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PubMed2004

Halitosis (Fetor oris) in patients seen at the periodontology clinic of the University College Hospital, Ibadan - a subjective evaluation.

The aim of this study was to assess the prevalence of halitosis among periodontal patients and to evaluate the association between this condition and increasing age, social class, gender and oral hygiene status. The subjects comprised two hundred and fifty five consecutive patients who attended the periodontology clinic of the University College Hospital from November 1996 and March 1997. The patients were matched for sex and their ages ranged from 16 years to 74 years and made up of 128 males and 127 females. Cases of halitosis were cross-validated by two examiners to rule out a biased diagnosis. One hundred and twenty eight patients were males while 127 were females. A total of 37 patients presented with halitosis representing 14.5% . There was no statistically significant difference in relation to gender, p > 0.05. In the different age groups, only 7% of the subjects in the 31 - 40 years age group had halitosis while 36% of the subjects in the over 60 years age group were affected, (chi(2) - 13.01, df = 5, p < 0.05). There was also a statistically significant difference in the prevalence of halitosis according to oral hygiene status and social class. The results showed a low prevalence of halitosis as erroneously claimed but showed an association between the condition and increasing age, social class and oral hygiene status.

Adult↗
PubMed2005

Factors associated with self-reported halitosis in Kuwaiti patients.

OBJECTIVES: Oral malodor is a common complaint of dental patients, yet limited data is available on the actual prevalence of this condition. The aim of this study was to assess the prevalence and factors associated with self-reported halitosis in Kuwaiti patients. METHODS: This was a cross-sectional study of Kuwaiti adults using a 19-point self-administered structured questionnaire on self-perception of halitosis. Significant associations between self-reported oral malodor and sociodemographic, medical history, and oral hygiene variables were examined with multiple logistic regression analysis. RESULTS: A total of 1551 subjects participated (response rate=86.2%). The prevalence of self-reported halitosis was 23.3%. Use of the toothbrush less than once daily was the factor most strongly associated with self-perceived halitosis (OR=2.68; 95% CI=1.83-3.92; p<0.001). Other factors significantly associated with self-perceived halitosis included current or past smoking (OR=2.51), female gender (OR=1.54), being 30 years of age or older (OR=1.35), having high school education or less (OR=1.41), history of chronic sinusitis (OR=1.58) or gastrointestinal disorders (OR=1.73), never using miswak (OR=1.56), and never using dental floss (OR=1.33). CONCLUSION: Inadequate oral hygiene practices were the factors most strongly associated with self-reported oral malodor in this sample of Kuwaiti patients. Other factors with significant associations included history of gastrointestinal tract disorders, chronic sinusitis, older age, female gender, and lower education levels.

Adolescent↗
PubMedDate not supplied

Halitosis: an interdisciplinary approach.

PURPOSE: To summarize the experience in our halitosis clinic, emphasizing an interdisciplinary approach. PATIENTS AND METHODS: Thirty-nine patients with a primary complaint of halitosis were evaluated. Their health was established by a questionnaire, by clinical examination, and by laboratory analysis. Halitosis was evaluated organoleptically by a dentist and an otolaryngologist (odds ratio [OR] = 5.7). The volatile sulfide levels were measured with a portable sulfide monitor (Halimeter; RH-17 series, Interscan, Chatsworth, CA). RESULTS: The patients were found to suffer from otolaryngological disorders (26%), dental problems (23%), oral discomfort (18%), and gastrointestinal pathology (10%), or several of the above. In 31% of the patients, however, no clinical involvement was detected. The salivary flow rates in the patients were similar to those in healthy controls, whereas their oral Candida carrier rate was low (28%). Fifty-seven percent of the patients had objective halitosis by organoleptic evaluation and 61% by Halimeter measurement. CONCLUSION: A high percentage of the patients who came to the clinic with a primary complaint of halitosis did not have a detectable problem.

Adolescent↗
PubMed2006

CO2 laser cryptolysis by coagulation for the treatment of halitosis.

OBJECTIVE: The aim of this study was to evaluate the impact of CO(2) laser cryptolysis by coagulation (LCC) treatment in the volatile sulphur compounds (VSC) halitometry in patients with chronic caseous tonsillitis (CCT). BACKGROUND DATA: Caseum retention and halitosis characterize CCT. Failure of clinical treatment indicated tonsillectomy. Recently, a conservative new treatment, CO(2 )LCC, has been introduced. It is painless and opens the crypt ostium, thus avoiding caseum retention. Halitometry is an objective new method for halitosis diagnosis. It measures VSC in parts per billion (ppb) in breathed air. METHODS: Thirty-eight patients with CCT and complaints of halitosis were selected, underwent physical examination and halitometry measurements, and then received four sessions of LCC. The laser technique consisted of 6-W applications, in scanned and unfocused mode, around crypts, following the shape of their openings (fluence 54.5 joules/cm(2)) and, afterwards, over the entire tonsillar surface (fluence 18 joules/cm(2)). Halitometries were done before each LCC session. RESULTS: LCC was well tolerated by all patients, and all patients showed improvement in halitosis after LCC treatment. Eight patients (21%) had abnormal halitometry (>150 ppb) before treatment, but after LCC sessions their halitometry values became normal. These patients had caseum at examination. VSC measurement was reduced by 30.1%, and caseum retention was significantly decreased in this group. CONCLUSION: Abnormal halitometry in this population is related to the presence of caseum. LCC is safe, well tolerated, and improves complaints of halitosis in patients with CCT. Improvement was related to a decrease in caseum retention. Patients with abnormal halitometry had VSC halitometry improvement of approximately 30%.

Adult↗
PubMed2005

Comparison of ninhydrin method of detecting amine compounds with other methods of halitosis detection.

OBJECTIVES: Halitosis is a result of overactivity of Gram-negative bacteria for which protein amino acids are the major source of energy. Therefore, statistical correlation between concentrations of volatile sulphur compounds (VSCs) and low-molecular-weight amines should be expected. MATERIALS AND METHODS: Eighty-four patients suffering from halitosis and 40 healthy volunteers aged 20-62 years (average 39.7) participated in the study. In all subjects low-molecular-weight amines were evaluated by the ninhydrin method. Patients with halitosis were randomized into treatment groups. Zinc tablets, tablets and mouthwash containing chlorhexidine or lyophilized lactic acid-forming bacteria were used. RESULTS: Analysis showed that the level of amines was highest in subjects with halitosis (0.39, s.d. +/- 0.06, P < 0.001) and correlated significantly with results of VSC measurement and organoleptic scores (P < 0.001). Reduction of amine levels after treatment was statistically significant (P < 0.001). Three months following treatment the amine levels began to increase (0.37, s.d. +/- 0.05). The amine levels in healthy controls were lower (0.29, s.d. +/- 0.07) and remained at a stable level. CONCLUSION: The salivary amine levels significantly correlated with VSC levels and organoleptic scores. Therefore, the ninhydrin method of detecting salivary amines may be an alternative or additional method of diagnosing halitosis. This method may also be used to evaluate treatment efficacy.

Adolescent↗
PubMed2003

Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients.

The primary purpose of the present study was to compare the microbial profiles of the tongue dorsa of healthy subjects and subjects with halitosis by using culture-independent molecular methods. Our overall goal was to determine the bacterial diversity on the surface of the tongue dorsum as part of our ongoing efforts to identify all cultivable and not-yet-cultivated species of the oral cavity. Tongue dorsum scrapings were analyzed from healthy subjects with no complaints of halitosis and subjects with halitosis, defined as an organoleptic score of 2 or more and volatile sulfur compound levels greater than 200 ppb. 16S rRNA genes from DNA isolated from tongue dorsum scrapings were amplified by PCR with universally conserved bacterial primers and cloned into Escherichia coli. Typically, 50 to 100 clones were analyzed from each subject. Fifty-one strains isolated from the tongue dorsa of healthy subjects were also analyzed. Partial sequences of approximately 500 bases of cloned inserts from the 16S rRNA genes of isolates were compared with sequences of known species or phylotypes to determine species identity or closest relatives. Nearly complete sequences of about 1,500 bases were obtained for potentially novel species or phylotypes. In an analysis of approximately 750 clones, 92 different bacterial species were identified. About half of the clones were identified as phylotypes, of which 29 were novel to the tongue microbiota. Fifty-one of the 92 species or phylotypes were detected in more than one subject. Those species most associated with healthy subjects were Streptococcus salivarius, Rothia mucilaginosa, and an uncharacterized species of Eubacterium (strain FTB41). Streptococcus salivarius was the predominant species in healthy subjects, as it represented 12 to 40% of the total clones analyzed from each healthy subject. Overall, the predominant microbiota on the tongue dorsa of healthy subjects was different from that on the tongue dorsa of subjects with halitosis. Those species most associated with halitosis were Atopobium parvulum, a phylotype (clone BS095) of Dialister, Eubacterium sulci, a phylotype (clone DR034) of the uncultivated phylum TM7, Solobacterium moorei, and a phylotype (clone BW009) of STREPTOCOCCUS: On the basis of our ongoing efforts to obtain full 16S rRNA sequences for all cultivable and not-yet-cultivated species that colonize the oral cavity, there are now over 600 species.

Adult↗
PubMedDate not supplied

Evaluation of halitosis in children and mothers.

PURPOSE: The purpose of this study was to investigate the occurrence and clinical parameters that are associated with halitosis in pediatric dental patients and compare these findings with those found for the patients' mother. METHODS: Children aged 5 to 12 years old were evaluated with mothers present during a dental visit. Each mother completed the child's medical history and a breath odor questionnaire. The mother and an oral breath judge (OBJ) evaluated the child's oral breath using organoleptic methods. A commercial breath analyzer (CBA) measured the oral and nasal levels of volatile sulfur compounds (VSCs) for child and mother before and after tongue debridement. A number of oral parameters were recorded for the children. RESULTS: Thirty children (mean age=8.8 years) and 18 mothers participated. Halitosis (VSC>100 parts per billion, or ppb) was found in 23% of children and 11% of mothers, but was not significantly correlated. In contrast, 61% of mothers reported halitosis in themselves and their child. Significant differences were found between VSC levels and frequency of tooth-brushing (P<.05, univariate ANOVA). There was significant correlation in the detection of breath odor between mother and OBJ (P<.05, Pearson); however, there was no significant correlation between evaluators and CBA. A positive correlation existed between the presence of interproximal restorations and breath odor by OBJ (P<.05, Pearson). CONCLUSIONS: Halitosis may be a problem in some healthy children, but it does not correlate well with mothers' breath odor or common oral parameters. The organoleptic and CBA results were inconsistent, suggesting factors other than VSCs may be associated with halitosis in children.

Analysis of Variance↗
PubMed2006

Tongue scraping for treating halitosis.

BACKGROUND: Halitosis is used to describe any disagreeable odour of expired air regardless of its origin. Mouthwashes which disguise oral malodor are more socially acceptable and generally more popular than tongue scrapers. OBJECTIVES: To provide reliable evidence regarding the effectiveness of tongue scraping versus other interventions (including mouthwashes) to control halitosis. SEARCH STRATEGY: We searched the following databases: Cochrane Oral Health Group Trials Register (to 15th September 2005); the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3 2005); MEDLINE 1966 to September Week 1 2005; EMBASE 1974 to September 2005 (searched September 19th 2005). SELECTION CRITERIA: Randomized controlled trials comparing different methods of tongue cleaning to reduce mouth odour in adults with halitosis. DATA COLLECTION AND ANALYSIS: Clinical heterogeneity between the two included trials precluded pooling of data, therefore a descriptive summary is presented. MAIN RESULTS: This review included two trials involving 40 participants. Both trials were methodologically sound but included no data for the primary outcomes specified in this review. Secondary outcomes expressed as volatile sulfur compound (VSC) levels were assessed by a portable sulfide monitor in both trials. One trial showed reductions of VSC levels of 42% with the tongue cleaner, 40% with the tongue scraper and 33% with the toothbrush. Reduced VSC levels persisted longer with the tongue cleaner than the toothbrush and could not be detected for more than 30 minutes after the intervention in any of the groups. Differences were assessed by the Friedman and Wilcoxon signed rank tests with the level of significance set at P < 0.05. The second trial, in which differences in totaled rank values between groups were compared by the Dunn method alpha = 0.01, showed a reduction of VSC levels compared with baseline measurements of 75% with the tongue scraper and 45% with the toothbrush. Adverse effects in one trial were nausea (60%) and trauma (10%) with the toothbrush and all participants receptive to using the tongue scraper. Based on the independent data from these two trials there was a statistically significant difference between the effectiveness of either the tongue cleaner or the tongue scraper in reducing VSC levels when compared with the toothbrush. AUTHORS' CONCLUSIONS: There is weak and unreliable evidence to show that there is a small but statistically significant difference in reduction of VSC levels when tongue scrapers or cleaners rather than toothbrushes are used to reduce halitosis in adults. We found no high level evidence comparing mechanical with other forms of tongue cleaning.

Dental Devices, Home Care↗
PubMed2002

The relationship between the presence of periodontopathogenic bacteria in saliva and halitosis.

OBJECTIVE: To evaluate the association between the presence of periodontal pathogenic bacteria in saliva and halitosis in mouth air. DESIGN: Cross-sectional microbiological and clinical oral examination of adult patients. SUBJECTS: 101 adult patients (25 males, 76 females) who attended the Preventive Dentistry and Breath Odour Clinic of Kyushu Dental College. Their average age was 50.0+/-13.5 years old (mean +/- SD). SETTING: The subjects were classified into three groups: halitosis subjects with a probing depth (PD) > or = 4mm (P group), halitosis subjects without PD > or = 4mm (H group), and non-halitosis subjects without PD > or = 4mm (C group). METHODS: All subjects received a periodontal examination. Volatile sulphur compounds (VSC: hydrogen sulphide and methyl mercaptan) were measured using gas chromatography. The presence of Bacteroides forsythus, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans and Prevotella intermedia in the saliva was detected by polymerase chain reaction. RESULTS AND CONCLUSION: The presence of B. forsythus, P. gingivalis and P. intermedia influenced the production of VSC. Specifically, the presence of B. forsythus in subjects with periodontitis was strongly correlated to the concentration of VSC in mouth air.

Actinobacillus Infections↗
PubMed1990

Delusional halitosis. Review of the literature and analysis of 32 cases.

Halitosis, or bad breath, is a feature of some oral and systemic diseases. However, there are apparently healthy individuals who complain of having bad breath which no one else can smell and for which no local or systemic condition can be found. This condition, referred to in this article as delusional halitosis, has identical features with a psychiatric disorder, monosymptomatic hypochondriacal psychosis. This paper reviews the literature on halitosis and oral psychogenic disorders and presents an analysis of 32 cases of delusional halitosis that presented at the University of Benin Dental Hospital, Nigeria, in the period 1984-1986.

Adolescent↗
PubMed2005

Bioelectronic detector with monoamine oxidase for halitosis monitoring.

Methyl mercaptan (MM) is known as one of the major chemicals of halitosis (bad breath). In this study, a bioelectronic gas sensor (bio-detector) for gaseous MM was developed and was applied to measure halitosis in breath. The bio-detector consisted of a Clark-type dissolved oxygen electrode, a monoamine oxidase type-A (MAO-A) immobilized membrane and a reaction unit that had liquid and gaseous compartments separated by a hydrophobic porous polytetrafluoroethylene (PTFE) diaphragm membrane. The tip of the electrode covered with MAO-A membrane was placed into the liquid compartment as touching to the PTFE diaphragm membrane. In order to amplify the bio-detector output, a substrate regeneration cycle caused by coupling the monooxygenase with l-ascorbic acid as reducing reaction with reagent system, was applied. The results of MM vapor measurements showed the calibration range of the bio-detector for MM vapor was from 0.087 to 11.5 ppm (correlation coefficient: 0.993) and included the human sense of smell level 5 (0.2 ppm). The bio-detector had good selectivity being attributed to enzyme specificity was obtained for several substances (trimethyl amine, ammonia, dimethyl sulfide, etc.). The bio-detector was applied for halitosis measurement. Expired gases in five subjects were sampled every hour and the concentrations of MM in the expired gases were monitored. The output of bio-detector showed behaviour of halitosis level changes in a day such as increasing with passage of time and decreasing after eating.

Biosensing Techniques↗
PubMed2002

Monitoring ammonia to assess halitosis.

OBJECTIVE: This study examined the applicability of ammonia monitoring for assessing halitosis. STUDY DESIGN: The actual degree of halitosis was determined by using an organoleptic test in 61 subjects aged 28 +/- 10 years (mean +/- SD). Levels of volatile sulfur compounds and ammonia were determined by using gas chromatography and ammonia monitoring, respectively. Levels of ammonia and methyl mercaptan produced by bacteria in dental plaque and tongue-coating samples obtained from 25 subjects were quantified. In addition, changes in ammonia levels were measured before and after removing tongue coating or dental plaque. RESULTS: There was no significant correlation between the organoleptic score and the ammonia level measured with ammonia monitoring, whereas there was a significant correlation between ammonia level and the total level of volatile sulfur compounds measured with gas chromatography. Significant correlations were also observed between ammonia level and levels of methyl mercaptan produced by bacteria in dental plaque and tongue coating. Furthermore, the ammonia level decreased after the removal of tongue coating and dental plaque. CONCLUSION: These results indicate that measuring ammonia levels is useful for assessing halitosis, specifically for halitosis arising from a lack of oral hygiene.

Adult↗
PubMed1992

Halitosis and Helicobacter pylori. A possible link?

The exact pathophysiological mechanism of halitosis is not clear, and in many patients the etiology is an enigma. We followed three couples in which one member or both had halitosis. All the subjects had evidence of Helicobacter pylori infection. All received a treatment course of colloidal bismuth subcitrate four times a day and 250 mg metronidazole three times a day. There was impressive improvement in their symptoms, the halitosis disappearing along with eradication of the organism. We call the attention of physicians to the possible connection between halitosis, H. pylori infection, and familial occurrence. Further studies to confirm this surprising association are in order.

Antacids↗
PubMed2005

Helicobacter pylori associated with glossitis and halitosis.

BACKGROUND: Helicobacter pylori is a curved microaerophilic Gram-negative bacterium considered as a risk factor for gastric cancer. The aim of this study was to find an association between burning sensations, acid taste, halitosis, and lingual hyperplasia with the effect of H. pylori on the mouth. MATERIALS AND METHODS: A total of 124 subjects with different gastric diseases were studied: 46 patients with burning, halitosis and lingual dorsum hyperplasia and 78 patients with other diseases. RESULTS: The detection of H. pylori in the oral cavity by histopathologic diagnosis and molecular biology was confirmed in 40/46 (87%) patients with burning, halitosis, and lingual hyperplasia, and in 2/78 (2.6%) subjects with other diseases. Chi2: 91.26 (p < .001) Mantel-Haenszel. CONCLUSION: This trial showed an association between H. pylori and burning, halitosis, and lingual hyperplasia, and further considered this bacterium a risk factor for gastric infection.

Adult↗
PubMed2005

Relationship between the SF-36 questionnaire and patient's satisfaction following halitosis therapy.

OBJECTIVE: To assess the health-related quality of life (HRQOL) of patients complaining of halitosis at their first visit and at a later time when their complaint had diminished following therapy, using a self-administered questionnaire, the Medical Outcome Study Short Form-36 (SF-36). The aim of this study was to examine the relationship between HRQOL of patients before and after self-reported disappearance of their complaint following oral hygiene improvements for halitosis. SUBJECTS AND METHODS: Seventy patients of our special clinic for halitosis served as subjects. At the first visit, each completed the SF-36 before determination of volatile sulfur compound (VSC) concentration in mouth air. After excluding dropouts, the same measurements were performed for subjects whose self-reported complaint had disappeared following oral hygiene therapy. RESULTS AND DISCUSSION: At the initial visit, SF-36 scale scores for general health, vitality, social functioning, role-emotion, and mental health were significantly lower when compared with the national averages in Japan. For subjects with self-reported disappearance of complaint, only social functioning rose significantly among SF-36 scores at the end of the study. These results suggest that an awareness of improvement in social life could be related to patient's satisfaction with halitosis oral hygiene therapy.

Breath Tests↗
PubMed1988

[Development of breath detector for halitosis (2). Clinical evaluation].

A breath detector was developed and its clinical application was investigated. 20 patients that included self-halitosis patients and periodontally diseased patients with halitosis were the subjects of this investigation. Measuring by breath detector was tried third time and most high score was taken for one's smell revel. The same time mouth air was analyzed by gas chromatograph. The amount of volatile sulphur compounds in mouth air was made a comparison between the two methods. The intensity of halitosis by olfactory panel were divided into four groups, (-) good, (+/-) slight, (+) warn, (++) severe. And we investigated that breath detector's judgement and olfactory panel were in agreement or not. A breath detector was very sensitive for volatile sulphur compounds as well as gas chromatograph. It was therefore concluded that breath detector seemed to be potentially useful in clinical objective evaluation of halitosis and periodontal diagnosis.

Dental Devices, Home Care↗
PubMed1998

A new era in halitosis and periodontal treatment.

An effective, 12 hour, anti-halitosis remedy is a spectacular breakthrough in the dental field and a significant step toward improving the lives of millions of people in the United States who suffer from chronic halitosis and the resultant psychological trauma. The technology contained in TriOral Anti-Halitosis Treatment Rinse, along with its significant research, will provide dentists with the ability to accelerate their halitosis treatment success curve. I am excited to present the science of this product and resulting research in my upcoming seminar series, and I view this as one of my greatest contributions to other dental professionals and their patients.

Bacteria, Anaerobic↗
PubMed2004

The aetiology and treatment of oral halitosis: an update.

Halitosis refers to the condition of offensive mouth odour. More than 90% of cases of halitosis originate from the oral cavity. The implicated bacteria (Fusobacterium nucleatum, Prevotella intermedia, and Tannerella forsythensis) are located in stagnant areas in the oral cavity, such as the dorsal surface of tongue, periodontal pockets, and interproximal areas. These bacteria proteolyse the amino acids releasing volatile sulphur compounds. The management of halitosis involves determining and eliminating the causes, which includes identifying any contributory factors, because certain medical conditions are also associated with characteristic smells. Professional advice should be given on oral hygiene and diet, and treatments should include dental scaling, and root planing of the associated periodontal pockets to reduce the bacterial loading. In addition to the normal oral hygiene practice, tongue cleaning and use of mouthwash are advocated. This paper discusses the common aetiological factors, classification of oral halitosis, and its treatment.

Bacteroidaceae Infections↗