THE ROLE AND EFFECT OF ANTIMICROBIAL MOUTHWASH ON ORAL MALODOR (HALITOSIS)

 Sumber : Webinar Docquity

drg. Rochman Mujayanto, Sp.PM


Halitosis is general term describing bad or unpleasant smells from the oral cavity or outside the oral cavity. 

Halitosis dibagi menjadi 2 : 

1. Delusional halitosis 

a. Pseudohalitosis => The patient complains of halitosis but the patient's oral malodor is not felt by others and the halitosis diagnosis can not be made objectively. 

b. Halitopobhobia => The patient's breath will be regarded as bad smell by other people. 


2. Genuine Halitosis (true halitosis)

a. Physiological halitosis => the transient bad oral malodor associated with nocturnal hyposalivation after sleep in the morning. there is no systemic disease or pathological condition that can cause halitosis. It develops due to bacterial activity during the night while sleeping. There was an association demonstrated between oral respiration and oral malodor. 

b. Pathologic halitosis : 

    - Extraoral :

        a) Diabetes Mellitus : Acetone breath, fruity, rotten apples

        b) Liver insufficiency : "Dead mice odour", Factor hepticus (breath of deatch)

        c) Kidney insufficiency : fish odor

        d) Kidney failure : Ammonia or urine like

        e) Lung abscess : rotten meat smell

        f) Blood dyscrasias : Resembelling decomposes blood of a healing surgical wound

    - Intraoral => is the problem was found to originate from the bacterial activity in the oral cavity : Periodontal infections, odontogenic infection, Xerostomia, mucosal lesions. 



Physiologic Halitosis (Oral Malodor), also known as bad breath is a common complaint among the general population. 

Oral malodor is caused by the presence in exhaled air of volatile sulfur compounds (   VSCs), especially methylmercapten (CH3SH) and hydrogen sulfide (H2S), but also short-chain fatty acids, such as butyric, propionic, and valeric acids, and polyamines, such as putresceine and cadaverine. 

VSCs = produced primarily by the action of gram-negative bacteria in gingival crevicular fluid, blood, desquamated epithelial cells, saliva and food.


Diagnosis & Assessment of Halitosis (Oral Malodor) 

1. Halimeter => untuk mendeteksi tingkat sulfur yang rendah

2. Kromatografi Gas => tes ini mengukur tiga senyawa sulfur yang mudah menguap, seperti hidrogen, sulfida, metil merkaptan, dan dimetil sulfida

3. Tes BANA => tes ini untuk mengukur kadar enzim spesifik yang diproduksi oleh bakteri penyebab halitosis 

4. Tes Beta-Galactosidase => riset menemukan bahwa enzim beta-galactosidase memiliki korelasi dengan bau mulut


How to prevent?

- Daily oral regime : sikat gigi, dental flos, berkumur dengan antiseptik atau air 

- rutin ke dokter gigi minimal 6 bulan sekali 

- Lifestyle : makanan, rokok, kurangnya asupan air, minum air putih


The role of prevention in oral care

Currrent best practices in oral hygiene might not be enough for optimal oral care. 

Recommendation from dental practitioners focusing mostly on mechanical methods of plaque removal may not be followed. 

Namun sikat gigi saja tidak cukup, karena hanya menghilangkan 30-50% plak. Gigi hanya menyusun 25% bagian dari keseluruhan rongga mulut. Plak/biofilm bisa melekat di seluruh bagian rongga mulut, bukan hanya gigi. 

Cara bersihkan rongga mulut dengan tuntas : 

ADA (american Dental ASSC) maupun PDGI (Persatuan Dokter Gigi Indonesia) merekomendasikan RINSING pada daily oral regions. ADA merekomendasikan :

1. Sikat gigi dua kali sehari dengan pasta gigi membersihakn plak dan permukaan gigi

2. Gunakan dental floss setiap hari untuk membersihkan sela gigi 

3. Kumur-kumur setiap hari dengan antiseptic mouthwash untuk melawan kuman/plak


Scientific Research about Essential Oil Mouthwash'tgrr

obat kumur yang mengandung essential oil dapat mengurangi halitosis







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