This is accomplished by subgingival scaling and root planing and irrigation with an antibiotic mouth rinse. The bacteria that cause gingivitis and periodontal disease (periodontopathogens) are invariably gram negative and capable of producing VSC. Methyl mercaptan is known to be the greatest contributing VSC in halitosis that is caused by periodontal disease and gingivitis. The level of VSC on breath has been shown to positively correlate with the depth of periodontal pocketing, the number of pockets, and whether the pockets bleed when examined with a dental probe. Indeed, VSC may themselves have been shown to contribute to the inflammation and tissue damage that is characteristic of periodontal disease. However, not all patients with periodontal disease have halitosis, and not all patients with halitosis have periodontal disease. Although patients with periodontal disease are more likely to develop halitosis than the general population, the halitosis symptom was shown to be more strongly associated with degree of tongue coating than with the severity of periodontal disease. Another possible symptom of periodontal disease is a bad taste, which does not necessarily accompany a malodour that is detectable by others. Other causes
Other less common reported causes from within the mouth include:
Deep carious lesions (dental decay) – which cause localized food impaction and stagnation
Recent dental extraction sockets – fill with blood clot, and provide an ideal habitat for bacterial proliferation
Interdental food packing – (food getting pushed down between teeth) - this can be caused by missing teeth, tilted, spaced or crowded teeth, or poorly contoured approximal dental fillings.
Telmisartan/hydrochlorothiazide, sold under the brand name Micardis HCT among others, is a fixed-dose combination medication used to treat high blood pressure. It is a combination of telmisartan an angiotensin II receptor antagonist with hydrochlorothiazide a diuretic. It may be used if telmisartan by itself is not sufficient. It is taken by mouth.Common side effects include dizziness, upper respiratory tract infections, nausea, diarrhea, and tiredness. Severe side effects may include kidney problems, electrolyte problems, and allergic reactions. Use during pregnancy may harm the baby. Telmisartan works by blocking the effects of angiotensin II while hydrochlorothiazide works by decreasing the kidneys ability to retain water.The combination was approved for medical use in the United States in November 2000, and in the European Union in April 2002. The combination is on the World Health Organizations List of Essential Medicines. It is available as a generic medication. References
External links
"Hydrochlorothiazide mixture with telmisartan". Drug Information Portal. U.S. National Library of Medicine.