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PubMed2003

Management of oral malodour.

Halitosis is a common problem. Its aetiology is multifactorial, but oral malodour is usually caused by microbial metabolism from the tongue, saliva or dental plaque. Mouthwashes are only effective against halitosis caused by intraoral factors. The principal causative agents of oral malodour are volatile sulphide compounds (VSCs), including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Data suggest that oral VSC levels correlate with the depth of periodontal pockets. Trials have shown that both mechanical oral care and mouthwash use can reduce halitosis levels. The majority of studies involving mouthwashes have investigated chlorhexidine and essential oil mouthwashes, although comparative studies are sparse.

Anti-Infective Agents, Local↗
PubMed2003

Oral signs and symptoms in relation to disease activity and site of involvement in patients with inflammatory bowel disease.

OBJECTIVE: An assessment of oral symptoms and signs in patients with inflammatory bowel disease (IBD). METHODS: Fifty-four patients with IBD, 34 with Crohn's disease (CD) and 20 with ulcerative colitis (UC) participated in the study. Forty-two patients without gastrointestinal disease or complaints attending the orthopedic clinic served as controls. Each patient completed a written questionnaire and was subjected to an oral examination. RESULTS: The main findings of this study were the higher prevalence of halitosis (50% vs 10% P < 0.0008), nausea (30% vs 7%, P < 0.017) and reflux (regurgitation) (45% vs 17%, P < 0.017) in patients with UC, and nausea (50% vs 7%, P < 0.026), dry mouth and halitosis (29% vs 10%, P < 0.026) and vomiting (41% vs 5%, P = 0.01) in patients with CD, compared with controls. Patients with active CD had a higher prevalence of dry mouth, nausea and vomiting compared with controls (46, 69 and 54% vs 10, 7 and 5%, respectively, P < 0.001) and of reflux compared with non-active CD (46% vs 5%, P < 0.001). Patients with active UC had a higher prevalence of halitosis and regurgitation (50 and 60% vs 10 and 17%, P < 0.001) compared with controls. CONCLUSIONS: The present study demonstrates increased frequency of oral signs and symptoms in patients with IBD. Patients with active CD had more oral signs compared with non-active CD patients. Manifestations such as nausea, vomiting, regurgitation and dry mouth may have detrimental effects on teeth and soft tissues of the oral cavity. Communication between gastroenterologists and dentists is imperative for success of the overall treatment of their patients.

Adult↗
PubMed2004

The association between clinical oral health status and oral impacts experienced by older individuals in Sri Lanka.

The aim of this study was to determine the association between clinical oral status and oral impacts experienced by older individuals in Sri Lanka. A total of 585 individuals who were above 60 years and were residents of an urban area was selected using a multistage cluster sampling combined with probability proportionate to size technique. However the present analysis is limited to 235 individuals who were subjected to a clinical oral examination. An interviewer administered Sinhala translation of the Oral Health Impact Profile-14 (OHIP-14) scale was used to assess the oral impacts experienced by the sample. An oral examination was carried out following the interview. Of the 235 subjects clinically examined 64 (27%) were edentulous. The associations between clinical parameters and oral impacts were assessed in the 171 dentate subjects. There were positive, weak but significant correlations between the number of missing teeth, the number of teeth with third degree mobility and the OHIP score. Also those who wore dentures and had halitosis had significantly higher OHIP scores than those who did not wear dentures and did not have halitosis. Logistic regression analysis revealed that 'wearing denture' and 'having halitosis' were significant predictors of the OHIP score. In conclusion, there was a weak association between clinical parameters and oral impacts experienced by these older individuals.

Aged↗
PubMed2004

Comparative effects of different chlorhexidine mouth-rinse formulations on volatile sulphur compounds and salivary bacterial counts.

AIM: To compare five different commercial mouth rinses with chlorhexidine (CHX) with respect to their anti-halitosis effect and anti-microbial activity on salivary bacterial counts, following a standardised research protocol. And secondly, to validate the study model proposed in the evaluation of patients suffering from halitosis. PATIENTS AND METHODS: Ten volunteers, with a healthy oral status, were enrolled in a double-blind, cross-over design, using sterile saline as negative control and five CHX-containing mouth rinses: 0.12% CHX alone (CHX+NO), plus alcohol (CHX+ALC), plus 0.05% cetylpiridinium chloride (CHX+CPC), plus sodium fluoride (CHX+NaF), and 0.05% CHX plus 0.05% CPC, plus 0.14% zinc lactate (CHX+Zn). The levels of whole-mouth volatile sulphur compounds (VSCs) were measured by means of a sulphide monitor at baseline, 1 and 5 h after rinsing with the assigned product. Baseline measurements also included an organoleptic assessment and the recording of the tongue-coating index. Aerobic and anaerobic salivary bacterial counts were also obtained by collecting unstimulated saliva samples at the same evaluation times, and processed by culturing techniques. Analysis of variance was used to evaluate whether significant differences existed among groups, at each evaluation point, or in changes between evaluations. RESULTS: No significant differences were detected at baseline, with VSC levels ranging between 190 and 227 parts per billion (p.p.b.) After rinsing, VSC levels were reduced with all products (except saline), after 1 h. Significant differences at 1 h were detected (p=0.04), corresponding to a lower amount of p.p.b. (109) in (CHX+Zn) as compared with the other groups (except CHX+NO). At 5 h, VSC levels were lower for CHX+CPC and CHX+Zn (155 and 169, respectively), while the other groups showed levels higher than 220 p.p.b. With respect to aerobic salivary bacterial counts, CHX+CPC demonstrated the lowest percentage of survival (6% after 1 h and 18% after 5 h). For anaerobic bacterial counts, again CHX+CPC demonstrated the lowest percentage of survival (10% at 1 h and 23% at 5 h), together with CHX+ALC (18% of survival at 5 h). However, salivary counts and VSCs were only significantly correlated at baseline, but not after treatment. CONCLUSION: Important differences can be expected from different CHX formulations, in relation to both their anti-halitosis effect and anti-microbial activity in saliva. Formulations that combine CHX and CPC achieved the best results, and a formulation combining CHX with NaF resulted in the poorest.

Adult↗
PubMed2001

Self-perception of breath odor.

BACKGROUND: Bad breath, also known as halitosis, is a common concern for millions of people. Yet there is almost no reliable way for people to properly assess their breath odor. While many develop faulty perceptions about having bad breath that affect their entire lives, others who have halitosis are unaware of their condition. OVERVIEW: The authors discuss the issues affecting self-perception of breath odor in patients who complain of halitosis, as well as in a more general, "noncomplaining" population. The article presents self-perception of breath odor as a multifactorial, psychophysiological issue that is related closely to one's body image and psychopathological profile. CONCLUSIONS: Based on their data, the authors suggest that every patient has a breath odor self-image. This self-image ranges from little or no distortion to severe psychopathology. Because treating patients with a specific complaint of oral malodor primarily is the responsibility of the dental practitioner, several treatment approaches are outlined: collecting odor samples from the mouth to increase objectivity, involving a confidant in diagnosis and follow-up, corroborating odor judges' scores with objective measurements, increasing the patient's sense of control over the problem and obtaining guidance from mental health professionals, when necessary. CLINICAL IMPLICATIONS: Dentists increasingly are being called on to help patients with complaints of bad breath. In diagnosing and treating such cases, dentists should consider psychological and physiological factors.

Adult↗
PubMed2004

Evaluation of oral and nasal odor in patients with and without cleft lip and palate: preliminary report.

OBJECTIVE: To evaluate oral and nasal halitosis parameters in patients with and without clefts. DESIGN: Randomized and prospective study. Patients with and without clefts were evaluated as to oral and nasal halitosis. SETTING: University of São Paulo, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil. PATIENTS: Twelve patients with clefts and 12 without clefts were evaluated, and no exclusion criteria were followed. INTERVENTIONS: Nasal and oral halitosis were measured with the use of a portable sulfide monitor during a single visit. RESULTS: One hundred percent of the patients with clefts had altered values for volatile sulfur compounds. Only 33.3% of the patients without clefts had at least one strong value for nasal halimeter measurements, and 58.3% of these patients showed alteration in the nasal values. Statistical evaluation, made using the Mann-Whitney U test, classifying the nasal halimeter values as normal, weak, and strong, showing a statistical significant group difference (p = .003). There was no significant difference in the oral halimeter values between the two groups. CONCLUSIONS: Patients with cleft lip and palate had a tendency to present higher values for the nasal halimeter measurements, when compared with patients without clefts.

Case-Control Studies↗
PubMed2004

Tongue-cleaning methods: a comparative clinical trial employing a toothbrush and a tongue scraper.

BACKGROUND: It is estimated that approximately 85% of all halitosis cases have their origin within the mouth; of these, 50% are caused by tongue residues. Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis. Thus, tongue cleaning gains importance as a means of halitosis management. METHODS: This investigation compared the efficacy of two mechanical methods for tongue cleaning through a handheld sulfide monitor. This crossover trial was carried out with 10 healthy subjects, 20 to 50 years old. Before the baseline measurement of the volatile sulfur compounds (VSCs), the subjects were instructed to refrain from any tongue cleaning method for 48 hours. The 10 participants were then placed in one of two groups (five each): 1) first week: tongue scraper, second week: soft-bristle toothbrush; 2) first week: toothbrush, second week: tongue scraper, with a 48-hour wash-out period between each week. RESULTS: The baseline measurements were compared with those of the end of each week using the Dunn method (alpha = 0.01). The tongue scraper showed a 75% reduction in VSCs, while the toothbrush only achieved a 45% reduction in VSCs. CONCLUSION: Although the tongue coating was removed by both methods, the tongue scraper performed better in reducing the production of volatile sulfur compounds.

Adult↗
PubMed1993

Oral malodor--a review.

Oral malodor has many etiologies. The use of accurate descriptor terms to describe this condition facilitates its clinical diagnosis and treatment by health care professionals. Oral malodor, a generic descriptor term for foul smells emanating from the mouth, encompasses ozostomia, stromatodysodia, halitosis (both pathological halitosis and physiological halitosis) and fetor oris or fetor ex ore. These latter terms, in turn, denote different sources of oral malodor. The terms ozaena, fetor narium, dysosmia, hyperosmia, cacogeusia, and dysgeusia are also related to oral malodor, and assist in accurately describing a clinical presentation. Systemic pathological states, such as diabetes mellitus, uremia and hepatic diseases, induce metabolic products that are detectable as oral smells. Local oral conditions produce volatile sulphur compounds and other breakdown products that intensify oral malodors. The clinical labelling and interpretation of different oral malodors both contribute to the diagnosis and treatment of underlying disease. This article stresses the relationship between smell and taste, emphasizes specific meanings for related oral malodor terms, reviews smell comprehension and indicates some of those commonly-encountered associated clinical conditions.

Halitosis↗
PubMed2006

Influence of anxiety on the production of oral volatile sulfur compounds.

Since many patients complain about halitosis without there being any clinical evidence of its cause, psychological symptoms have been pointed out as halitosis-inducing factors. The aim of this study was to evaluate the influence of anxiety on the production of volatile sulfur compounds (VSC). Seventeen undergraduate men in good oral and general health participated in this study, after approval by the ethics committee. The volunteers were requested to refrain from toothbrushing, using mouth rinse and eating on the experimental day. Before presenting the anxiogenic condition, the volunteer was asked to fill out the Beck Anxiety Inventory questionnaire, to check whether he had been exposed to stressors during the previous week. The Video-Recorded Stroop Color-Word Test (VRSCWT) was used to elicit anxiety. The VSC (halimeter), blood pressure, heart rate and salivary flow measurements were taken before and after the VRSCWT. The volunteers presented a minimal or slight level of anxiety before the test. There was an increase in the oral concentration of VSC, Systolic Blood Pressure and of heart rate (p < 0.05) after the VRSCWT, and no changes in the salivary flow. The results of the present study showed that the anxiogenic condition (VRSCWT) induced increases in VSC concentration, which might contribute to halitosis.

Adult↗
PubMed2004

Antimicrobial effects of a new therapeutic liquid dentifrice formulation on oral bacteria including odorigenic species.

The control of oral malodor is well-recognized in efforts to improve oral health. Antimicrobial formulations can mitigate oral malodor, however, procedures to assess effects on oral bacteria including those implicated in halitosis are unavailable. This investigation examined the antimicrobial effects of a new liquid triclosan/copolymer dentifrice (test) formulation that demonstrated significant inhibition of oral malodor in previous organoleptic clinical studies. Procedures compared antimicrobial effects of the test and control formulations on a range of oral micro-organisms including members implicated in halitosis, substantive antimicrobial effects of formulations with hydroxyapatite as a surrogate for human teeth and ex vivo effects on oral bacteria from human volunteers. With Actinomyces viscosus, as a model system, the test formulation demonstrated a dose-dependent effect. At these concentrations the test formulation provided significant antimicrobial effects on 13 strains of oral bacteria including those implicated in bad breath at selected posttreatment time points. Treatment of hydroxyapatite by the test dentifrice resulted in a significant and substantive antimicrobial effect vs. controls. Oral bacteria from subjects treated ex vivo with the test dentifrice resulted in significant reductions in cultivable oral bacteria and odorigenic bacteria producing hydrogen sulfide. In summary, microbiological methods adapted to study odorigenic bacteria demonstrate the significant antimicrobial effects of the test (triclosan/copolymer) dentifrice with laboratory and clinical strains of oral bacteria implicated in bad breath.

Actinomyces viscosus↗
PubMed2001

Effects of metal salts on the oral production of volatile sulfur-containing compounds (VSC).

BACKGROUND/AIM: Halitosis, mainly caused by bacteria located on the posterior dorsum of the tongue and in periodontal pockets, is due to formation of volatile sulfur compounds (VSC). The hypothesis to be tested was that the affinity of a metal for sulfur determines its anti-VSC activity. METHOD: Clinical tests were carried out on 12 subjects who rinsed with cysteine to induce halitosis (baseline) before rinsing with 7.34 mM ZnCl2, SnF2 and CuCl2. Mouth air VSC analyses were repeated following cysteine rinses at 1 h, 2 h and 3 h using a gas chromatograph. In vitro experiments tested toxic metals Hg2+, Pb2+ and Cd2+. 10-microl aliquots of metal salts were added to 1-ml aliquots of human whole saliva from 30 subjects. Samples were incubated overnight at 37oC and saliva headspace was analyzed for VSC in a gas chromatograph. CLINICAL RESULTS: Cu2+>Sn2+>Zn2+ (supports hypothesis). Zn2+ had significantly less anti-VSC effect compared with Cu2+ and Sn2+ at 1, 2 and 3 h. In vitro results indicated that Hg2+, Cu2+ and Cd2+ had close to 100% anti-VSC effect, and that Pb2+ was less effective and Cd2+ more effective than expected in inhibiting VSC. CONCLUSIONS: Apart from Hg2+ and Cu2+, the metals had a significantly greater effect on H2S than on CH3SH. Cu2+ and Hg2+ have well-known antibacterial activity and may presumably also operate by this mechanism.

Adult↗
PubMed2003

Tongue coating and tongue brushing: a literature review.

The present paper reviews the role of the tongue as a habitat for oral microorganisms and the potential need for tongue cleaning as part of daily oral hygiene. In addition tongue coating is described. Many microorganisms have been found colonizing the dorsum of the tongue. Some studies find a positive effect to tongue brushing on bacterial counts on the tongue. On the other hand there are also studies that do not find any differences in bacterial counts before or after tongue brushing. Bacteria colonizing the tongue and periodontal pockets play an important role in the production of volatile sulphur compounds in periodontal health and disease. These compounds can be the cause of oral malodour. The amount of tongue coating in patients complaining of halitosis was significantly greater than in patients without halitosis. Tongue brushing on a regular basis, particular aiming at removing the coating on the dorsum of the tongue, has been found to be fruitful in reducing oral malodour. Studies investigating the role of tongue brushing and plaque accumulation or gingival inflammation show conflicting results. It is clear that the tongue forms the largest niche for microorganims in the oral cavity. However, on the basis of literature, there appears to be no data to justify the necessity to clean the tongue on a regular basis. One exception would be oral malodour.

Bacteria↗
PubMedDate not supplied

Volatile sulfur compounds produced by Helicobacter pylori.

GOALS: To assess the volatile sulfur compounds produced by three strains of Helicobacter pylori in broth cultures mixed with sulfur-containing amino acids. BACKGROUND: Halitosis has been reported in H. pylori-positive patients, and volatile sulfur compounds such as hydrogen sulfide and methyl mercaptan are known to be responsible for inducing oral malodor. Whether H. pylori produces these volatile sulfur compounds has yet to be established. STUDY: Three strains of H. pylori (ATCC 43504, SS 1, DSM 4867) were cultured with 5 mM cysteine and methionine. After 72 hours of incubation, the headspace air was aspirated and injected directly into a gas chromatograph. The concentrations of hydrogen sulfide and methyl mercaptan were analyzed and compared between experimental and control cultures RESULTS: In broth containing 5 mM cysteine, hydrogen sulfide was increased by ATCC 43504 (P < 0.01) and SS 1 (P < 0.05), while methyl mercaptan was elevated only by SS 1 (P < 0.05). In broth containing 5 mM methionine, methyl mercaptan increases were significant for SS 1 (P < 0.05) and DSM 4867 (P < 0.05). In broth containing 5 mM cysteine and 5 mM methionine, the concentration of hydrogen sulfide was higher than in controls for all three strains (P < 0.01); that of methyl mercaptan was higher only for SS 1 (P < 0.01). Cysteine addition to cultures containing methionine increased hydrogen sulfide and methyl mercaptan for ATCC 43504 (P < 0.05) and SS 1 (P < 0.05). Conversely, addition of methionine to cultures containing cysteine increased methyl mercaptan only for DSM 4867 (P < 0.01). CONCLUSIONS: The production of volatile sulfur compounds by H. pylori is not only very complicated but also strain-specific. Nevertheless, H. pylori was shown to produce hydrogen sulfide and methyl mercaptan, which suggests that this microorganism can contribute to the development of halitosis.

Chromatography, Gas↗
PubMed2004

Effects of low dose chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide.

BACKGROUND/AIMS: Clinical studies have demonstrated the considerable effects of chlorhexidine on dental plaque and oral microbiota as well as improvements in indices of oral health. This investigation examined the efficacy of lower concentrations of chlorhexidine. METHODS: Mouthrinses with 0.03%, 0.06%, 0.12% chlorhexidine and a control rinse without chlorhexidine were examined. Alamar blue, an oxidation-reduction dye with fluorescent end-points proportional to bacterial viability, was used to determine bacterial viability. Further clinical studies examined the effects of these rinses on salivary bacteria and on bacteria producing hydrogen sulfide (H(2)S) and implicated in halitosis. RESULTS: In laboratory tests, a significant dose-dependent effect was observed with Actinomyces viscosus as a model system using the Alamar blue procedure (P < 0.05). Clinical studies examined the effects 1.5 h and 3 h post-treatment on salivary bacteria and bacteria producing H(2)S. The first study compared the control rinse with the 0.03% and 0.06% chlorhexidine rinses; a second study compared the effects of the control rinse and the 0.06% and 0.12% chlorhexidine mouthrinses. In both studies, chlorhexidine rinses demonstrated significant dose-dependent effects post-treatment on salivary bacteria vs. the control rinse (P < 0.05). Significant decreases in H(2)S-producing bacteria were noted with these chlorhexidine rinses vs. the control rinse (P < 0.05). CONCLUSION: The results highlight the dose-dependent relationships noted in laboratory and clinical tests which have potential implications for the use of lower doses of chlorhexidine to inhibit oral bacteria, including those implicated in halitosis.

Actinomyces viscosus↗
PubMed2003

Effect of tongue brushing on oral malodor in adolescents.

BACKGROUND: Halitosis is a common problem in humans, and is a social and psychological handicap for those affected by it. Halitosis has a positive correlation with the accumulation of bacterial plaque in the oral cavity. AIMS: The aim of the present study was to determine the effect of tongue brushing on oral malodor in adolescents. METHODS: The subjects of the investigation were 28 adolescents who had oral malodor and whose average age was 16 +/- 0.12 years. Subjects were chosen to participate in the study if they had an established routine of oral care, and did not have systemic or periodontal disease or dentures (such as fixed prosthesis or partial and total dentures). The subjects with oral malodor were randomly assigned into two groups. Individuals in the first group received instructions regarding professional procedures of oral care from a periodontist. In addition, individuals in this group had the surface of their tongue cleaned using a hard toothbrush, wetted with 0.12% chlorhexidine gluconate. Individuals in the second group (control) underwent the same professional procedures of oral care executed by the same periodontist, however, they did not have their tongues cleaned. Oral malodor of individuals was then evaluated for all individuals using the organoleptic method. The pH of the subjects tongues were recorded before and after treatment. The results of the oral malodor test were compared between the two groups. RESULTS: The results of the study found that oral malodor scores obtained by an organoleptic method was more severe in the second group than the first group, and statistical differences were found between the two groups (P < 0.001). CONCLUSION: These results revealed that accumulation of bacterial plaque on the tongue is an important factor for oral malodor in the adolescents. Oral malodor levels were significantly reduced after cleaning the surface of the tongue. Thus, tongue care shouldn't be neglected in order to avoid oral malodor.

Adolescent↗
PubMed1997

On the transformation of sulfur-containing amino acids and peptides to volatile sulfur compounds (VSC) in the human mouth.

Halitosis is most often caused by oral conditions. Volatile sulfur compounds (VSC), constituting the major components of oral malodor, are produced by anaerobic, gram-negative bacteria retained mainly in periodontal pockets or on the tongue dorsum. Sulfur-containing amino acids serve as substrate for these bacteria. VSC have also been found to have unfavorable effect on the tissue. The aim of this study was to examine whether normal, healthy individuals with no history of halitosis were able to produce VSC from cysteine, when applied as a mouthrinse. A further aim of the study was to investigate and compare the potential of other sulfur-containing amino acids and peptides as substrates for oral VSC production and to localize the odor-production sites. A portable sulfide monitor was used for VSC registration. Results showed that all test subjects produced high oral concentrations of VSC upon rinses with cysteine, which thus seems to be a major substrate for VSC production. The other sulfur-containing substrates had much less effect. It was found that the tongue was the major site for VSC production, and that saliva per se caused low VSC production.

Adult↗
PubMed2005

The rationale and potential for the reduction of oral malodour using Streptococcus salivarius probiotics.

The primary treatment for oral malodour is the reduction of bacterial populations, especially those present on the tongue, by use of a variety of antimicrobial agents or mechanical devices. However, shortly after treatment the problematic bacteria quickly repopulate the tongue and the malodour returns. In our studies, we have used a broadly-active antimicrobial (chlorhexidine) to effect temporary depletion of the oral microbiota and then have attempted to repopulate the tongue surface with Streptococcus salivarius K12, a benign commensal probiotic. The objective of this is to prevent re-establishment of non-desirable bacterial populations and thus help limit the re-occurrence of oral malodour over a prolonged period. In this paper, we discuss why contemporary probiotics are inadequate for treatment of oral malodour and examine the rationale for selection of particular bacterial species for future use in the treatment of this condition. In our preliminary trials of the use of a chlorhexidine rinse followed by strain K12 lozenges, the majority (8/13) of subjects with confirmed halitosis maintained reduced breath levels of volatile sulphur compounds for at least 2 weeks. We conclude that probiotic bacterial strains originally sourced from the indigenous oral microbiotas of healthy humans may have potential application as adjuncts for the prevention and treatment of halitosis.

Halitosis↗
PubMed2002

Pharyngeal foreign body in a child persisting for three years.

Foreign body ingestions are common in children. They can pose a diagnostic problem if the foreign body is embedded in the soft tissues of pharynx. A 4 year old girl presented with halitosis for two years. A pharyngeal foreign body, a metallic ring, was seen on lateral radiographs of the neck. The foreign body was removed under general anaesthesia. A completely embedded pharyngeal foreign body should be considered in cases presenting with halitosis.

Child, Preschool↗