Propuesta de un protocolo de diagnóstico y tratamiento de la halitosis para uso en clínica odontológica

Resumo

INTRODUCTION. Halitosis, defined as an unpleasant breath odour, has become a health concern among the general public. However, dental practitioners lack high evidence-support protocols to manage this condition. OBJECTIVES. To develop and evaluate a protocol, for outpatient dentistry, that allows the diagnosis and treatment of patients complaining of halitosis. SUBJECTS AND METHODS. A protocol was created based on the literature and was used throughout a three-year clinical study comprising 714 patients. It was carried out at a novel bad breath consultation in Lisbon. This protocol consisted of a detailed questionnaire, clinical and psychological examination, evaluation by a confidant, organoleptic assessment, mouth air examination with a chromatograph (Oralchroma®), and others. Treatment differed depending on aetiological diagnosis assumption and multidisciplinary approach was performed whenever needed. After the initial visit, each patient was scheduled for follow-up sessions: day 15, and months 1, 3 and 6. RESULTS. The majority of patients had an adequate oral hygiene (76% with O'Leary IP<20% and 69% with Löe & Silness GI¿1). A considerable impact on quality of life was assessed (average OHIP-14 of 17.5). Oral and extra-oral causes were found for 60.2% and 16.9% of cases, respectively. Pseudo-halitosis patients (20.4%), mostly women (68%), significantly referred (p<0.05) higher prevalence of gastrointestinal symptoms, dysgeusia and anxiety, and lower salivation secretion rate. Adequate treatment response was obtained in 87.8% and 96.6% of cases, at month 3 and 6 respectively. Eight of a total of 15 halitophobic patients (2.1%) responded to treatment. Confidant evaluation significantly correlated (p<0.01) with other parameters (r=0,56 and r=0,49 with organoleptic scores and VSCs, respectively). CONCLUSIONS. The proposed protocol was found to successfully improve clinical, self-perceptive and psychosocial halitosis-related parameters. Cooperation from someone close to the patient (confidant), regular psychosocial assessment and accountability when multidisciplinary approach occurs (both by the dentist) are key factors.