Dr. John
Halmaghi is in private practice in Southfield, MI, and has been
a pioneer in cosmetic dentistry and complex dental care. A graduate
of The University of Michigan, Medical College of Ohio, and University
of Buffalo, he has maintained over ten times the national continuing
education credits, and has written and published numerous articles and
textbooks sold internationally. He loves to take on challenging cases.
Visit his website.
At our office, we do not look at
Halitosis treatment as a huge profit center. Rather, we approach it
as a service to our patients that helps them improve a part of their
lives with our help. It improves referrals and confidence immensely.
Now, here is the basic routine for our breath treatment:
1. Patient fills out simple consultation form.
2. Patient introduction and health history is performed. We take the
time to see what medications or health issues the patient may have
that could contribute to the breath problem. G.I. problems, hernias,
ulcers, "heartburn", digestive problems, xerostomia inducing
meds, etc. can exacerbate halitosis.
3. Take two bitewing x-rays, unless patient denies. If patient does
not consent, I inform them of the possibility of periodontal issues
that we cannot address.
4. Take Halimeter® reading. Any levels between 150-180
are addressed as minor halitosis problems and treated normally with
improved hygiene as discussed below. Any levels between 190-250 are
addressed as moderate-severe halitosis problems and treated as discussed
below. Any patients who present with levels higher than 250 are considered
chronic, and may need antibiotic intervention (Doxycycline 100mg bid
x 28 days, with or without periodontal treatment, if necessary) along
with the following steps.
5. Periodontal screening. I feel that every dentist and hygienist
can diagnose periodontal problems, however I see patients from other
offices every day with undiagnosed periodontal problems. There is
a large segment of the population with poorly or completely undiagnosed
periodontal problems. These are the same patients that visit the dentist
on a regular basis. These are the patients that bring in the profit
margin at my office, and they are one of the reasons that we continue
to perform Halitosis treatment.
What I am talking about is that I take the time to
properly check for periodontal problems. Many patients have what I
call the result of "supervised neglect," from years of improper
professional care. These patients have burnished interproximal calculus,
pocketing, bleeding, and bone loss. A lot of these problems are usually
a result of not only improper home care, but also poor professional
treatment. I take the time to do what the office down the street has
not done properly, maybe for many years. You can diagnose a patient's
periodontal condition with two bitewings and a probe. After careful
diagnosis, I take the time to inform these patients of their problem
and how it is contributing to their breath problem. They watch a video
about periodontal disease and then they are informed about the need
to perform a complete set of x-rays.
Once they are committed to complete diagnosis, I treat
them as a new patient at our office and we perform our normal New
Patient routine, including a periodontal chart and restorative findings.
At this point I have gone from a $95 visit to a $2000 periodontal
case, plus other possible restorative work.
6. The visit ends with proper instructions on how to use Oxyfresh
products to cure the bad breath. The most important part of this education
is to get the patient gargling briskly with mouthwash, brushing appropriately,
flossing vigorously, and scrubbing the tongue with heavy duty force.
The critical part is the scrubbing of the tongue. If the patient can
keep their tongue clean and free of sulfur producing bacteria, their
problem is solved.
Some patients have a huge gag reflex, so I reassure
them that the problem will subside slowly as the brain learns to control
the gagging. It helps to have the patient squeeze the tip of their
tongue between thumb and forefinger. This breaks the gag reflex somewhat.
As a treating dentist you have to emphasize to your patients that
the tongue is responsible for 95% of all breath problems. Of course
you cannot cure onion or garlic breath, but all halitosis issues can
be successfully treated by making sure that the tongue is squeaky
clean. Again, the patient must be educated about their problem. Take
the time to explain to them how the tongue harbors sulfur producing
bacteria. These bacteria hide in the ridges of the tongue and when
patients try to use regular toothpaste to brush their tongue they
are "sealing" the bacteria deep in the tongue, making the
problem worse.
Only Oxyfresh and other chlorine dioxide products can
kill the sulfur producing bacteria and get rid of the smell. Also,
explain to patients that using mouthwashes such as Listerine, Scope,
Listermint, etc. end up killing the good bacteria and allowing the
sulfur bacteria to live. Furthermore, alcohol containing mouthwashes
can make teeth sensitive by "drying" them, not to mention
increasing the chance for oral cancer by 65%. Get your patients to
stop using store products and switch them to Oxyfresh.
7. For patients with periodontal problems, we continue to address
the breath issue during their periodontal care. We place these patients
on fluoride as well as Oxyfresh. If the patient has xerostomia we
also recommend Biotene products or Xero-Lube.
Although you will have to learn more about the specifics of Halitosis
treatment, the above format will help you get started. This routine
works for most of our patients. The patients that refuse bitewing
x-rays are not denied treatment. You can still help these patients
by showing them the basics of oral hygiene and tongue scrubbing. Just
let them know about gum issues and the future need for evaluation.
You'll be surprised how many will return as new patients later. Oxyfresh
has available all the products that you need, including patient home
care videos. Don't wait any longer to perform this treatment.
