May 25, 2020
Chronic Halitosis Is No Joke
By Michael D. Shaw
It may seem frivolous to discuss chronic halitosis in the wake of the COVID-19 pandemic, but I propose some context here. Pandemics–much worse ones–have always been with us, and this one is unique in terms of the overreaction, coupled with a wanton disregard for those truly at risk. Moreover, people are still dying from other causes in greater numbers. Bear in mind that true COVID-19 mortality statistics may never be known, given the reporting guidelines and incentives to list it as the cause of death.
Beware of those who would order you to focus on one problem or issue above all others, since this is an absurd and losing strategy in nearly all cases–references to “rearranging the deck chairs on the Titanic” notwithstanding. To cite but one example, the ridiculous draconian policy of not allowing “elective” medical procedures can cause undue harm.
When all the COVID-19 urgency and media hype disappear, we will still be left with those chronic conditions that have plagued humankind since the beginning; and chronic halitosis is on that list. Moreover, chronic halitosis is most often linked to a periodontal condition, and if these are left untreated, serious complications–including loss of teeth–can occur.
Note that we are talking here about chronic halitosis, which is different from the occasional food-borne bad breath that nearly everyone can experience on occasion.
Complaints about halitosis date back to dim antiquity, and a reference even appears in the Old Testament (Job 19:17): “My breath is abhorred by my wife; I am loathsome to the men of my family.” This Smithsonian Magazine article traces the history of bad breath. Here are some highlights:
- The first breath mint appears to date back to the ancient Egyptians.
- There are Talmudic references to the societal horrors of bad breath, as well as an antibacterial remedy that is still used today.
- The mother of Alexander the Great was put into exile because of her awful breath.
- In 1923, Listerine heir Gerard Barnes Lambert and his younger brother Marion had an epiphany about the best way to tout their formerly general-purpose antiseptic. It was halitosis.
Perhaps the biggest scientific breakthrough in the study of chronic halitosis came in 1976, with this paper from Tonzetich and Ng. Based on studies with a gas chromatograph, the researchers determined that the primary components of oral malodor are hydrogen sulfide and methyl mercaptan. Some years later, the list of malodorants was increased to include dimethyl sulfide and certain other thiols. Within the context of halitosis studies, this group of substances became known as “volatile sulfur compounds” [VSC].
Further research has added short-chain fatty acids such as propionic acid, butyric acid, and valeric acid; polyamines such as putrescine and cadaverine; and skatole to the list of oral malodorants.
The origin of the VSCs is from anaerobic bacteria living on the tongue and surrounding areas. These chemicals are the products of their protein metabolism. So, the early commercials about “killing the germs that cause bad breath” were accurate.
The Tonzetich/Ng research cited above used gas chromatography, an elegant and expensive technology, well suited to an academic research lab, but impractical for dental clinicians. As such, in 1997, Interscan Corporation introduced its Halimeter®, as the first analyzer for VSCs, suitable for dental chairside use. After only a few years, thousands of dental practices had their own Halimeters, and many practitioners published their results.
While the instrument has undergone several revisions and updates over the years, Interscan has just released its newest version: The Halimeter® PLUS. The PLUS is a complete reimagining of the unit, and features all-new electronics, easy-to-use controls, and a real-time graphics display. The integral SD memory allows the practitioner to store all patient readings, and export the records to Excel for further analysis.
Using VSC readings as a basis to follow professional oral hygiene therapy, chronic halitosis can be treated and cured. Anyone with this condition should contact their dentist.