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The significance of the source of zinc and its anti-VSC effect.

UNLABELLED: The anti-VSC (volatile sulphur compounds) effect of zinc is known to be associated with free zinc ions. OBJECTIVE: To examine whether zinc salts with low stability constants were more suitable as sources of zinc in zinc lozenges than zinc salts with high stability constants. The former provide free zinc ions upon dissolution in water, whereas the latter provide few such ions. DESIGN AND PARTICIPANTS: Identical lozenges were produced which contained either zinc acetate, zinc gluconate (low stability constants), zinc citrate or amino-acid chelated zinc (extremely high stability constants). All the lozenges contained 0.1 per cent of zinc. A test panel of 10 volunteers used the different lozenges randomly. VSC were measured by GC. RESULTS AND CONCLUSION: The lozenge with the highest stability constant was as effective as those with very low stability constants. The anti-VSC effect was thus not related to this constant. These findings may be explained by the possibility that alternative ligands with stronger affinity for zinc than the original ligands in the lozenges may be present in the oral cavity. An in vitro experiment indicated that the sulphide ion (S2-) may be such a ligand.

Adult↗

Role of saliva in oral dryness, oral feel and oral malodour.

Patients who believe they have oral malodour often have a dry mouth condition instead. Here we have examined its relation to oral malodour, real or perceived. A direct relationship between the thickness of the film of residual saliva on mucosal surfaces throughout the mouth and perception of a dry mouth was observed. On the hard palate, the thickness of this film proved to be diagnostic for a dry mouth and corresponded to lower resting saliva flow and pH levels (P< 0.001). Intra-muscular administration of the anti-sialogogue, Robinul, accurately produced the dry mouth condition. Using a sulphide monitor, loss of volatile sulphur compounds into mouth air progressively occurred as the mouth became drier. Mouth pH and Eh on the dorsum of the tongue correspondingly fell. Mouth breathing led to tongue and palate moisture loss thus enabling escape of malodour volatiles into mouth air. Measurement of oral dryness should make it possible to differentiate genuine malodour from dry mouth related pseudo-malodour subjects, and in turn, the latter from patients that are halitophobic. This should facilitate identification of such patients and avoid error in their clinical management.

Diagnosis, Differential↗

The effects of methyl mercaptan on epithelial cell growth and proliferation.

AIM: Previous studies have demonstrated that methyl mercaptan (CH3SH), one of the main causes of oral malodour, might contribute to the initiation and progression of periodontal disease. These studies suggested that CH3SH may affect the epithelial cells of the gingival crevice, which form a barrier to the penetration of microbial substances. In this study, the effects of CH3SH on the epithelial cells and gingival fibroblasts were investigated. METHOD: Human oral epithelial carcinoma cell line (KB), human oral squamous cell carcinoma cell line (HSC-2), and human gingival fibroblasts (HGF) derived from healthy gingiva were used in this study. These cells were cultured in conditions of 5% CO2/95% air with or without CH3SH (10 ng/ml or 50 ng/ml) for 5 days. Cell numbers, proliferation and cytotoxicity were evaluated. RESULTS: CH3SH inhibited epithelial cell growth and proliferation at the concentration of 50 ng/ml, and a cytotoxic effect of CH3SH was also noted. On the other hand, HGF cells were not affected by 50 ng/ml CH3SH. CONCLUSION: High concentrations of CH3SH such as 50 ng/ml have an inhibitory effect on the growth and proliferation of epithelial cells, but not on those of fibroblasts.

Analysis of Variance↗

L-Methionine-gamma-lyase, as a target to inhibit malodorous bacterial growth by trifluoromethionine.

Methyl mercaptan is a major component responsible for oral malodor. This compound arises from the bacterial metabolism of methionine. Here we show that the growth of Porphyromonas gingivalis, a periodontal microorganism that produces large amounts of methyl mercaptan, was strongly inhibited by l-trifluoromethionine (TFM), a fluorinated derivative of methionine. In contrast, TFM had no effect on the growth of bacteria which do not produce methyl mercaptan. In addition, the survival rate of P. gingivalis-infected mice was remarkably increased by the co-injection of TFM. These results suggest that TFM is a promising antibacterial agent specific to the malodorous oral bacteria.

Animals↗

Review of the treatment strategies for oral malodour.

Breath malodour, a significant social and/or psychological handicap, may be caused by several intra- and extraoral factors. Malodour of intraoral origin is the result of microbial putrefaction, during which volatile sulphur compounds (VSC) and other volatile compounds are produced. The treatment of oral malodour can therefore be focused on the reduction of the intraoral bacterial load and/or the conversion of VSC to nonvolatile substrates. This article outlines the efficacy and mechanisms of different antimalodour approaches. Most approaches were found to be inefficient and/or short lasting. The most successful treatment involves mechanical debridement (including toothbrushing, flossing, and tongue cleaning), possibly combined with the use of an antimicrobial mouthrinse.

Anti-Infective Agents, Local↗

Oral malodor reduction by a combination of chemotherapeutical and mechanical treatments.

Bacterial proliferation and plaque accumulation on the surface of the tongue are major factors contributing to oral malodor. In this research, we used subjective and objective methods to evaluate the breath benefit of a triclosan-containing dentifrice (Blend-a-Med Complete Night) with and without tongue brushing in a randomized, examiner-blinded, three-period crossover clinical trial. Twenty-nine adults (mean age 40.2 years) with morning malodor were randomly assigned to a treatment sequence: triclosan dentifrice, triclosan dentifrice plus tongue brushing, and a control dentifrice (Crest Cavity Protection). The subjects used each product four times in 27 h with a 2-day wash-out period between treatments. Halimeter measurements were taken at baseline and at 3, 24 and 27 h. Subject questionnaire data assessing the breath quality were collected at 24 and 27 h. Both triclosan regimens showed significant improvement in oral malodor (p < 0.03) relative to the control. Significant (p = 0.035) malodor benefit was observed when tooth brushing with triclosan dentifrice was supplemented with tongue brushing. The triclosan dentifrice was associated with significant improvement (p < 0.05) in morning mouth feel and feeling of clean and fresh breath during the day relative to the control. There were no adverse events reported. The triclosan dentifrice was effective against overnight and daytime oral malodor. Supplementing routine brushing with tongue brushing resulted in additional breath improvement and breath benefits of the triclosan dentifrice were first-person noticeable.

Adult↗

Reduction of malodor by oral cleansing procedures.

Organoleptic and gas chromatographic methods were employed to establish the threshold of odor objectionability of methylmercaptan and hydrogen sulfide and to assess the relative effectiveness of different oral hygiene measures to reduce the malodor to acceptable levels. The study showed that methylmercaptan and hydrogen sulfide concentrations below 0.5 ng. and 1.5 ng., respectively, are considered nonobjectionable. Gas chromatographic analyses indicate that these concentrations were exceeded in the early morning mouth air samples of approximately 50 per cent of the adult population studied. In these instances, methylmercaptan and hydrogen sulfide occurred in sufficiently high concentrations to account for the malodor. Brushing studies suggest that the early morning malodor arising from the oral cavity can be controlled by proper oral hygiene. The tongue was the major source of both offending compounds in the persons studied. Methods that involved cleansing of the dorsoposterior surface of the tongue caused the most pronounced reductions of both compounds. Since methylmercaptan was found to be more objectionable and to exhibit a lower threshold of objectionability, it was more difficult to reduce to acceptable levels.

Adult↗

The correlation between organoleptic mouth-odor ratings and levels of volatile sulfur compounds.

An organoleptic rating (OR) technique and gas-liquid chromatography were employed to study the relationship between oral-malodor ratings and the corresponding concentrations of oral volatile sulfur compounds (VSC) in a total of 102 subjects in two separate studies. Both studies demonstrated a statistically significant positive correlation between the intensity of perceived oral malodor and the concentration of VSC (H2S + CH3SH) emitted by individual subjects.

Chromatography, Gas↗

The assessment of methyl mercaptan, an important clinical marker for the diagnosis of oral malodor.

OBJECTIVE: This study aimed to determine the clinical assessment of volatile sulfur compound (VSCs) for the evaluation of noticeable oral malodor using gas chromatography (GC). METHODS: The oral malodor of 127 adult patients was investigated using the organoleptic test and GC, and the relation between the organoleptic evaluation and VSCs were analyzed. RESULTS: The optimum cut-off values of CH3SH, H2S and total VSC (CH3SH + H2S) to discriminate between the patients with and without noticeable oral malodor were obtained from ROC curves, and determined to be 0.44, 1.10 and 2.20 ng/10 ml, respectively. The logistic regression was analyzed for estimation of the association between an organoleptic evaluation greater than a slight level and the groups with CH3SH, H2S or total VSC with concentrations above the optimum cut-off value. Only CH3SH showed an independent association with noticeable oral malodor. CONCLUSIONS: It was evident that CH3SH was a more useful marker for the evaluation of oral malodor than H2S. Moreover, it appears CH3SH is the predominant causative factor of noticeable oral malodor.

Adult↗

Association between oral malodor and measurements obtained using a new sulfide monitor.

OBJECTIVE: The purpose of this study was to evaluate the ability of a new volatile sulfur compounds (VSCs) monitor to assess oral malodor in subjects and compare its performance with those of organoleptic testing and gas chromatography. METHODS: The mouth air of 260 patients was measured by three methods: VSCs monitor (Breathtron), organoleptic test by two judges and gas chromatography (GC). Mcnemar test and Pearson correlation were used to analyze the data among these methods. RESULTS: The log values of VSCs measured by a sulfide monitor were significantly correlated with the organoleptic ratings, and also with log values of H(2)S, CH(3)SH, and (CH(3))(2)S determined by GC (P<0.01). Using the results of organoleptic and GC to classify subjects into normal and malodor groups, the sulfide monitor's sensitivity was shown to be more than 79% and the specificity was 61-73%. CONCLUSIONS: This sulfide monitor could be used for oral malodor measurement, moreover, according to its portability, it could be conveniently used for clinical setting and field surveys.

Breath Tests↗

Contribution of periodontal pathogens on tongue dorsa analyzed with real-time PCR to oral malodor.

Oral malodor is considered to originate primarily from tongue microbiota populations. However, the relationship between oral malodor and tongue microbiota remains unclear. In this study, tongue periodontal pathogens were analyzed via real-time PCR, and the association between oral malodor and tongue periodontal pathogens, including Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens and Treponema denticola, was examined. The subject population consisted of 29 individuals with and 10 healthy persons without oral malodor. Oral malodor was assessed by organoleptic test and volatile sulfur compound (VSC) levels as measured by gas chromatography. Real-time PCR was conducted for anaerobes in tongue biofilm samples employing a LightCycler system; furthermore, bacterial proportion served as a quantitative parameter. Among the five anaerobes, only T. forsythia displayed higher proportions in malodor subjects than corresponding values in healthy controls. Proportions of P. intermedia and P. nigrescens correlated strongly with hydrogen sulfide concentration. Proportions of P. gingivalis and P. nigrescens also exhibited strong correlation with methyl mercaptan concentration. The correlation coefficient between the proportion of the total of the five anaerobes and total VSC level (r = 0.88) was greater than that between bacterial proportion and organoleptic score (r = 0.29). When a linear regression analysis was performed utilizing the proportion of each of the five periodontal pathogens as an independent variable, the explanatory power of these independent variables revealed 81% for total VSC level and 16% for organoleptic score. These results suggest that these five periodontal pathogens on tongue dorsa may contribute greatly to VSC production.

Adult↗