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COJ Nursing & Healthcare

A Case Report of Sjörgens Syndrome and Pseudo Halitosis

Hikmet Solak1* and Tamer Yılmaz2

1 Department of Restorative Dentistry, Neareast University, Turkey

2 Deparment of Biochemistry, Neareast University, Turkey

*Corresponding author: Hikmet Solak, Department of Restorative Dentistry, Neareast University, Turkey, Email:hikmet.solak@neu.edu.tr

Submission: June 27, 2018Published: July23, 2018

DOI: 10.31031/COJNH.2018.03.000574

ISSN: 2577-2007
Volume3 Issue5

Abstract

Halitosis is a condition that has health and social implications. The origin of breath malodour problems are related to both systemic and oral conditions. In some cases malodor is not physically detected, but the patient still feels that they have bad breath. Halitosis is one of common reason for social problems between couples, In this case report, we describe a family case of non oral pathological halitosis caused by sjörgen sydrome, and pseudo halitosis.

Keywords: Malodor; Sjörgens syndrome and pseudo halitosis

Introduction

Halitosis is a general term used to describe any disagreeable smell of expired air from the mouth [1]. This situation is termed as oral malodor, bad breath, halitosis, fetor ex ore etc. The origin of breath malodour problems are related to both systemic and oral conditions but primarily associated with the condition of the oral cavity [2-4].

Halitosis is a condition that has health and social implications that may periodically affect most of the adult population. The origin of breath malodour problems are related to both systemic and oral conditions [2,3].

In the large majority of cases, oral malodor originates in the oral cavity as the result of microbial metabolism [3-5]. Malodor of oral etiology may result from food impaction, diet, loss of oral hygiene, neurologic and gastrointestinal disorders, various systemic diseases, metabolic or hormonal changes, hepatic or renal insufficiency, pulmonary diseases gastroenterological pathologies and use of certain drugs [6-8].

The general concensus on oral etiology is commonly depending on volatile sulfure componds anaerobic bacterial flora such as hydrogen sulfide and methyl mercaptan. Additionally, methylamine, dimethylamine, propionic acid, butyric acid, indole, scatole, and cadaverine have been reported to cause oral malodor [9-10].

To evaluate the level of oral malodor in patients complaining of halitosis, VSC levels have typically been measured, along with an organoleptic test [11,12]. To diagnose halitosis, a simple classification with corresponding treatment needs to be developed [2], which includes the categories of genuine halitosis, pseudo halitosis, and halitophobia. In some cases malodor is not physically detected, there is no local or systemic problem. This situation is termed as imaginary halitosis, delusional halitosis, pseudohalitosis, non-genuine halitosis, halitophobia , olfactory reference syndrome (ORS), psychogenic halitosis, body odor psychosis (depression and hypochondriasis) [2-14]. This classification refers to a situation where no real breath problem exists, but the patient still feels that they have bad breath.

Genuine halitosis is sub classified as physiological or pathological halitosis, and pathological halitosis is sub classified as oral or nonoral pathological halitosis. Oral pathological halitosis is caused largely by periodontal disease [15], and its treatment requires periodontal treatment in addition to dental and oral care, oral hygiene instruction, and counselling. Additionally, dental treatment may be necessary to correct faulty restorations that could contribute to poor oral health [2-17].

Halitosis is one of common reason for social problems between couples, In this case report, we describe a family case of non oral pathological halitosis caused by sjörgen sydrome, and pseudo halitosis. Husband is complaning from his wife’s malodor, Wife claimed her husband also having a malodor, This situation began to effect their relationship. We examined both of them [18].

Family Case

The wife was 47 years old. She don’t have any remarkable medical or surgical history. She visited our clinic complaining of breath odor. She had been examined by our oral radiology and diagnosis department and oriented to periodontology clinic. We performed periodontal treatment including scaling and root planning. We also performed Class II composite filling. Her breath malodor never decreased. Under the control of our oral hygienist we cleaned her teeth several times, but we cannot able to reduce her breath malodor. There was no any valid dental abnormal findings to explain her situation.

She had a feeling of dry mouth. She need to drink water continiously. She had been studied for ophtalmology, ear nose and trout, and gastrointestinal, hepatic, neurological and respiratory diseases in releated departments. She had undergone computed tomography of sinuses, and laboratory analyses. With the help of the salivary gland biopsy and The presence of SS-A (Anti-Ro) antibody Sjörgen’s Syndrome was diagnosed. The Husband was 52 years old. He also didn’t have any remarkable medical or surgical history either. He attempted using oral sprays, carnation seed, to reduce or mask his breath odor, chewing mint gum for long periods to clean his mouth, and brushing his teeth with a large, hard bristled brush minimum 3 times a day.

Next he had been examined by our oral radiology department first for any type of dental problems. We performed an oral examination again to identify if any cause of the oral malodor. There was no any valid dental abnormal findings. Than we examined his breath ador with using an organoleptic test (18) as described [19,20]. We cannot detected any malodor. His periodontal conditions were good. Extensive tooth wear was seen and the patient had a little hypersensitivity in some teeth. We explained that his tooth wear seemed to be caused by his inappropriate odor-reducing methods. We showed him how to brush his teeth without damaging the tooth surfaces and recommended a special toothpaste that prevents.

We performed our organoleptic test for both husband and wife 3 times and every time we found husband dont have any malodor. But the wife kept on having it because Sjörgen’s Syndrome. We thought the wife create a kind of defance mechanism against her husbant to get ride of his complain about malodor.

Conclusion

Halitosis is one of common reason for social problems between couples. This family is a typical case to demostrate the social issue of malodor within a couple.

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© 2018 Hikmet Solak. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.



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