Halitosis As seen through the mirror of a wet-fingered, full-time, down-in-the-trenches, general dentist
I first heard of sodium chlorite while sitting in a continuing education seminar about five years ago. The lecturer was heralding the effects of this active ingredient as a very powerful oral deodorizer, which would also have some serious periodontal implications. As a full time general dentist with a strong interest in cosmetic dentistry and non-surgical periodontics, my ears perked up. I was always searching for something other than Peridex to recommend to my patients. As we all know, Peridex works extremely well controlling periodontal conditions…as long as the patient uses it. Therein lies the problem…compliance! Universally, patients do not like brown teeth, nor something distasteful. For lack of anything else to recommend, I was indeed a Peridex “abuser.” I also knew when my patients were not doing their home care from a lack of the telltale signs of staining. It was frustrating, to say the least. We would work our tails off getting these patients into shape, only to see our efforts go down the tubes because of patient non-compliance.
Over the next few months, my search for a sodium chlorite-based product propelled me into the world of Oxyfresh. From the very first phone call, I knew I had found something very unique. I started to work with another general dentist who had been utilizing the products in his office and he literally walked me through the proper usage and implementation of the Oxyfresh program into my patient base. I already had a strong periodontal management program in my office and the missing link (improving patient compliance) was about to be solved.
Is it Safe?
Skeptical, yet somewhat excited, I had two main concerns. Did it work and was it safe? Five years ago, Oxyfresh did not have the name recognition it has today. Sodium chlorite also sounded a bit scary. As I began to find out more about the product, I learned that sodium chlorite has been used for many years to purify water systems throughout the world. It is the purification system of choice for Boeing and Lockheed aircraft. It has been used commercially to deodorize hospitals, fish markets, and other areas of industry. There were also studies done to show that there were no signs of toxicity associated with sodium chlorite. I was convinced it would do no harm.
Does it work?
In order to prove to myself that these products really worked, I then set up a clinical trial. I chose fifteen of my tougher recall patients, charted them thoroughly, gave them specific instructions on how to use the products and asked them to return within two to three weeks at no charge to re-evaluate their perio condition. This was very important because I wanted to see how they were responding while in peak usage of the products. The results were impressive. Twelve of them showed marked improvements and the other three had no change. I since have challenged my hygienists to do the same and the results are always consistent.
At this time, Oxyfresh became the cornerstone of my non-surgical periodontal management program and I have been delighted ever since. As I gained more experience with these products, I would also begin to hear from patients that their mouths felt cleaner and fresher. Some patients were commenting how they no longer had morning bad breath. And as others would periodically ask if I had anything for their breath, I started to recommend Oxyfresh for that problem as well. Considering the company claims that the products cleanse, soothe and deodorize, I figured it was worth a try. Surprisingly, many of these people are raving about how they or their significant other had become kissable again.
Early on, one of the challenges we faced with dealing with halitosis solely on a product basis, was that although a high percentage of patients had favorable results, not all of them responded equally well. This was not only perplexing to myself but to my other Oxyfresh colleagues as well. One of the great things about Oxyfresh, the company, is the vast network of dentists who not only use the products, but who are also willing to share their experiences with you. This dramatically cuts the learning process down and eliminates the need to reinvent the wheel. As we brainstormed together, what we realized was that we were missing a means to make a differential diagnosis. Once a protocol for diagnosis was established and instrumentation put into place to locate and quantify the sources of malodor, we were then able to properly treat those who had long-term chronic halitosis and refer those individuals who felt we could not help, thereby improving our rate of success.
How does Oxyfresh work?
The active ingredient in Oxyfresh is sodium chlorite. It acts by neutralizing odors at the source by breaking the covalent bond that holds sulfur molecules to the rest of the compound. Volatile Sulfur Compounds (VSCs) such as hydrogen sulfide, methyl mercapten and others are found in high concentrations on the tongue and in the periodontal sulcus. VSCs are the result of the degradation of bacteria and epithelial cells that have died, degraded and have not been removed. As they accumulate, they create an odor. They also increase periodontal membrane permeability, setting off the cascade of events leading to periodontitis.
It becomes virtually impossible to discuss the treatment of halitosis without discussing the treatment of periodontal disease. Although many of my halitosis patients have pink, firm and healthy gingiva (they brush a million times a day), it is not unusual for us to locate the source of odors from the sulcus. The home care regimen is very similar. For mild to severe gingivitis cases, I use the Oxygene Toothpaste and Mouthrinse in tandem, which creates a very powerful synergistic reaction. If a patient presents with a few localized interproximal areas that are inflamed, I will have them use the Oxygene Dental Gel on a proxybrush. This is a more viscous form of sodium chlorite mixed with aloe and chamomile. We have also used it routinely under the immediate dentures, eliminating any post-operative odor and decreasing healing time dramatically.
Halitosis patients will use a similar regimen of toothpaste and mouthrinse. Almost every patient has a tongue coating, which has offensive odors, and this residue needs to be mechanically removed using the Oolitt tongue scraper. Once removed, we can chemically neutralize the odors on the tongue by brushing vigorously with the Oxygene toothpaste.
Show me the money!
Most offices can passively produce an additional $500 to $1000 per month just by dispensing these products. Incorporating the halitosis treatment concept can generate even more revenues not to mention the additional income that will be produced from routine procedures once you have solved their biggest complaint. Let’s look at some arbitrary numbers:
8 hygiene patients per day X 5 days per week = 40 patients per week
40 patients X 4 weeks = 160 patients per month
If only 50% of your patients accept your product recommendation for a $30 Oral Health Kit (toothpaste, mouthrinse, gel, and Oolitt), then
80 x $30 = $2400 per month
Can you afford to lose $20,000 again next year by not offering these services?
How much is a new patient worth?
Halitosis as a marketing tool can be very effective. However, this type of service must be continuously marketed in order to create a constant flow of new patients. I have worked with many offices with varied success. Some have reported as many as 25 to 30 new patients per month from halitosis marketing. Conservatively, it would be fair to expect from 2 to 8 new patients per month from the fresh breath concept. If you know how much an average new patient generates in a year, then you will know how this service can enhance your practice. We have had a number of patients that we turned into “aces” after we took care of their breath problem and subsequently had their entire mouth restored cosmetically. The potential is limitless and with an estimated 90 million bad breath sufferers there is plenty of business to go around.