day.  A subsequent evaluation has shown that the odors had subsided.
 
In conclusion, this method of treatment has been successful, however the client must be made aware of possible side effects such as staining, change in taste perception and potential allergies.  Staining seems to be the most common side effect.  However, clients who suffer from oral malodour may often overlook the staining if the chlorhexidine is effective at reducing bad breath.  If the side effects are problematic or chlorhexidine is not effective, other rinses such as those containing zinc chloride or active Zn++ ions, or even herbal rinses need to be examined for suitability to the client's needs.
 
 Bosy, A. (2002) "Oral Malodour: One Approach to Treatment (Case Study)", Contemporary Oral Hygiene January/February 25-31.

ABSTRACT:  The most common cause of oral malodour is elevated levels of volatile sulfur compounds.  The production of these gases results from the action of gram-negative anaerobic bacteria on protein matter.  Individuals who suffer from oral malodour experience anxiety and may exhibit antisocial behavior.  Some develop a psychosomatic condition called halitophobia.  Interest in treating oral malodour has increased in recent years but dentists and dental hygienists are still reluctant to address the problem.  Treatment of this condition consists of good oral hygiene along with the use of antimicrobial agents, oxidizing agents, and anti-odorants such as sodium bicarbonate.  Not commonly used for the treatment of oral malodour in the past, studies indicate that sodium bicarbonate should be given serious consideration.  Dentifrices containing 20% or more baking soda can significantly reduce odor for up to 3 hours.  Dentifrices with the zinc ion and baking soda, although still not available commercially, have an enhanced anti-odor effect.
 
 Bosy, A. (2001) "Oral Malodour - Cosmetic Problem or Chronic Infection?" Compendium of Continuing Education in Oral Hygiene 8(2) 3-11

ABSTRACT:  The facts indicate that up to 50% of the population suffer from oral malodour, many finding it a chronic condition. When do people become aware of their bad breath? How do you distinguish between bad breath and normal breath? This paper discusses these issues and reviews current assessment and treatment options.
 
  Bosy, A. (2000): "Oral Malodour - Up Close and Personal", D.A.M. Dental Auxiliary Magazine 1(1) 7-9

ABSTRACT: Although their quality of life is diminished, people often go for long periods of time prior to seeking professional treatment for their bad breath problem.  There is a feeling of isolation and deep embarrassment.  The most common cause of oral malodour is anaerobic bacteria and fungi as the major contributors.  Factors, such as stress and decreased salivary flow, help to increase the density of microbes and result in greater odor production.  Bad breath can be treated with a variety of different antimicrobial rinses.
 
  Bosy, A. (1998): "Oral Malodour", P.H.D. Services 5(6) 2-4

ABSTRACT:  The production of oral malodour is primarily the result of degradation of certain amino acids by gram-negative microorganisms.  There is sufficient evidence that the tongue coating is one of the main sites of hydrogen sulfide production in healthy mouths since large numbers of bacteria are present on the tongue dorsum.  This article discusses the possibility of taste as an indicator that sufficient bacteria are present in the oral cavity to cause breath odor.  The effect of stress is another factor that is examined in this article.  Stress may impact upon the immune system creating an ineffective response against invading bacteria.  Secondly, stress decreases the flow of saliva, thus allowing the volatile sulphide compounds to contaminate the mouth air.
 
  Bosy, A and Geller, J.: "Bad Taste: An Indicator of Bad Breath", Aorta June 1998.

ABSTRACT:  Although oral malodour or bad breath is an unpleasant condition experienced by most individuals, it typically results in transient discomfort.  At least 50% of the population suffer from chronic oral malodour, and approximately half of these individuals experience a severe problem that creates personal discomfort and social embarrassment.  The mouth air of chronic malodour sufferers is tainted with compounds such as hydrogen sulphide, methyl mercaptan and organic acids, which produce a stream of foul air that is gravely offensive to people in their vicinity.  Sufferers often make desperate attempts to mask their odor with mints and chewing gum, compulsive brushing and repeatedly rinsing with commercial mouthwashes.  While dental diseases have been strongly associated with this condition, there is considerable evidence that dentally healthy individuals can exhibit significant levels of mouth odor.  Proteolytic activity by microorganisms residing on the tongue and teeth results in foul-smelling compounds and is the most common cause of oral malodour.  A specialized device called the halimeter is available to measure the volatile sulphur compounds in mouth air.  Many manufacturers of bad breath remedies claim that their products contain antibacterial mechanisms with sufficient strength to control oral malodour over long periods of time.  None, however, effectively eliminate the problem.  Interest in oral malodour research and clinical treatment has increased in the last few years and this distressing problem is finally getting the attention it deserves.
 
  Bosy, A. (1997): "Oral Malodour: Philosophical and Practical Aspects", J. Canadian Dental Association, March 1997, 63 (3) 196-201

ABSTRACT:  Ignored and misunderstood by the medical and dental profession for decades, there has been an increasing amount of attention focused on oral malodour within the last few years.

Breath becomes odorous when certain unpleasant chemicals are present in mouth air.  The most common and abundant chemicals present in bad breath are volatile sulphur compounds such as hydrogen sulphide, methyl mercaptan and in smaller amounts, methyl disulphide and dimethyl disulphide.  The composition and malodour of the mouth air depends on the underlying cause of the problem.

Responding to a growing need for relief from the problem of oral malodour, a new clinic has recently opened which specializes solely in the treatment of this condition.  The Fresh Breath Clinic began over two years ago and has now developed into a one of a kind operation, specializing in the assessment and treatment of bad breath on a full time basis.