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PubMed1981

Solitary psychosis--three cases of monosymptomatic delusion of alimentary stench treated with behavioural psychotherapy.

Three cases of monosymptomatic delusion of alimentary stench are described. Each patient was referred for behaviour therapy as a last resort, after extensive medical investigation for halitosis or flatulence and failure of other psychiatric treatment. Two of the patients showed clinical improvement after treatment, sustained at follow-up. Monosymptomatic delusion is now a treatable condition and is important to diagnosis.

Adult↗
PubMed1977

Production and origin of oral malodor: a review of mechanisms and methods of analysis.

Organoleptic studies indicate that the oral cavity is usually the principal source of physiologic malodor associated with the early morning halitosis. In all individuals, regardless of the age or health status of the oral tissues, the most intense oral malodor is exhibited after prolonged periods of reduced saliva flow and abstinence from food and liquid. This results from normal metabolic activity in the oral cavity and is accentuated in cases with periodontal involvement. Physiologic oral malodor is transient in duration as it can be controlled to varying degrees in most individuals by oral hygiene measures, such as tooth brushing, dental prophylaxis, tongue scraping and rinsing with antiseptic mouth washes. Experimental evidence strongly suggests that putrefaction of sulphur-containing proteinaceous substrates by predominantly gram-negative oral microorganisms is the primary cause of oral malodor. Optimum putrefactive activity occurs in low carbohydrate environment, physiological pH, and anaerobic conditions. Salivary sediment containing the exfoliated epithelial cells is the primary source of substrate which exists in a disulphide state. Proteolysis and reduction of disulphide bonds precedes the formation of odor. The odor intensity of putrescent saliva and plaque head-space vapor has been correlated with the concentration of volatile sulphur compounds consisting of hydrogen sulphide, methyl mercaptan, dimethyl sulphide and dimethyl disulphide. Except for dimethyl disulphide, the same sulphur-containing compounds have been found in mouth air of all tested individuals. Hydrogen sulphide and methyl mercaptan emanate an offensive putrid odor and account for approxiamtely 90% of the total sulphur content of mouth air. In half of the population tested, methyl mercaptan and hydrogen sulphide content of early morning mouth air is sufficiently high to account for the oral malodor. Brushing studies indicate that both plaque and tongue are important sources of malodor with most of the odor emanating from the dorso-posterior surface of the tongue. None of the gas chromatographic or mass spectrometric analyses have detected the presence of amines, indole, or skatole in the head-space, mouth air, or breath vapor samples.

Amino Acids↗
PubMed1992

Non-oral etiologies of oral malodor and altered chemosensation.

A number of non-oral causes for oral malodor have been discussed. Several well documented etiologies for non-oral malodor include renal failure, cirrhosis of the liver, and diabetes mellitus. Each of these conditions has been examined using analytical instrumentation. In addition there appear to be several other metabolic conditions involving enzymatic and transport anomalies (such as trimethylaminuria) which lead to the systemic production of volatile malodors that manifest themselves as halitosis and/or altered chemoreception. Our studies include patients who have been referred to us after being examined by numerous clinical specialists with no identification or relief from their problem. This is due in part to the intermittent nature of many of these problems as well as an apparent lack of knowledge concerning many of these metabolic problems and their relation to oral symptoms.

Acetoin↗
PubMed1994

Relationship of oral malodor to periodontitis: evidence of independence in discrete subpopulations.

Associations between oral malodor, measures of periodontal disease, and trypsin-like activity of periodontal pathogens on tongue and teeth were examined in 127 subjects. Volatile sulphur compound (VSC) measurements were made with a portable sulphide monitor; oral malodor was also estimated by organoleptic methods. Measurements repeated one week apart indicated that steady-state VSC levels (r = 0.72; P = 0.0001) and peak VSC levels (r = 0.63; P = 0.0001) were reproducible but these r values were not significantly different (P > 0.1). There was a significant correlation between tongue odor and peak VSC levels (r = 0.40; P = 0.0001) and between tongue odor and whole mouth organoleptic measures (r = 0.55; P = 0.0001). To study the effect of reducing microbial colonization on oral malodor, chlorhexidine gluconate (0.2%) rinsing was prescribed for 7 days. Reductions of VSC levels were significant for both peak (37%) and steady-state (41%) data (P = 0.0001). Anaerobic periodontal pathogens on the tongue estimated by the proportions of positive BANA tests were reduced 19% (P = 0.001) and this was concomitant with a 40% (P = 0.0001) decrease in organoleptic measurement of the tongue dorsum. Mean pH measurements of the tongue dorsum showed large reductions from 6.9 initially to 6.3 post-treatment (P = 0.0001). Subjects were divided into periodontitis/no periodontitis based on periodontal inflammation and probing depth (> or = 5 mm). Of the 37 subjects with periodontitis, 23 had oral malodor whereas 52 out of 90 periodontally healthy subjects exhibited malodor. Chi square analysis comparing halitosis in subjects with and without periodontitis showed no statistically significant association (chi 2 = 0.208; P 0.65) between these two factors although the intensity of malodor as based on VSC concentration in periodontally healthy subjects was 19% less (mean = 111 ppb) than in subjects with periodontitis (mean = 136 ppb). The odds ratio was 1.2, indicating that oral malodor was not associated with periodontitis. These data indicate that a large proportion of individuals with oral malodor are periodontally healthy and that the mucosal surface of the tongue is a major site of oral malodor production.

Adult↗
PubMed1999

The relationship between oral malodor, gingivitis, and periodontitis. A review.

Volatile sulfur compounds (VSC) are a family of gases which are primarily responsible for halitosis, a condition in which objectionable odors are present in mouth air. Although most patients perceive this condition as primarily a cosmetic problem, an increasing volume of evidence is demonstrating that extremely low concentrations of many of these compounds are highly toxic to tissues. VSC may, therefore, play a role in the pathogenesis of inflammatory conditions such as periodontitis. Since these compounds result from bacterial putrefaction of protein, investigations have been conducted to determine whether specific bacteria are associated with odor production. Two members of this family, hydrogen sulfide (H2S) and methyl mercaptan (CH3SH), are primarily responsible for mouth odor. Although many bacteria produce H2S, the production of CH3SH, especially at high levels, is primarily restricted to periodontal pathogens. Direct exposure to either of these metabolites adversely affects protein synthesis by human gingival fibroblasts in culture. However, methyl mercaptan has the greatest effect. Other in vitro experiments have demonstrated that cells exposed to methyl mercaptan synthesize less collagen, degrade more collagen, and accumulate collagen precursors which are poorly cross-linked and susceptible to proteolysis. CH3SH also increases permeability of intact mucosa and stimulates production of cytokines which have been associated with periodontal disease. VSC, and in particular methyl mercaptan, are therefore capable of inducing deleterious changes in both the extracellular matrix and the local immune response of periodontal tissues to plaque antigens. This article reviews these data and emphasizes the potential importance of VSC in the transition of periodontal tissues from clinical health to gingivitis and then to periodontitis.

Antigens↗
PubMed2002

The relationship of oral malodor in patients with or without periodontal disease.

BACKGROUND: Halitosis has been correlated with the concentration of volatile sulfur compounds (VSC) produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal area and the dorsum of the tongue. The aim of this study was to determine whether there is some relationship between the presence of N-benzoyl-DL-arginine-2-napthylamide (BANA)-positive species Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus and clinical and oral malodor parameters. METHODS: Twenty-one subjects (21 to 59 years old) with probing depths (PD) > 3.0 mm and 20 subjects (21 to 63 years old) with PD < or = 3.0 mm (controls) participated. The quality of the mouth air was assessed organoleptically, and a portable sulfide monitor was used to measure the concentration of VSC. Clinical parameters, plaque index (PI) and gingival index (GI), were obtained from 6 teeth. Samples for BANA test were taken from the dorsal surface of the tongue, saliva, and the 6 reference teeth. RESULTS: The scores of PI, GI, subgingival samples that tested positive for BANA hydrolyzing species, organoleptic ratings, and VSC values were significantly higher in the subjects with PD > 3.0 mm (P < 0.01, Mann-Whitney U test). There was a correlation between BANA hydrolysis by subgingival plaque bacteria and VSC values (r = 0.55, P < 0.01), and between GI and VSC values (r = 0.48, P < 0.05) in patients with PD > 3.0 mm. There was no significant correlation between these parameters in the control group. CONCLUSION: These results confirm that the BANA hydrolyzing bacteria in the subgingival plaque are an important source of malodor production in the oral cavity.

Adult↗
PubMed2005

The impact of periodontal therapy and the adjunctive effect of antiseptics on breath odor-related outcome variables: a double-blind randomized study.

BACKGROUND: Bad breath is often caused by periodontitis and/or tongue coating. This study followed the impact of initial periodontal therapy on several halitosis-related outcome variables over a 6-month period. Organoleptic ratings are often uncomfortable for the patient and have several disadvantages. They are, for instance, influenced by external parameters (e.g., food intake and cosmetics) and need to be calibrated among researchers worldwide. A second aim was to evaluate the reliability of saliva incubation as an in vitro indirect test for breath recording. METHODS: In this double-blind, randomized, medium-term, parallel study 45 moderate periodontitis patients without obvious tongue coating were enrolled. Besides a one-stage, full-mouth disinfection and oral hygiene improvement (including daily tongue scraping), patients were instructed to rinse daily for 6 months with one of the following products (randomly allocated): chlorhexidine (CHX) 0.2% + alcohol, CHX 0.05% + cetyl pyridinium chloride (CPC) 0.05% without alcohol (a new formulation), or a placebo solution. At baseline and 3 and 6 months, a series of parameters were recorded including: concentration of volatile sulfide compounds (VSC), tongue coating, and an estimation of the microbial load (at anterior and posterior parts of the tongue, saliva, dental plaque). The intraoral VSC ratings were compared to in vitro VSC recordings and organoleptic evaluations of the headspace air from 1 and 2 hours incubated saliva (0.5 ml, 37 degrees C, anaerobic chamber). RESULTS: Even though the initial VSC values were not high (+/-90 ppb with only 18 patients revealing more than 100 ppb), significant (P <0.05) reductions could be achieved in the CHX and CHX + CPC group, and to a lower extent in the placebo group (P = 0.10). Tongue scraping resulted in a significant reduction (P < or =0.05) of the tongue coating up to month 6 in the placebo and CHX + CPC group, but not in the CHX group (confusion due to staining). The CHX and CHX + CPC group showed, in comparison to baseline, significant (P <0.001) reductions in the number of anaerobic species in the supragingival plaque, in the saliva, and on the anterior part of the tongue. For the posterior part of the tongue the microbial changes remained < or =0.3 log values (P >0.05). For the placebo group, the microbial changes never reached a level of significance (< or =0.3 log values). A strong correlation was found between the intraoral VSC ratings and the 1-hour (r = 0.48, P <0.0001; r = 0.54, P = 0.0003 for baseline data only) and 2-hour (r = 0.43, P <0.0001) VSC production of incubated saliva. The latter also correlated very strongly (r = 0.71) with the number of anaerobic species in the saliva. The VSC values and organoleptic ratings of the incubated saliva also correlated strongly with each other (r = 0.64 for 1-hour and 0.73 for 2-hour incubation). CONCLUSIONS: The results of this study indicate that in patients with moderate periodontitis, initial periodontal therapy including tongue scraping did not have a significant effect on the microbial load of the tongue and had only a weak impact on the VSC level, except when combined with a mouthrinse. Saliva incubation can be used as an indirect way to score breath odor. It offers simplicity, objectivity, and is less invasive.

Anti-Infective Agents, Local↗
PubMed2006

Development of a compact and simple gas chromatography for oral malodor measurement.

BACKGROUND: Volatile sulfur compounds (VSCs) in oral air are the only type of gases correlated with the strength of oral malodor. We developed a compact and simple gas chromatograph (GC) equipped with a newly invented indium oxide semiconductor gas sensor (SCS) for measuring the concentrations of VSCs in mouth air. We have assessed the correlation between measurements with a GC-SCS and those with a regular GC. METHODS: Oral air samples from randomly selected volunteers were analyzed with both a GC-SCS and a GC with a flame photometric detector (FPD), which is specific to VSCs, and GC-SCS measurements were compared to those obtained by GC-FPD. Subsequently, oral air samples before and after mouthrinsing with 5% ethanol mouthwash were analyzed to determine the effect of ethanol on VSC measurements by GC-SCS. RESULTS: There were strong correlations between VSC concentrations determined using these two gas chromatography methods (hydrogen sulfide, R=0.821, P<0.0001; methyl mercaptan, R=0.870, P<0.0001; and dimethyl sulfide, R=0.770, P<0.0001). Although GC-SCS can differentiate ethanol and VSCs in oral air samples after mouthrinsing, GC-SCS measurements demonstrated higher values than those obtained by GC-FPD; however, this discrepancy improved over time due to the reduced effect of ethanol. CONCLUSION: The results suggest that GC-SCS may be useful for the diagnosis of halitosis.

Adolescent↗
PubMed2006

Oral malodor associated with internal resorption.

We report a case of oral malodor associated with internal resorption. A 39-year-old male attended our hospital complaining of oral malodor. Utilizing organoleptic measurement, the halimeter test and gas chromatography, it was diagnosed as a strong halitosis caused by oral origin. The pocket probing depth of tooth 21 was 10 mm, and X-ray examination revealed a vertical bone loss around this tooth. The patient had received periodontal treatment at two dental offices previously, but the periodontal conditions and oral malodor persisted. We performed an initial periodontal preparation, however a deep pocket remained. We therefore performed a surgical inspection including flap reflection, and found that the tooth had a large perforating defect in the distal surface. The extracted tooth had multiple perforating defects covered with granulation tissues on all root surfaces including the root apex. Taking into consideration the anamnesis and X-ray examination of the extracted tooth, internal absorption was considered to have been the cause of the multiple perforating defects. After extraction of the causative tooth, oral malodor dramatically decreased. To our knowledge, this is the first report of an oral malodor associated with internal resorption.

Adult↗
PubMed1997

The effect of zinc-containing chewing gum on volatile sulfur-containing compounds in the oral cavity.

Volatile sulfur-containing compounds (VSC) are known to constitute the major component of halitosis. Aqueous solutions of zinc salts have been shown to reduce the levels of VSC produced orally. The aim of the present study was to examine whether zinc could be made available in the oral cavity and inhibit VSC production when delivered by a chewing gum. VSC measurements were carried out on the 'morning breath' of 11 test subjects and re-examined after the use of test solutions containing 0.02% zinc chloride, 0.2% chlorhexidine, or water or the use of chewing gums containing 2 mg, 0.5 mg, or 0 mg zinc acetate. The results showed that similar amounts of zinc in mouthrinses or chewing gum had the same effect, with a reduction of the oral VSC of 45%. Chewing gum thus seems to be a viable alternative for delivering zinc to reduce VSC levels in the oral cavity.

Adolescent↗
PubMed2006

[Health information on oral malodor in Japanese newspaper articles].

OBJECTIVES: Mass media is an important source for the general public to obtain health information. Newspapers especially have the advantages of providing a variety of information to a broad range of age groups, with wide regional coverage of both urban and rural areas. The purposes of this study were to review the oral malodor information in Japanese newspapers and to investigate peoples' knowledge on the causes of oral malodor. METHODS: The Nikkei Database was used to select articles published in five major newspapers over a period of 12 years from 1993 to 2004. "Oral malodor" was used as a key search word. A total of 386 articles which contained oral malodor information were identified and used for the analysis. A questionnaire survey was conducted for the patients who visited a fresh breath clinic (n=295). RESULTS: The average number of articles per year was 32.2 +/- 7.3 and there was not a significant difference among years and months. There were only 25 articles (6.5%) with the central theme of oral malodor. More than half of the articles introduced anti-oral malodor products. The causes of oral malodor were described in 35% of the articles (n=134). Periodontal disease (n=57), tongue coating (n=35), otorhinolaryngological diseases (n=19), stomach problems (n=14) and psychological factors (n=21) were described as the causes of malodor. Only 35 articles (26%) described the treatment and prevention of halitosis. According to the questionnaire survey, 39% of the patients answered that they did not know the causes of malodor. Less than half knew that oral problems were related with malodor. DISCUSSION: It was revealed that the information about oral malodor in newspapers was not enough both quantitatively and qualitatively; people had little information about oral malodor. It is suggested that dental professionals should be aware of the importance of media advocacy to provide appropriate oral health information to the public.

Halitosis↗
PubMed1999

Operation of bad breath clinics.

The diagnosis and management of bad breath can be easily incorporated in routine dental care by attending dentists. This article outlines the information necessary to establish a differential diagnosis of oral malodor. This includes evaluation of medical, dental, and halitosis history. It also includes the examination of extraoral and intraoral tissues and a thorough periodontal examination. The presence of bad breath is established with organoleptic and hydrogen sulfide-monitor (Halimeter) measurements. The treatment of malodor resulting from oral overgrowth of anaerobic organisms in the oral cavity consists of mechanical and chemical reduction of the microbial flora by methods that are supported by scientific evidence.

Bacteria, Anaerobic↗
PubMed1999

The effects of antimicrobial mouthrinses on oral malodor and their status relative to US Food and Drug Administration regulations.

This study was undertaken to review the rationale behind the usage of antibacterial mouthrinses to control oral malodor and to evaluate the claims made for antibacterial mouthrinses against the statements of US Food and Drug Administration regulations. The literature from 1960 to August 1997, found in a MEDLINE search on oral malodor, halitosis, and tongue microbiology, was examined. Clinical trials that were double blind and had selected subjects who exhibited a detectable level of oral malodor were evaluated. Individuals who experience oral malodor resulting from the overgrowth of proteolytic, anaerobic bacteria on their tongue surfaces can be successfully treated by a regimen that includes tongue brushing and toothbrushing, often in combination with use of a mouthrinse containing an antibacterial agent. Several candidate mouthrinses containing essential oils, zinc chloride, or an oil-water-cetylpyridinium chloride mouthrinse have reduced the organoleptic scores of individuals with moderate levels of oral malodor in the absence of tongue brushing. Very little long-term data beyond 6 weeks of usage are available. These mouthrinses should be marketed as oral deodorants that are analogous in purpose to the usage of deodorant soaps to control and/or eliminate body malodors.

Anti-Infective Agents, Local↗
PubMed1996

Effects of baking-soda-containing dentifrices on oral malodor.

Oral malodor, also known as bad breath or halitosis, is an extremely common problem. Bad breath can arise from many sources in the body, but most frequently is produced in the mouth by the action of gram-negative anaerobic bacteria on sulfur-containing proteinaceous substrates in the saliva, such as debris and plaque. The primary molecules responsible for oral malodor are volatile sulfur compounds (VSC), such as hydrogen sulfide and methylmercaptan. Increased malodor production is related to greater bacterial numbers, reducing conditions, availability of protein substrates, and a pH above neutral. Bad breath is more common in the elderly, as well as those with unhygienic mouths, gingivitis, and periodontitis, but bad breath can also be found in some individuals who are periodontally healthy. The major source of oral malodor is the tongue. Approaches to controlling malodor have included masking, oral hygiene, antibacterial agents, conversion of VSC to nonodorous forms, oxidizing agents, and traditional approaches, including the use of baking soda. Results of controlled double-blind crossover studies, using both organoleptic (sensory) and gas chromatographic analysis of mouth air VSC, indicate that two dentifrices with high baking-soda concentrations, Arm & Hammer Dental Care and Arm & Hammer PeroxiCare, reduce oral malodor.

Adult↗
PubMed1997

Effects of baking-soda-containing dentifrices on oral malodor.

Oral malodor, also known as bad breath or halitosis, is an extremely common problem. Bad breath can arise from many sources in the body, but most frequently is produced in the mouth by the action of gram-negative anaerobic bacteria on sulfur-containing proteinaceous substrates in the saliva, such as debris and plaque. The primary molecules responsible for oral malodor are volatile sulfur compounds (VSC), such as hydrogen sulfide and methylmercaptan. Increased malodor production is related to greater bacterial numbers, reducing conditions, availability of protein substrates, and a pH above neutral. Bad breath is more common in the elderly, as well as those with unhygienic mouths, gingivitis, and periodontitis, but bad breath can also be found in some individuals who are periodontally healthy. The major source of oral malodor is the tongue. Approaches to controlling malodor have included masking, oral hygiene, antibacterial agents, conversion of VSC to nonodorous forms, oxidizing agents, and traditional approaches, including the use of backing soda. Results of controlled double-blind crossover studies, using both organoleptic (sensory) and gas chromatographic analysis of mouth air VSC, indicate that two dentifrices with high baking-soda concentrations, Arm & Hammer Dental Care and Arm & Hammer PeroxiCare, reduce oral malodor.

Analysis of Variance↗
PubMed2001

Counseling and treating bad breath patients: a step-by-step approach.

Bad breath (oral malodor, halitosis) can be detrimental to one's self-image and confidence causing social, emotional, and psychological anxiety. With the majority of breath problems having an oral origin, the dental office is the most logical place for patients to seek treatment. When patients look to dental professionals for expert advice, it is critical they have the knowledge base and communication techniques to provide quality clinical assessment and implement effective intervention programs. Moreover, dental professionals should feel comfortable proactively counseling patients about oral malodor without fear of offending the patient. Numerous continuing education programs and journal articles related to the diagnosis and treatment of oral malodor are available. In addition, electronic sources are accessible for dental professionals to expand their knowledge base regarding oral malodor information. Fewer resources are available, however, regarding techniques to facilitate an effective dialogue with patients on this sensitive issue. This article seeks to provide such information and to help professionals tailor the target communication message to meet the specific needs of individual patients.

Communication↗
PubMed2002

The relationship between oral malodor, VSCs levels in the mouth air with periodontitis and tongue coating.

OBJECTIVE: To assess the relationship between oral malodor, volatile sulphur compounds (VSCs) levels in the mouth air and periodontal index; the role of tongue in the production of VSCs and halitosis. METHODS: 60 periodontitis patients with oral malodor were included. Oral malodor was estimated by organoleptic method (organoleptic rating, OR); VSCs level measurements before and after cleaning the tongue coating were made with a portable sulphide monitor (halimeter), respectively; periodontal probing depth (PD) and the proportion of PD >/= 4 mm sites, bleeding index (BI) and plaque index (PLI) were examined; tongue coating was estimated with thickness (Tt) and area (Ta) on the dorsal surface of tongue. RESULTS: The correlation was analyzed with Spearman method. There was a significantly positive correlation between OR, VSCs levels and BI, PLI, and Tt, respectively (P < 0.01). OR and VSCs levels was also related with Ta (P < 0.05). There was a weakly correlation between VSCs levels and PD, and the proportion of PD >/= 4 mm sites (r = 0.26, P < 0.05). No correlation between OR and PD, and the proportion of PD >/= 4 mm sites was existed. Reduction of VSCs levels after cleaning tongue coating was statistically significant (t = 10.15, P < 0.01), and also significantly related with thickness and area of tongue coating (P < 0.01). CONCLUSIONS: In present study, OR and VSCs levels were significantly correlated with gingival inflammation (BI), condition of oral hygiene (PLI), and tongue coating. The relationship between OR, VSCs levels and periodontal probing depth was not found obviously. VSCs levels were significantly reduced after cleaning tongue coating, but the percentage of reduction was less than that of the previous studies.

Dental Plaque Index↗
PubMed1953

Controversial problems in adenotonsillectomy.

It is doubtful that the tonsils or adenoids contribute sufficiently to immunity or to hematopoiesis to warrant withholding adenotonsillectomy when there is need for the operation. Focal infection, rheumatic fever and allergic disease must be evaluated in the individual case. A seldom discussed reason for operation is the prophylaxis or treatment of malformation of the nose, sinuses, mouth and jaw. Well defined indications for adenotonsillectomy include frequent occurrence of infection, peritonsillar abscess, cervical lymph node disease believed caused by tonsillar infection, otitis media, and hypertrophy sufficient to embarrass swallowing or breathing. The operation may also be indicated in certain cases of impaired hearing, halitosis, or anorexia, and sometimes for carriers of diphtheria. Psychic trauma can be obviated by proper preparation of a child for the operation he is to undergo. There is a good evidence of evidence of relationship between recent adenotonsillectomy and infection with poliomyelitis-and a good deal of evidence to the contrary. Nationwide rules cannot be established on the basis of the evidence presented thus far. Since in many cases it is unwise to put off adenotonsillectomy, each case in each community in each season must be evaluated separately.

Adenoidectomy↗