Krespi Yosef P, Shrime Mark G, Kacker Ashutosh
Department of Otolaryngology, St Luke's / Roosevelt Hospital, New York, New York, USA.
Otolaryngol Head Neck Surg. 2006 Nov;135(5):671-6. doi: 10.1016/j.otohns.2005.09.036.
Halitosis can be a crippling social problem, and standard dental treatments and mouthwashes often provide only temporary relief. The mouth is home to hundreds of bacterial species that produce several fetid substances as a result of protein degradation. Volatile sulfur compound (VSC)-producing bacteria colonizing the lingual dorsum have recently been implicated in the generation of halitosis. Detection of VSCs, such as methylmercaptan and hydrogen sulfite, via organoleptic and objective methods, can aid in the identification of their source. Following comprehensive evaluation for possible causes, most halitosis in patients seen in an ENT practice can be localized to the tongue. We review methods of diagnosis and treatment of oral malodor from the overgrowth of proteolytic, anaerobic, gram-negative bacteria on the crevices of the lingual dorsum. Bacteriologic analysis of biofilm and scraped specimens obtained from the lingual dorsum and other oral sites, primarily gingival pockets and tonsillar crypts, can identify VSC-producing bacteria. Porphyromonas, Prevotella, Actinobacillus, and Fusobacterium species are the most common organisms identified. Halitosis is an oral phenomenon, with almost no cases originating distal to the tonsils. Halitosis arising from the lingual dorsum secondary to overpopulated VSC-producing bacteria can be successfully managed with a combination of mechanical cleansing using tongue brushes or scrapes and chemical solutions containing essential oils, zinc chloride, and cetylpyridinium chloride.
口臭可能是一个严重的社会问题，而标准的牙科治疗和漱口水通常只能提供暂时的缓解。口腔中存在数百种细菌，这些细菌会因蛋白质降解而产生多种有臭味的物质。最近发现，在舌背定植的产生挥发性硫化物（VSC）的细菌与口臭的产生有关。通过感官和客观方法检测甲硫醇和亚硫酸氢等VSC，有助于确定其来源。在对可能的病因进行全面评估后，耳鼻喉科诊所中大多数患者的口臭都可定位到舌头。我们综述了因舌背缝隙处蛋白水解、厌氧、革兰氏阴性菌过度生长导致的口腔异味的诊断和治疗方法。对从舌背及其他口腔部位（主要是牙龈沟和扁桃体隐窝）获取的生物膜和刮取标本进行细菌学分析，可鉴定出产生VSC的细菌。卟啉单胞菌、普雷沃菌、放线杆菌和梭杆菌属是最常见的鉴定出的微生物。口臭是一种口腔现象，几乎没有病例起源于扁桃体远端。对于因产生VSC的细菌过多而继发于舌背的口臭，可通过使用舌刷或舌刮进行机械清洁以及含有精油、氯化锌和氯化十六烷基吡啶的化学溶液联合治疗来成功解决。
